Predicting Mental Health and Functional Scores After Single Digit Non-Thumb Traumatic Amputation
Carrie Roth Bettlach, MSN, FNP-BC1, Ella Gibson, BA1, John M Daines, BS1, Emma R Payne, BS1, Linh Vuong, BS1, Corinne Merrill, BSN1 and Mitchell A Pet, M.D.2, (1)Washington University, St. Louis, MO, (2)Washington University School of Medicine, Saint Louis, MO
Recently the FRANCHISE study has clarified functional outcomes after digital amputation using several PROMS including the MHQ, and PROMIS Upper Extremity (UE) instruments. However, little attention has been paid to mental health outcomes in this population. It is the dual aim of this study to 1) describe patient-reported mental health outcomes after traumatic digital amputation and understand how they correlate with functional outcomes, and 2) determine which patient/injury attributes confer risk of unfavorable mental health outcomes after traumatic digital amputation.
Materials & Methods
We enrolled 77 patients with a history of single digit, non-thumb, traumatic digital amputation. Records were reviewed for age, sex, area deprivation index (ADI), race, hand dominance, amputation level, time since amputation, and worker's compensation status. Each of these variables was treated as an explanatory variable. Additionally, enrollees completed PROMIS Upper Extremity (UE), Pain Interference, Anger, Anxiety, and Depression instruments. Pearson's correlation was used to assess relationships between the five measured PROMs. Bivariate and stepwise multivariable regression analysis was used to assess association between historical/injury explanatory variables and each PROM.
The enrolled population is described in (Table 1). Mean follow-up duration was 2.6 years. Correlation between the three PROMIS Mental Health domains (Anger, Anxiety, Depression) was uniformly strong (½r½ = 0.82-0.9) and statistically significant. Correlation between the PROMIS Mental Health and Functional (UE and Pain Interference) domains were much weaker (½r½ = 0.37-0.50).
Younger age and a worker's compensation claim had independent statistically significant predictive value for worse PROMIS Anger, Anxiety, and Depression scores. No explanatory variable (including agree and worker's compensation status) was independently associated with PROMIS UE or Pain Interference (Table 2).
In patients with a history of single digit, non-thumb, traumatic digital amputations, anger, anxiety, and depression seem to co-occur, and are more likely to be present in younger patients and those involved in a worker's compensation claim. These negative mental health outcomes do not correspond with inferior functional outcomes.This information suggests that after traumatic digital amputation, younger patients and those involved in a worker's compensation claim might benefit from a surgeon-initial mental health care referral.
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