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• W3214790062 abstract "Where Are We Now? Those of us who regularly manage patients with open tibia fractures understand the potential life-long patient burden that can accompany these injuries. In their qualitative study, Nightingale and colleagues [7] elicit patients’ own insights about the psychological, financial, and functional consequences of these injuries in a qualitative study. Prior studies have quantified the emotional toll [1] and physical disability [3] that persist beyond the healing of a fracture. Up to 56% of orthopaedic trauma patients have depression, anxiety, or pain catastrophizing [11]. The qualitative approach and phenomenological principles [5] used in Nightingale et al. [7] help us to go deeper into the actual experience of patient recovery, and their use of framework analysis [4] helped to identify recurring themes. Four main themes emerged from their interviews: (1) patient desire to rapidly regain mobility, (2) the burden of surgery, (3) hope and expectations, and (4) coping strategies. For orthopaedic surgeons, the coping theme was particularly enlightening. The authors found a strong patient preference for task-oriented coping strategies as a way to relieve some of their worries about the procedure. It’s important for orthopaedic surgeons to recognize this and include pre- or postoperative goal setting, with achievable targets that allow patients to regain control of either their preoperative health habits or postoperative rehabilitation. The findings of this study, re-emphasize how critical coping strategies are for our patients. Our patients can benefit from coping strategy education by utilizing healthcare providers, peer support (patients with similar injuries), and even the internet. As healthcare providers, we must understand that a patient’s uncertainty of recovery, protracted recovery phase, and societal consequences like lost income significantly affect them. We need to emphasize patient expectations preoperatively and at each postoperative encounter to maximize patient outcomes. Surgeons must be aware of the mental health resources that their institution has available to help facilitate a successful patient recovery. We don’t need to be the experts in mental health; however, we can facilitate the care that may in the end prove to be more beneficial than the procedures that we perform. Where Do We Need To Go? Although orthopaedic surgeons may not feel equipped to have potentially lengthy and detailed conversations with their patients with open tibia fractures, it is important for us to understand that the emotional and societal cost of fractures are real and should not be ignored. It is essential that we acknowledge this with patients. Patients want honesty regarding their injuries, recovery, and the length of time it may take before they can get back to “normal.” Among the key findings of a 2013 LEAP study were the longitudinal relationships among emotional stress, disability, and pain [1]. Orthopaedic surgeons who regularly treat patients with trauma should have a screening protocol to help identify which patients will benefit from the available mental health support services within their systems and communities. Coping strategies and support, including social support, are so important to patients facing acute, severe life changes like recovery from trauma. Nightingale and colleagues [7] used a very time-intensive method in evaluating these patients. The average interview time was 53 minutes. To be more practical for orthopaedic surgeons with limited time available in clinic, we need a fast and reliable screening tool for identifying patients who have less than ideal coping strategies in order to help find them resources [6]. As indicated in the paper, resources available online were very helpful for patients since they’re readily available to patients with internet access. This is particularly important because access to mental health services is perceived as lacking [2]. In a 2018 survey, 6 out of 10 Americans have sought out mental health, but over 30% list cost, wait times to see a provider, social stigma of mental health disorders, and not knowing available resources as major barriers [2]. This appeared to more likely affect patients with lower incomes and those who live in rural areas. How Do We Get There? Although it may seem like the current perception in accessing mental health services is a barrier, there are positive developments. Online resources as well as telemedicine are potential ways to increase mental health awareness and access to mental health resources and services. Furthermore, the current study helps continue to raise awareness about the issues that affect patients beyond the objective physical findings. Although this study addressed patients with open tibia fractures, psychosocial issues affect all orthopaedic surgery subspecialties [11]. We must increase the use of patient-reported outcomes like PROMIS [8] that have mental health components to better identify patients who are at risk for mental health issues. By continuing to investigate mental health, coping strategies, and things that matter most to the patients through prospective trials, we may identify more efficient screening tools while also being stronger advocates for our patients [6]. An efficient and practical screening tool may increase the likelihood of an orthopaedic surgeon to both identify and refer their patient for mental health services either pre- or postoperatively. Although 90% of orthopaedic surgeons think they can identify psychosocial issues in their patients, only 27% of orthopaedic surgeons surveyed were likely to refer their patients for mental health services [11]. One such screening tool was investigated in an upcoming article in CORR® that evaluated the effectiveness of the Traumatic Injuries Distress Scale (TIDS) in identifying patients at risk for chronic pain at 12 months after injury. Modarresi et al. [6] screened 160 patients and showed that a TIDS score of 5 or higher at baseline indicated a higher risk for chronic pain at 12 months. The TIDS scale takes 3 minutes to complete and helped identify patients that could be referred for further biopsychosocial intervention. Fortunately, data are already available for the effectiveness of coping strategy education for older patients with hip fractures. The FIT-Hip trial, a prospective randomized control trial investigating cognitive behavioral therapy and coping strategies in geriatric patients with hip fractures, showed the benefits of both cognitive behavioral therapy to address fear of falling [10] and active coping strategies [9] for anxiety and depression. Investigating the effectiveness of screening tools and coping strategy education will not take hundreds of patients. Still, such studies need to use prospective, randomized, or at least cohort designs to see the true effect. Modarresi et al. [6] showed that this can be done in a relatively small number of patients. Increasing awareness of the physical, emotional, and societal costs of open tibia fractures will lead to increased funding for research to investigate the psychosocial component for recovery from injury and surgery." @default.
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• W3214790062 date "2021-12-03" @default.
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• W3214790062 title "CORR Insights®: What Is Important to Patients Who Are Recovering From an Open Tibial Fracture? A Qualitative Study" @default.
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• W3214790062 doi "https://doi.org/10.1097/corr.0000000000002080" @default.
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