Background: The sudden and debilitating nature of lower extremity injuries can trigger mood disturbances, including major depressive disorder. Methods: This prospective study enrolled patients undergoing operative repair of ankle fractures and Achilles ruptures and followed them for 1 year postoperatively. The validated Patient Health Questionnaire (PHQ-9) for depressive symptoms was administered at the preoperative visit and at postoperative weeks 1, 2, 4, 8, 16, 24, 32, 40, and 52. PHQ-9 is scored 0 to 27, with higher values indicating greater depression symptoms. Results: Fifty-eight patients completed 1 year of follow-up. The mean PHQ-9 score was 2.7 (range, 0-20) at the preoperative visit, peaked at postoperative week 1 (4.9; range, 0-16), and reached its low at postoperative week 52 (0.8; range, 0-7). Cumulative incidences of depressive symptoms during the first year following surgery were 51.7% for at least mild depression, 22.4% for at least moderate depression, and 6.9% for severe depression. A history of mental health disorder and the inability to work during the period of postoperative immobilization were independently associated with greater depressive symptoms. Conclusion: The majority of patients undergoing operative treatment of Achilles ruptures and ankle fractures develop postoperative symptoms of mild to moderate depression that normalize after several months. Patients with a history of mental health disorder or who cannot work while immobilized postoperatively are at greatest risk. Level of Evidence: Level II.
INTRODUCTION:There are limitations to acute medical management of low back pain in the ED. Transcutaneous electrical nerve stimulation (TENS) provides a non-invasive, safe, accessible, and promising therapy.OBJECTIVES: To evaluate the role of a TENS unit in managing low back pain in the ED, and to compare the average patient length of stay in the ED to conventional treatment. METHODS: 71 patients with a chief complaint of low back pain were enrolled in the active arm. Pain scores on a 0-10 scale were obtained before and after treatment with the TENS units. The control group included 70 historical cases with conventional treatment. T-test analysis was used to evaluate for any statistical difference in pain reduction. RESULTS:The pain scale before and after treatment was statistically significant between control and active arms: Before--controls 8.53 ± 1.52 and active arm 7.65 ± 1.81; after--controls 5.89 ± 2 and active arm (5.01 ± 2.65). The Delta score related variables were not statistically significant between historical and treatment groups. An analysis was conducted for the EXACT matched pairs (n=25). The pain scale before treatment was statistically significant between historical arm (8.52 ± 1.45) and active arm (7.56 ± 1.83). The pain scale after treatment was NOT statistically significant between historical and active arms. The delta score related variables were NOT statistically significant between the two arms. Length of stay was not statistically significant between the arms. CONCLUSION:These results suggest that TENS is a viable treatment modality for lower back pain in the ED.
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