Purpose
The relationship between biopsychosocial factors and patient-reported function is
less clear in pediatric than in adult hand surgery patients. Our primary hypothesis
was that pain interference (PI) and peer relationships (PR) would demonstrate association
with upper extremity function. Secondarily, we hypothesized that the magnitude of
this effect would increase with age.
Methods
Patients aged 5 to 17 years presenting to a tertiary academic clinic between October
2017 and January 2019 were included. The parent/guardian was administered the following
instruments after indicating they, rather than the patient, were answering the questions
on a tablet computer: Patient-Reported Outcomes Measurement Information System (PROMIS)
Upper Extremity (UE) Parent Proxy (PP) Computer Adaptive Test (CAT) v2.0, PROMIS PI
PP CAT v2.0, and the PROMIS PR PP CAT v2.0. Ceiling/floor effects and Spearman correlations
were calculated. Multivariable Tobit modeling was performed to determine whether biopsychosocial
factors and upper extremity function were associated. Multivariable regression coefficients
were compared between age cohorts using a separate multivariable model to evaluate
the interaction between age and other predictors.
Results
Of 139 included participants, the mean age was 11.7 ± 3.7 years and 50% were female.
For patients 11 years of age or younger, UE was weakly correlated with PI (coefficient,
–0.34; 95% confidence interval, –0.56 to –0.08) and was not correlated with PR. For
patients older than 11 years, UE had moderate correlation with PI (coefficient, –0.60;
95% confidence interval, –0.72 to –0.45) and was not correlated with PR. Multivariable
analysis demonstrated a significant negative association between PI and UE, with a
significantly larger magnitude of effect for patients older than 11 years of age.
Conclusions
The biopsychosocial model applies to pediatric hand surgery patients. The association
between greater pain interference and worse patient-reported upper extremity function,
as assessed using parent proxy instruments, was significantly stronger for patients
older than 11 years than those 11 years old or younger.
Clinical relevance
This study suggests that the biopsychosocial model applies to pediatric hand patients.
Key words
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References
- Self-reported upper extremity health status correlates with depression.J Bone Joint Surg Am. 2006; 88: 1983-1988
- Predictors of pain intensity and disability after minor hand surgery.J Hand Surg Am. 2010; 35: 956-960
- Predicting pain and disability in patients with hand fractures: comparing pain anxiety, anxiety sensitivity and pain catastrophizing.Eur J Pain. 2010; 14: 446-451
- Predictors of pain during and the day after corticosteroid injection for idiopathic trigger finger.J Hand Surg Am. 2012; 37: 237-242
- Computerized adaptive testing of psychological factors: relation to upper-extremity disability.J Bone Joint Surg Am. 2013; 95: e149
- Contribution of kinesophobia and catastrophic thinking to upper-extremity-specific disability.J Bone Joint Surg Am. 2013; 95: 76-81
- The role of emotional health in functional outcomes after orthopaedic surgery: extending the biopsychosocial model to orthopaedics: AOA critical issues.J Bone Joint Surg Am. 2013; 95: e165
- To what degree do pain-coping strategies affect joint stiffness and functional outcomes in patients with hand fractures?.Clin Orthop Relat Res. 2015; 473: 3484-3490
- Prevalence of and factors associated with major depression in patients with upper extremity conditions.J Hand Surg Am. 2016; 41 (e1–7): 263-269
- Is social support associated with upper extremity disability?.Clin Orthop Relat Res. 2016; 474: 1830-1836
- Association of physical function, anxiety, and pain interference in nonshoulder upper extremity patients using the PROMIS platform.J Hand Surg Am. 2017; 42: 781-787
- Performance of pediatric PROMIS CATs in children with upper extremity fractures.Hand (N Y). 2020; 15: 194-200
- The development of coping across childhood and adolescence: an integrative review and critique of research.Int J Behav Devel. 2011; 35: 1-17
- Development of six PROMIS pediatrics proxy-report item banks.Health Qual Life Outcomes. 2012; 10: 22
- Statistics corner: a guide to appropriate use of correlation coefficient in medical research.Malawi Med J. 2012; 24: 69-71
- Applied Statistics for the Behavioral Sciences.Houghton Mifflin, Boston, MA2003
- Modeling outcomes with floor or ceiling effects: an introduction to the Tobit model.Gifted Child Q. 2010; 54: 314-320
- What is the most useful questionnaire for measurement of coping strategies in response to nociception?.Clin Orthop Relat Res. 2015; 473: 3511-3518
- Self-reliance and relations with parents as predictors of anxiety and depression in college students.Res Psychol Behav Sci. 2016; 4: 24-27
- Who helps you? Self and other sources of support among youth in japan and the USA.Int J Behav Devel. 2008; 32: 496-508
- Score Cut Points.Northwestern University, Evanston, IL2019 (Available at:)http://www.healthmeasures.net/score-and-interpret/interpret-scores/promis/promis-score-cut-pointsDate accessed: November 21, 2019
- A combination of distribution- and anchor-based approaches determined minimally important differences (MIDS) for four endpoints in a breast cancer scale.J Clin Epidemiol. 2004; 57: 898-910
- Minimally important differences were estimated for six patient-reported outcomes measurement information system-cancer scales in advanced-stage cancer patients.J Clin Epidemiol. 2011; 64: 507-516
- Minimally important differences for patient reported outcomes measurement information system pain interference for individuals with back pain.J Pain Res. 2016; 9: 251-255
- Estimating minimally important differences for the PROMIS pain interference scales: results from 3 randomized clinical trials.Pain. 2018; 159: 775-782
- Estimating minimally important difference (MID) in PROMIS pediatric measures using the scale-judgment method.Qual Life Res. 2016; 25: 13-23
- Minimal clinically important difference after carpal tunnel release using the PROMIS platform.J Hand Surg Am. 2019; 44: 947-953.e1
- The minimal clinically important difference of the PROMIS and QuickDASH instruments in a nonshoulder hand and upper extremity patient population.J Hand Surg Am. 2020; 45: 399-407.e6
- The impact of social deprivation on pediatric PROMIS health scores after upper extremity fracture.J Hand Surg Am. 2018; 43: 897-902
- Functional impact of congenital hand differences: early results from the congenital upper limb differences (CoULD) registry.J Hand Surg. 2018; 43: 321-330
- Interpret Scores: PROMIS.Northwestern University, Evanston, IL2019 (Available at:)http://www.healthmeasures.net/score-and-interpret/interpret-scores/promisDate accessed: January 25, 2019
- Evaluation of version 2.0 of the PROMIS upper extremity computer adaptive test in nonshoulder upper extremity patients.J Hand Surg Am. 2019; 44: 267-273
- PROMIS(R) parent proxy report scales for children ages 5–7 years: an item response theory analysis of differential item functioning across age groups.Qual Life Res. 2014; 23: 349-361
- Do injured adolescent athletes and their parents agree on the athletes' level of psychologic and physical functioning?.Clin Orthop Relat Res. 2018; 476: 767-775
Article info
Publication history
Published online: July 05, 2020
Accepted:
May 12,
2020
Received:
May 30,
2019
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
