title: Determinants of disability after fingertip injuries.
abstract: BACKGROUND
  Psychological factors, such as depression, catastrophic thinking, and self-efficacy, account for more of the variation in upper extremity disability than motion and other impairments, but their influence in the setting of hand trauma is less well studied.
  
  
  OBJECTIVE
  The aim of this study was to determine which factors account for variation in disability 1 month after fingertip injuries.
  
  
  METHODS
  We enrolled 82 patients with finger injuries distal to the proximal interphalangeal joint, and 70 patients completed the study. Questionnaires and measurements were taken at the initial visit and approximately 1 month later. Patients completed the short version of the Disabilities of the Arm Shoulder and Hand questionnaire, the pain self-efficacy questionnaire, and the Patient Health Questionnaire to assess depressive symptoms. Bivariate and multivariable analyses determined factors associated with QuickDASH scores.
  
  
  RESULTS
  The mean disabilities of the arm shoulder and hand questionnaire score was 35 at the initial visit (the U.S. norm is 10) and 17 approximately 1 month later. The best model explained 54% of the variation in disabilities of the arm shoulder and hand questionnaire 1 month after injury and included symptoms of depression (Patient Health Questionnaire; partial R2 0.43) and injury mechanism (saw injury compared with sport injury; partial R2 0.14). The criterion symptoms of depression was also the factor most strongly associated with both pain intensity and time off work.
  
  
  CONCLUSIONS
  In patients with fingertip injury, symptoms of depression account for most of the variability in hand and arm-specific disability, pain intensity, and days to return to work. Identification and treatment of symptoms of depression might facilitate recovery from fingertip injuries.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
authors.forename: Arjan G J
authors.initials: AGJ
authors.lastname: Bot
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
authors.forename: Jeroen K J
authors.initials: JKJ
authors.lastname: Bossen
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
authors.forename: Chaitanya S
authors.initials: CS
authors.lastname: Mudgal
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Jupiter
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA. Electronic address: dring@partners.org.
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D000328:Adult; D000368:Aged; D003863:Depression / Q000209:etiology; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D005383:Finger Injuries / Q000150:complications* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000523:psychology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult