Pre-existing Mental Health Diagnosis is Associated with Outcomes after Upper Extremity Fragility Fractures: Systematic Review

Additional Authors

David A Ferguson, Physical Therapy Program, College of Health Sciences, East Tennessee State University, Johnson City, TN Marylou Morales, Physical Therapy Program, College of Health Sciences, East Tennessee State University, Johnson City, TN Takeem young, Physical Therapy Program, College of Health Sciences, East Tennessee State University, Johnson City, TN Christiana Keinath, Sherrod Library, East Tennessee State University, Johnson City, TN

Abstract

Purpose: Distal radius (DRF) and humerus (HF) are common upper extremity fragility fractures (UEFF). A subset of people sustaining UEFF are at risk of poor pain and function outcomes. This systematic review examined the associations between pre-existing mental health conditions and poor pain and functional outcomes 6- and 12 months after the UEFF. Methods: A focused search of MEDLINE, CINAHL, PsycINFO, and Cochrane Register for Controlled Trial was conducted to locate studies examining the associations between pre-existing mental health conditions with pain or functions at 6- and 12-months after UEFF. The risk of bias (RoB) in the included studies was examined independently by two reviewers using the Quality In Prognosis Studies tool. The relevant data quantifying the associations between the predictors (pre-existing mental health conditions) and outcomes (pain or function at 6- and 12-months after UEFF), such as beta coefficients (β) or odds ratio, were extracted. Results: Of the sixteen that met the eligibility criteria and were included in the review, seven had low RoB, four had moderate, and five had high RoB. Three high-quality studies (low RoB) showed that pre-surgery depression (explained variance 16.8%; p<0.001), post-traumatic stress (β=0.2; p<0.05), and use of anti-depressants (β=-9.79; p<0.001) were associated with worse function at 6-months after DRF. Post-traumatic stress (β=0.3; p = 0.008) was also associated with poor pain outcomes at 6-months after DRF. Similarly, pre-surgery anxiety (β=0.35; p=0.02) and affective disorder (β=-5.67; p<0.05) were associated with poor shoulder functions 6-months after HF. Conclusion: The results of this review suggest that people who have pre-existing mental health conditions are at risk of persistent pain and poor functions after UEFF. Screening for pre-existing mental health diagnoses in people with UEFF at the time of initial encounter in orthopedic surgery or rehabilitation practice can provide an opportunity to improve outcomes in this population.

Start Time

16-4-2025 11:00 AM

End Time

16-4-2025 12:00 PM

Room Number

311

Presentation Type

Oral Presentation

Presentation Subtype

Grad/Comp Orals

Presentation Category

Health

Faculty Mentor

Saurabh Mehta

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Apr 16th, 11:00 AM Apr 16th, 12:00 PM

Pre-existing Mental Health Diagnosis is Associated with Outcomes after Upper Extremity Fragility Fractures: Systematic Review

311

Purpose: Distal radius (DRF) and humerus (HF) are common upper extremity fragility fractures (UEFF). A subset of people sustaining UEFF are at risk of poor pain and function outcomes. This systematic review examined the associations between pre-existing mental health conditions and poor pain and functional outcomes 6- and 12 months after the UEFF. Methods: A focused search of MEDLINE, CINAHL, PsycINFO, and Cochrane Register for Controlled Trial was conducted to locate studies examining the associations between pre-existing mental health conditions with pain or functions at 6- and 12-months after UEFF. The risk of bias (RoB) in the included studies was examined independently by two reviewers using the Quality In Prognosis Studies tool. The relevant data quantifying the associations between the predictors (pre-existing mental health conditions) and outcomes (pain or function at 6- and 12-months after UEFF), such as beta coefficients (β) or odds ratio, were extracted. Results: Of the sixteen that met the eligibility criteria and were included in the review, seven had low RoB, four had moderate, and five had high RoB. Three high-quality studies (low RoB) showed that pre-surgery depression (explained variance 16.8%; p<0.001), post-traumatic stress (β=0.2; p<0.05), and use of anti-depressants (β=-9.79; p<0.001) were associated with worse function at 6-months after DRF. Post-traumatic stress (β=0.3; p = 0.008) was also associated with poor pain outcomes at 6-months after DRF. Similarly, pre-surgery anxiety (β=0.35; p=0.02) and affective disorder (β=-5.67; p<0.05) were associated with poor shoulder functions 6-months after HF. Conclusion: The results of this review suggest that people who have pre-existing mental health conditions are at risk of persistent pain and poor functions after UEFF. Screening for pre-existing mental health diagnoses in people with UEFF at the time of initial encounter in orthopedic surgery or rehabilitation practice can provide an opportunity to improve outcomes in this population.