Misperception of Disease Onset in People with Gradual-Onset Disease of the Upper Extremity

Abstract

Background: Misperception that an established, gradual-onset disease such as osteoarthritis started when the symptoms were first noticed might lead to testing and treatment choices that are inconsistent with what matters most to a patient. In the present study, the primary null hypothesis was that there are no factors associated with patient-reported symptom duration (in months). The secondary null hypotheses were that there are no factors independently associated with (1) a sudden versus gradual perception of disease onset, (2) an event or injury-related versus age-related perceived cause of disease onset, and (3) the magnitude of physical limitations. Methods: In this cross-sectional study, 121 patients with an atraumatic, established, gradual-onset condition of the upper extremity completed a demographic questionnaire, measures of mental health (symptoms of depression and anxiety, worst-case thinking, and self-efficacy [the ability to adapt and continue with daily activity] when in pain), measurement of the magnitude of upper extremity-specific limitations, and questions about the perceived course and cause of the disease. Results: The median patient-reported symptom duration was 12 months (interquartile range, 3 to 36 months). Twenty-two patients (18%) perceived their disease as new, and 29 patients (24%) believed that the condition was related to ≥1 event (injury) rather than being time and age-related. In multivariable analysis, patients with Medicare insurance were independently associated with longer reported symptom duration (in months). Greater self-efficacy was associated with longer symptom duration in bivariate, but not multivariable, analysis. No factors were independently associated with a sudden versus gradual onset of symptoms. Hispanic ethnicity and federal, county, or no insurance were independently associated with the perception that the problem was caused by an injury or event. Conclusions: Approximately 1 in 5 patients misperceived new symptoms as representing a new disease, often as a type of injury. Misperception of the pathology as new had a limited association with unhealthy thoughts and is likely generally responsive to reorientation. We speculate that gentle, strategic reorientation of misperception can protect patients from choices inconsistent with their values.

What are People That Seek Care for Rotator Cuff Tendinopathy Experiencing in Their Daily Life?

“…For instance, tendon defects tend to enlarge slowly over time, but symptoms often resolve (13,14). New pain can cause RCT to seem like a new problem when the asymptomatic shoulder has comparable degeneration (15,16), which is consistent with the known tendency for humans to misinterpret new symptoms as representing new pathology (17). Even if the pathology is not worsening, painful movement may feel harmful as embodied in the well-studied unhelpful thoughts of kinesiophobia and catastrophic thinking, creating or reinforcing a sense of vulnerability (18).…”

The mind and the hand

“…There is mounting evidence that unhelpful thinking – essentially misconceptions and misinterpretation of symptoms – is particularly bad for one’s health (Das De et al., 2013; Miner et al., 2021; Teunis et al., 2022). For example, people often misinterpret new symptoms from established pathophysiology as new pathophysiology (Lemmers et al., 2020; van Hoorn et al., 2017) or even as an injury (Furlough et al., 2021; Lemmers et al., 2020; Liu et al., 2017). Another common misinterpretation is the sense that painful movement will make the problem worse (Das De et al., 2013).…”

Recovery After Musculoskeletal Injury: Mental and Social Health

“…Think of the lifelong laborer in their 50s unsure of how they will make a living as they start to experience the influence of age on the body. They often present with the misconception that new symptoms indicate new pathology 52,53 or even an injury. 52,54,55 In addition, they may pin their last hope on the orthopaedic surgeon fixing the problem.…”

“…They often present with the misconception that new symptoms indicate new pathology 52,53 or even an injury. 52,54,55 In addition, they may pin their last hope on the orthopaedic surgeon fixing the problem.…”

“…They often present with the misconception that new symptoms indicate new pathology 52,53 or even an injury. 52,54,55 In addition, they may pin their last hope on the orthopaedic surgeon fixing the problem. A key aspect of good health is guiding people away from this passive, powerful other, magical-thinking approach to their health toward an active, agentic, and matter-of-fact approach to their health.…”