Mental illness is associated with more pain and worse functional outcomes after ankle fracture

Simske, Natasha M.; Audet, Megan A; Kim, Chang-Yeon; Benedick, Alex; Vallier, Heather A.

doi:10.1097/oi9.0000000000000037

Cited by 17 publications

(16 citation statements)

References 43 publications

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“…Psychiatric illness was also associated with worse scores on the pain category of the FFI and on the emotion, mobility, and bothersome categories of the SMFA, consistent with prior work. [ 39 ]…”

Section: Discussionmentioning

confidence: 99%

Ankle fractures in patients over age 55 years

Simske

Benedick

Audet

et al. 2020

OTA International: The Open Access Journal of Orthopaedic Trauma

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Objectives: To identify predictors of functional outcomes following treatment of ankle fracture in patients 55 years or older. Setting: Level 1 Trauma Center. Patients/participants: Four hundred twenty-nine patients with torsional ankle fractures (44A-C): 233 patients (54%) were ages 55 to 64, 25% were between the ages 65 and 74; 21% were 75 years or older. Intervention: Operative or nonoperative management of ankle fracture. Main outcome measure: Early complications were assessed for all patients after minimum of 6 months, and functional outcome scores as assessed by the Foot Function Index (FFI; n = 166, 39%) and Short Musculoskeletal Function Assessment (SMFA; n = 168, 39%) after median 57 months follow-up. Results: Surgical management was elected in 67% of patients. Nonoperative management became more common with advancing age and was associated with fewer unplanned operations (12% vs 3%, P < .01) and complications (21% vs 13%, P = .07). African American race was associated with worse pain on the FFI ( P = .002) and BMI was associated with worse (higher) scores on all categories of the FFI and SMFA (all P < .05). Diabetes, neuropathy, and mental illness were also predictive of worse scores on various categories of both surveys. Assistive device use or nonambulatory status at the time of injury was associated with worse disability/dysfunction, activity, and mobility scores on both the FFI and SMFA (all P > 15, P < .05). Sex, Hispanic ethnicity, tobacco use, open fracture, dislocation, fracture pattern, and operative management were not independent predictors in this regression model. Conclusions: Baseline health and ambulatory capacity at injury were more predictive of outcomes following ankle fracture than were fracture characteristics or type of treatment.

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Section: Discussionmentioning

confidence: 99%

Ankle fractures in patients over age 55 years

Simske

Benedick

Audet

et al. 2020

OTA International: The Open Access Journal of Orthopaedic Trauma

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“…Patient with anxiety and depression are less likely to engage with rehabilitation protocols and exhibit lower functional recovery. [11][12][13] Identifying patients with preexisting mental health disease or those who may develop posttraumatic disorders is critical in optimizing patients' outcome and interpreting their outcome scores. Many general outcome PROMs include a mental health component as an assessment domain.…”

Section: Discussionmentioning

confidence: 99%

The utility of patient-reported outcome measures in orthopaedic trauma research: a systematic review

Magnusson

Novak

Bagley

et al. 2022

Current Orthopaedic Practice

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“…Although prior research has recognized the impact of depression on surgical outcomes in orthopaedic surgery, 3 , 6 , 19 including in ankle fractures, 21 , 28 , 31 there is a paucity of literature examining this association over time in a sample of operatively treated ankle fractures. Perhaps the best way to evaluate recovery is using patient-reported outcome measures (PROMs), which are instruments that measures the outcomes most important to patients and provide patients with a greater voice in their own care.…”

Section: Introductionmentioning

confidence: 99%

Clinical Improvement Following Operative Management of Ankle Fractures Among Patients With and Without Moderate to High Depressive Symptoms: An Analysis Using PROMIS

Bernstein

Ramirez

Thirukumaran

et al. 2023

Foot & Ankle Orthopaedics

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Background: Understanding the recovery trajectory following operative management of ankle fractures can help surgeons guide patient expectations. Further, it is beneficial to consider the impact of mental health on the recovery trajectory. Our study aimed to address the paucity of literature focused on understanding the recovery trajectory following surgery for ankle fractures, including in patients with depressive symptoms. Methods: From February 2015 to March 2020, patients with isolated ankle fractures were asked to complete Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Pain Interference (PI), and Depression questionnaires as part of routine care at presentation and follow-up time points. Linear mixed effects regression models were used to evaluate the patient recovery pattern, comparing the preoperative time point to <3 months, 3-6 months, and >6 months across all patients. Additional models that included the presence of depression symptoms as a covariate were then used. Results: A total of 153 patients met inclusion criteria. By 3-6 months, PROMIS PF (β: 9.95, 95% CI: 7.97-11.94, P < .001), PI (β: −10.30, 95% CI: −11.87 to −8.72, P < .001), and Depression (β: −5.60, 95% CI: −7.01 to −4.20, P < .001) improved relative to the preoperative time point. This level of recovery was sustained thereafter. When incorporating depressive symptoms into our model as a covariate, the moderate to high depressive symptoms were associated with significantly and clinically important worse PROMIS PF (β: −4.00, 95% CI: −7.00 to −1.00, P = .01) and PI (β: 3.16, 95% CI: −0.55 to 5.76, P = .02) scores. Conclusion: Following ankle fracture surgery, all patients tend to clinically improve by 3-6 months postoperatively and then continue to appreciate this clinical improvement. Although patients with moderate to high depressive symptoms also clinically improve following the same trajectory, they tend to do so to a lesser level than those who have low depressive symptoms. Level of Evidence: Level III, case-control study.

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Mental illness is associated with more pain and worse functional outcomes after ankle fracture

Cited by 17 publications

References 43 publications

Ankle fractures in patients over age 55 years

Ankle fractures in patients over age 55 years

The utility of patient-reported outcome measures in orthopaedic trauma research: a systematic review

Clinical Improvement Following Operative Management of Ankle Fractures Among Patients With and Without Moderate to High Depressive Symptoms: An Analysis Using PROMIS

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