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Patients With Thumb-base Osteoarthritis Scheduled for Surgery Have More Symptoms, Worse Psychological Profile, and Higher Expectations Than Nonsurgical Counterparts: A Large Cohort Analysis

Wouters, Robbert M. MSc, PT; Vranceanu, Ana-Maria PhD; Slijper, Harm P. PhD; Vermeulen, Guus M. MD, PhD; van der Oest, Mark J.W. BSc; Selles, Ruud W. PhD; Porsius, Jarry T. PhD; ; The Hand-Wrist Study Group

Clinical Orthopaedics and Related Research: December 2019 - Volume 477 - Issue 12 - p 2735-2746
doi: 10.1097/CORR.0000000000000897

Background Psychological characteristics, such as depression, anxiety or negative illness perception are highly prevalent in patients with several types of OA. It is unclear whether there are differences in the clinical and psychological characteristics of patients with thumb carpometacarpal (CMC-1) osteoarthritis (OA) scheduled for nonsurgical treatment and those with surgical treatment.

Questions/purposes (1) What are the differences in baseline sociodemographic characteristics and clinical characteristics (including pain, hand function, and health-related quality of life) between patients with thumb CMC-1 OA scheduled for surgery and those treated nonoperatively? (2) What are the differences in psychological characteristics between patients scheduled for surgery and those treated nonsurgically, for treatment credibility, expectations, illness perception, pain catastrophizing, and anxiety and depression? (3) What is the relative contribution of baseline sociodemographic, clinical, and psychological characteristics to the probability of being scheduled for surgery?

Methods This was a cross-sectional study using observational data. Patients with CMC-1 OA completed outcome measures before undergoing either nonsurgical or surgical treatment. Between September 2017 and June 2018, 1273 patients were screened for eligibility. In total, 584 participants were included: 208 in the surgery group and 376 in the nonsurgery group. Baseline sociodemographic, clinical, and psychological characteristics were compared between groups, and a hierarchical logistic regression analysis was used to investigate the relative contribution of psychological characteristics to being scheduled for surgery, over and above clinical and sociodemographic variables. Baseline measures included pain, hand function, satisfaction with the patient’s hand, health-related quality of life, treatment credibility and expectations, illness perception, pain catastrophizing, and anxiety and depression.

Results Patients in the surgery group had longer symptom duration, more often a second opinion, higher pain, treatment credibility and expectations and worse hand function, satisfaction, HRQoL, illness perception and pain catastrophizing compared with the non-surgery group (effect sizes ranged from 0.20 to 1.20; p values ranged from < 0.001 to 0.044). After adjusting for sociodemographic, clinical, and psychological factors, we found that the following increased the probability of being scheduled for surgery: longer symptom duration (standardized odds ratio [SOR], 1.86; p = 0.004), second-opinion visit (SOR, 3.81; p = 0.027), lower satisfaction with the hand (SOR, 0.65; p = 0.004), higher treatment expectations (SOR, 5.04; p < 0.001), shorter perceived timeline (SOR, 0.70; p = 0.011), worse personal control (SOR, 0.57; p < 0.001) and emotional response (SOR, 1.40; p = 0.040). The hierarchical logistic regression analysis including sociodemographic, clinical, and psychological factors provided the highest area under the curve (sociodemographics alone: 0.663 [95% confidence interval 0.618 to 0.709]; sociodemographics and clinical: 0.750 [95% CI 0.708 to 0.791]; sociodemographics, clinical and psychological: 0.900 [95% CI 0.875 to 0.925]).

Conclusions Patients scheduled to undergo surgery for CMC-1 OA have a worse psychological profile than those scheduled for nonsurgical treatment. Our findings suggest that psychological characteristics should be considered during shared decision-making, and they might indicate if psychological interventions, training in coping strategies, and patient education are needed. Future studies should prospectively investigate the influence of psychological characteristics on the outcomes of patients with CMC-1 OA.

Level of Evidence Level III, therapeutic study.

R. M. Wouters, Center for Hand Therapy, Handtherapie Nederland, Utrecht, the Netherlands

R. M. Wouters, H. P. Slijper, M. J. W. van der Oest, R. W. Selles, J. T. Porsius, Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

R. M. Wouters, H. P. Slijper, M. J. W. van der Oest, R. W. Selles, J. T. Porsius, Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

A.-M. Vranceanu, J. T. Porsius, Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

H. P. Slijper, G. M. Vermeulen, M. J. W. van der Oest, J. T. Porsius, Hand and Wrist Center, Xpert Clinic, Eindhoven, the Netherlands

R. M. Wouters, Wallesteinlaan 45, 3554 HM, Utrecht, the Netherlands, Email:

The members of The Hand-Wrist Study Group are R. A. M. Blomme, B. J. R. Sluijter, C. Schouten, D. J. J. C. van der Avoort, E. T. Walbeehm, G. M. van Couwelaar, G. M. Vermeulen, J. P. de Schipper, J. F. M. Temming, J. H. van Uchelen, H. L. de Boer, K. P. de Haas, O. T. Zöphel, R. Feitz, J. S. Souer, S. E. R. Hovius, T. M. Moojen, X. Smit, R. van Huis, P. Y. Pennehouat, K. Schoneveld, Y. E. van Kooij, R. M. Wouters, P. Zagt, F. J. van Ewijk, Frederik Moussault, J. J. Veltkamp, A. F. te Velde, A. Fink, W. A. de Ridder, H. P. Slijper, R. W. Selles, J. T. Porsius, K. R. Spekreijse, C. Zhou, J. Tsehaie, R. Poelstra, M. C. Janssen, M. J. W. van der Oest, S. Evers, P. O. Sun, V. J. M. M. Schrier, Jak Dekker, Matijs de Jong, Jasper van Gestel, Marloes ter Stege, Menno Dekker, Roel Faber, Frank Santegoets, Monique Sieber-Rasch, and Ton Gerritsen.

The institution of one or more of the authors (RW, MO, JP) has received, during the study period, funding from Handtherapie Nederland, Xpert Clinic, Erasmus MC, Geert Geertsen Foundation, Netherlands Organisation for Scientific Research, and Medical Delta. Each author certifies that neither he or she, nor any member of his or her immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Erasmus MC, University Medical Center Rotterdam, The Netherlands.

© 2019 by the Association of Bone and Joint Surgeons
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