Willie Dong, Makoa Mau, Silvia Soule, Eleanor Sato, Tyler Thorne, Thomas Higgins, David Rothberg, Lucas Marchand, Justin Haller
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A subanalysis was performed between patients with low anxiety and no PT (LANP) versus low anxiety with PT (LAP) versus high anxiety and no PT (HANP), and high anxiety with PT (HAP).</p><p><strong>Results: </strong>A total of 161 patients, 111 women (68.9%), with an average age of 46 years (range: 18-72 years), were included in this study: 127 PT, 34 no PT, 88 low anxiety, and 73 high anxiety. PT did not yield any significant differences in PROMIS PF (44.9 PT vs. 42.6 no PT, P = 0.180) or PI (53.5 PT vs. 54.4 no PT, P = 0.656) at final follow-up. At final follow-up, patients with high anxiety had similar PROMIS PF (43.0) versus patients with low anxiety (45.5, P = 0.088), but significantly worse PROMIS PI scores (51.5 vs. 56.7, respectively; P = 0.001). Univariate analysis demonstrated a significant difference in age between patients with high and low anxiety and was thus selected as a control variable in the analysis of HANP, HAP, LANP, and LAP. After controlling for age, pairwise comparisons of estimated PROMIS PF scores at final follow-up were significantly lower for HANP (39.0) than for HAP (43.9, P = 0.05), LANP (45.1, P = 0.05), and LAP patients (45.9, P = 0.04). Final PROMIS PI scores were significantly worse for HANP (59.1) and HAP (56.5) when compared with LANP (51.3, P = 0.021 vs. HANP, P = 0.049 vs. HAP) and LAP (51.3, P = 0.005 vs. HANP, P = 0.004 vs. HAP) groups.</p><p><strong>Conclusions: </strong>Patients with high anxiety who undergo isolated ankle fracture fixation perform worse regarding PROMIS PI irrespective of PT status. However, some patients with high anxiety may benefit from formal PT referral to maximize their functional outcomes.</p><p><strong>Level of evidence: </strong>Prognostic Level III. 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A subanalysis was performed between patients with low anxiety and no PT (LANP) versus low anxiety with PT (LAP) versus high anxiety and no PT (HANP), and high anxiety with PT (HAP).</p><p><strong>Results: </strong>A total of 161 patients, 111 women (68.9%), with an average age of 46 years (range: 18-72 years), were included in this study: 127 PT, 34 no PT, 88 low anxiety, and 73 high anxiety. PT did not yield any significant differences in PROMIS PF (44.9 PT vs. 42.6 no PT, P = 0.180) or PI (53.5 PT vs. 54.4 no PT, P = 0.656) at final follow-up. At final follow-up, patients with high anxiety had similar PROMIS PF (43.0) versus patients with low anxiety (45.5, P = 0.088), but significantly worse PROMIS PI scores (51.5 vs. 56.7, respectively; P = 0.001). Univariate analysis demonstrated a significant difference in age between patients with high and low anxiety and was thus selected as a control variable in the analysis of HANP, HAP, LANP, and LAP. After controlling for age, pairwise comparisons of estimated PROMIS PF scores at final follow-up were significantly lower for HANP (39.0) than for HAP (43.9, P = 0.05), LANP (45.1, P = 0.05), and LAP patients (45.9, P = 0.04). Final PROMIS PI scores were significantly worse for HANP (59.1) and HAP (56.5) when compared with LANP (51.3, P = 0.021 vs. HANP, P = 0.049 vs. HAP) and LAP (51.3, P = 0.005 vs. HANP, P = 0.004 vs. HAP) groups.</p><p><strong>Conclusions: </strong>Patients with high anxiety who undergo isolated ankle fracture fixation perform worse regarding PROMIS PI irrespective of PT status. However, some patients with high anxiety may benefit from formal PT referral to maximize their functional outcomes.</p><p><strong>Level of evidence: </strong>Prognostic Level III. 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引用次数: 0
摘要
目的：比较接受正规物理治疗（PT）与未接受正规物理治疗（PT）以及PROMIS焦虑评分（AS）高与低的患者踝关节骨折固定后的预后，并评价PT在PROMIS AS评分设置中的作用。方法：设计：回顾性队列研究。地点：一级创伤中心。患者选择标准：年龄在bb0 ~ 18岁的患者，接受孤立性踝关节骨折（OTA/ ao44a, 44B, 44C）固定，术后有记录的PROMIS评分。结果测量和比较：比较接受正式PT和未接受PT的患者以及基线PROMIS AS评分高和低的患者的术后PROMIS身体功能（PF）和疼痛干扰（PI）。对低焦虑无PT （LANP）、低焦虑伴PT （LAP）、高焦虑无PT （HANP）、高焦虑伴PT （HAP）患者进行亚分析。结果：共纳入161例患者，其中女性111例（68.9%），平均年龄46岁（范围：72岁），有焦虑127例，无焦虑34例，低焦虑88例，高焦虑73例。在最终随访时，PT组在PROMIS PF （44.9 PT vs 42.6 PT, p=0.180）或PI （53.5 PT vs 54.4 PT, p=0.656）方面没有任何显著差异。在最后的随访中，高焦虑患者的PROMIS PF（43.0）与低焦虑患者（45.5,p=0.088）相似，但PROMIS PI评分明显较差(分别为51.5比56.7；p = 0.001)。单因素分析显示高、低焦虑患者的年龄有显著差异，因此在HANP、HAP、LANP和LAP分析中选择年龄作为控制变量。在控制年龄后，HANP患者最终随访时PROMIS PF评分（39.0）的两两比较显著低于HAP患者（43.9,p=0.05）、LANP患者（45.1,p=0.05）和LAP患者（45.9,p=0.04）。与LANP组（51.3,p=0.021 vs HANP, p=0.049 vs HAP）和LAP组（51.3,p=0.005 vs HANP, p=0.004 vs HAP）相比，HANP组（59.1）和HAP组（56.5）的最终PROMIS PI评分明显较差。结论：接受孤立踝关节骨折固定的高焦虑患者在PROMIS PI方面的表现较差，与PT状态无关。然而，一些高焦虑患者可能受益于正式的PT转诊，以最大限度地提高其功能预后。证据等级：III级，预后。
Formal Physical Therapy Improves Patient-Reported Outcome Measurement Information System Physical Function for High Anxiety Patients After Ankle ORIF.
Objectives: To compare outcomes after ankle fracture fixation between those receiving formal physical therapy (PT) versus no formal PT and those with high versus low patient-reported outcome measurement information system (PROMIS) anxiety score (AS), and to evaluate the effect of PT in the setting of PROMIS ASs.
Outcome measures and comparisons: The postoperative PROMIS physical function (PF) and pain interference (PI) were compared between patients receiving formal PT versus those receiving no PT and those with baseline high versus low PROMIS ASs. A subanalysis was performed between patients with low anxiety and no PT (LANP) versus low anxiety with PT (LAP) versus high anxiety and no PT (HANP), and high anxiety with PT (HAP).
Results: A total of 161 patients, 111 women (68.9%), with an average age of 46 years (range: 18-72 years), were included in this study: 127 PT, 34 no PT, 88 low anxiety, and 73 high anxiety. PT did not yield any significant differences in PROMIS PF (44.9 PT vs. 42.6 no PT, P = 0.180) or PI (53.5 PT vs. 54.4 no PT, P = 0.656) at final follow-up. At final follow-up, patients with high anxiety had similar PROMIS PF (43.0) versus patients with low anxiety (45.5, P = 0.088), but significantly worse PROMIS PI scores (51.5 vs. 56.7, respectively; P = 0.001). Univariate analysis demonstrated a significant difference in age between patients with high and low anxiety and was thus selected as a control variable in the analysis of HANP, HAP, LANP, and LAP. After controlling for age, pairwise comparisons of estimated PROMIS PF scores at final follow-up were significantly lower for HANP (39.0) than for HAP (43.9, P = 0.05), LANP (45.1, P = 0.05), and LAP patients (45.9, P = 0.04). Final PROMIS PI scores were significantly worse for HANP (59.1) and HAP (56.5) when compared with LANP (51.3, P = 0.021 vs. HANP, P = 0.049 vs. HAP) and LAP (51.3, P = 0.005 vs. HANP, P = 0.004 vs. HAP) groups.
Conclusions: Patients with high anxiety who undergo isolated ankle fracture fixation perform worse regarding PROMIS PI irrespective of PT status. However, some patients with high anxiety may benefit from formal PT referral to maximize their functional outcomes.
Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
期刊介绍：
Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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