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Effect of Anxiety on Patients with Hand Conditions
Casey Beleckas, BS; Jason Guattery, MS; Melissa Wright, MD; Ryan P. Calfee, MD, MSc
Washington University in St. Louis School of Medicine, St. Louis, MO

Objective: PROMIS CAT scores have been normalized according to a standard population distribution. We sought to determine whether patients seeking specialty hand care present with a normal distribution of anxiety scores, and how these scores are correlated with depression, physical function, and pain interference scores.
Methods: This cross-sectional evaluation analyzed 1040 consecutive initial outpatient clinic visits of adult patients, ages 18 or older, presenting to a tertiary hand practice in the United States from 4/21/2016-5/19/2016. All patients completed electronic PROMIS Anxiety, Depression, Physical Function, and Pain Interference CATs during registration as routine clinical care. Univariate descriptive analyses, Kolmogorov-Smirnov tests, histograms, and Pearson's correlation statistically and graphically explored these PROMIS data.
Results: PROMIS anxiety scores ranged from 32.9 to 84.9 with a median of 51.2. The histogram indicated a bimodal distribution with a dominant peak at 32.9 and a secondary peak at 51 (Figure 1). Twelve percent of all patients scored 32.9 indicating minimal anxiety. A one-sample Kolmogorov-Smirnov test rejected the null hypothesis of a normal distribution (p<0.001). Depression also demonstrated a bimodal distribution with a primary peak at 34.2. With both minimum peaks removed, anxiety and depression remained strongly correlated at r=0.73. PROMIS anxiety demonstrated a linear correlation with physical function (r=-0.43) (Figure 2) and pain interference (r=0.50), which slightly exceeded the correlation of PROMIS depression scores with physical function (r=-0.32) and pain interference (r=0.37).
Conclusion: In patients presenting to a specialty hand practice, PROMIS anxiety and depression scores present in a bimodal distribution with a substantial floor effect. As PROMIS scores for physical function and pain interference were normally distributed, it is likely that the unexpectedly low scores on the anxiety and depression CAT indicates patients' reluctance to admit these symptoms. Not only are the anxiety and depression CAT closely correlated, but anxiety also has a closer correlation to physical function and pain interference, suggesting a strong role of anxiety in hand surgical patients' perception of their physical condition.

Figure 1. Histogram of PROMIS Anxiety scores

Figure 2. Correlation of PROMIS Anxiety and Physical Function scores

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