A Hand Posture as Nonverbal Indicator of Catastrophic Thinking for Finger, Hand or Wrist Injury
Suzanne Caroline Wilkens, MD1; Jonathan Lans, MD1, Claudia Antoinette Bargon, BSc1, David Ring, MD, PhD2; Neal C Chen, MD1
1Massachusetts General Hospital/Harvard Medical School, Boston, MA; 2Dell Medical School, Austin, TX
Introduction: Given the strong relationship between distress (anxiety/depression) and less effective coping strategies (catastrophic thinking, kinesiophobia) with pain intensity and magnitude of limitations, we sought nonverbal indicators of catastrophic thinking. We aimed to determine if patients with specific hand postures during physical examination score higher on questionnaires assessing pain interference, symptoms of depression, limitations, catastrophic thinking, and kinesiophobia and if these measures correlate with the number of observed hand postures.
Materials & Methods: A total of 149 patients with stiff or painful fingers within 2 months after sustaining a finger, hand, or wrist injury were included. We asked all patients to complete a set of questionnaires: sociodemographic survey, Patient Reported Outcomes Measurement Information System (PROMIS) Pain Interference computer adaptive test (CAT), PROMIS Upper Extremity Physical Function CAT, PROMIS Depression CAT, the Abbreviated Pain Catastrophizing Scale (PCS-4), and the Tampa Scale of Kinesiophobia (TSK). The occurrence of specific hand postures during the physical examination was noted.
Results: Patients with one or more specific hand postures did not score higher on the PROMIS Pain Interference CAT. A higher degree of catastrophic thinking and kinesiophobia was associated with at least one hand posture. Patients with greater catastrophic thinking had a higher total number of hand postures on average.
Conclusions: There are verbal and nonverbal signs of less effective coping strategies that hinder recovery. Surgeons can learn to recognize these signs and treat them starting with compassion, empathy, and patience and being prepared to add formal support (e.g. cognitive behavioral therapy) to help facilitate recovery.
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