0
Scientific Articles   |    
Correspondence Between Perceived Disability and Objective Physical Impairment After Elbow Trauma
Anneluuk L.C. Lindenhovius, MSc1; Geert A. Buijze, MSc1; Peter Kloen, MD, PhD2; David C. Ring, MD, PhD1
1 Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114. E-mail address for D.C. Ring: dring@partners.org
2 Department of Orthopaedic Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Small Bone Innovations, Smith and Nephew, Wright Medical, Tornier, Acumed, Medical Modeling Inc., Joint Active Systems, Stichting Professor Michael van Vloten Fonds, Annafonds, and Stichting Wetenschappelijk Onderzoek Orthopaedische Chirurgie. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at Massachusetts General Hospital, Boston, Massachusetts, and Academic Medical Center, Amsterdam, The Netherlands

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Oct 01;90(10):2090-2097. doi: 10.2106/JBJS.G.00793
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: Substantial differences between disability and impairment are commonplace and puzzling. Subjective (psychosocial) factors may be paramount given that pain is a more important determinant of perceived overall arm-specific disability than is objective elbow impairment. To further evaluate the relationship between impairment and disability, we tested the hypothesis that objective loss of elbow motion predicts perceived elbow-related task-specific disability better than does pain after elbow trauma.

Methods: One hundred and fifty-eight patients were evaluated at a median of twenty-six months after a traumatic elbow injury and completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Predictors of the total DASH score and of the scores for individual DASH items that were expected to be related to elbow function were evaluated with univariate and multivariate analyses.

Results: Motion accounted for 35% of the variability in the total DASH score, for 11% to 12% of the variability in the responses to questions specific to hand-based activities, and for 24% to 33% of the variability in the scores for tasks depending on elbow motion. Pain accounted for 41% of the variability in the total DASH score and was a better predictor than motion of disability associated with three tasks: opening a tight jar (with pain and motion accounting for 24% and 11% of the variability, respectively), pushing open a door (25% and 12%, respectively), and placing an object overhead (28% and 25%, respectively). None of the multivariate models explained more than 53% of the variability in the DASH scores.

Conclusions: Objective physical elbow impairment correlated with self-reported disability with respect to specific tasks, but a large proportion of disability remains unexplained. Further research is needed to better understand the differences between objective impairment and perceived disability.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    David Ring
    Posted on October 15, 2008
    Dr. Ring responds to Dr. Lack
    Massachusetts General Hospital

    I agree entirely with Dr.Lack. The gap between impairment and disability is largely explained by psychosocial factors, some of which are responsive to cognitive behavioral therapy. As we overcome the dichotomization between the mental and physical aspects of illness and the stigmatization and demonization of the mental aspects, we will come to realize that collaborative care delivered by surgeons, non-surgeons, therapists, and psychologists will help our patients.

    Dorothea Z. Lack, PhD
    Posted on October 05, 2008
    A Psychologist Responds, Again.
    Independent Practice

    To the Editor:

    In the articles by Lindenhovius, et al.(1) and Henn, et al.(2), we have more evidence of the power of psychosocial variables as they impact outcome in orthopaedic patients.

    Since the average orthopaedic practice is far too busy to accommodate the labor intensive nature of psychological interventions, I would suggest again that an alliance be formed between the clinical practice of orthopaedics and the clinical practice of psychology. There is burgeoning evidence that psychological variables can be modified. Hopefully, this type of intervention will improve outcome.

    The author did not receive any outside funding or grants in support of her research for or preparation of this work. Neither she nor a member of her immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of her immediate family, is affiliated or associated.

    References

    1.Anneluuk L.C. Lindenhovius, Geert A. Buijze, Peter Kloen, and David C. Ring Correspondence Between Perceived Disability and Objective Physical Impairment After Elbow Trauma J Bone Joint Surg Am 2008; 90: 2090-2097

    2.R. Frank Henn, III, Lana Kang, Robert Z. Tashjian, and Andrew Green Patients with Workers' Compensation Claims Have Worse Outcomes After Rotator Cuff Repair J Bone Joint Surg Am. 2008;90:2105-2113.

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    04/16/2014
    CT - Yale University School of Medicine
    04/02/2014
    WV - Charleston Area Medical Center
    03/27/2014
    MA - Boston Medical Center and Boston University School of Medicine