OTA 2008 Posters

Scientific Poster #122 Upper Extremity OTA-2008

Influence of Psychological Distress on Performance-Based Upper Extremity Evaluation

Jeffrey Watson, BS (n); David C. Ring, MD, PhD (a,e-Acumed, LLC, Biomet; a-Joint Active
Systems, a,b-Small Bone Innovations; a,b,e- Smith + Nephew, Wright Medical Technology, Inc.;
c-Hand Innovations; d-Illuminos, Inc., Mimedex, Inc.; e-Tornier);
Massachusetts General Hospital, Boston, Massachusetts, USA

Purpose: Grip strength is widely used to assess upper extremity function. Although considered to be an objective measure, grip strength is also a reflection of effort and may be influenced by subjective factors including psychological distress. We investigated the determinants of grip strength with the hypothesis that psychosocial factors are associated with diminished grip strength.

Methods: 134 patients with an isolated, discrete upper extremity condition had grip strength measurements and completed two or more of the following surveys: the Center for Epidemiologic Studies-Depression (CES-D) scale, Pain Anxiety Symptoms Scale (PASS), and Pain Catastrophizing Scale (PCS) as part of one of several prospective clinical studies. Univariate and multivariate statistical analysis sought determinants of absolute grip strength and grip strength as a percentage of the opposite, uninvolved limb.

Results: Determinants of absolute grip strength included gender (P <0.001) and grip strength of the uninvolved limb (r = 0.82, P <0.001). The association between CES-D score and absolute grip strength was near significant but very weak (r = –0.16, P = 0.06). Multivariate regression analysis produced a best-fit model that retained grip of the uninvolved limb and CES-D scores (R2 = 0.69, F = 144.9, P <0.001). When grip of involved limb was evaluated as a percentage of grip of the uninvolved limb, CES-D score was a weak but significant predictor (r = –0.19, P = 0.03), and patients recovering from a fracture of the distal radius had weaker grip than patients with nontraumatic conditions.

Conclusions: Psychological distress, as captured by depression scores, was minimally associated with diminished grip strength. Psychological factors influence reported disability much more than they influence performance-based functional measures.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.