title: Determinants of disability after proximal interphalangeal joint sprain or dislocation.
abstract: BACKGROUND
  Sprain or dislocation of the proximal interphalangeal joint may be a useful example of the counterintuitive aspects of recovery as the prognosis is excellent, but protectiveness in response to discomfort often hinders the stretching exercises that are a key component of the recovery process.
  
  
  OBJECTIVE
  The aim of this study was to investigate the relationship between disability and pain self-efficacy in this context.
  
  
  METHODS
  A total of 82 patients (54 men and 28 women) were enrolled in this prospective study. Finger motion was measured, and the patients completed measures of upper limb-specific disability (the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire), symptoms of depression (Patient Health Questionnaire-9), effective coping strategies in response to pain (the Pain Self-Efficacy Questionnaire), and a pain scale at enrollment.
  
  
  RESULTS
  Patients were enrolled a mean of 48 days after injury. The final multivariable model accounting for greater disability included lower self-efficacy, greater symptoms of depression, and gender (women have more disability). Lower self-efficacy was also the strongest predictor of pain intensity and finger stiffness.
  
  
  CONCLUSIONS
  Effective coping strategies such as self-efficacy facilitate recovery (less disability, pain, and stiffness) after proximal interphalangeal joint sprain/dislocation.
  
  
  METHODS
  Prognostic level I.
authors.affiliation: Massachusetts General Hospital, Boston, MA. Electronic address: dring@partners.org.
authors.forename: Arjan G J
authors.initials: AG
authors.lastname: Bot
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Stijn
authors.initials: S
authors.lastname: Bekkers
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: James H
authors.initials: JH
authors.lastname: Herndon
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Chaitanya S
authors.initials: CS
authors.lastname: Mudgal
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Jupiter
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D005383:Finger Injuries / Q000175:diagnosis*; D005384:Finger Joint; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020377:Self Efficacy; D013180:Sprains and Strains / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D055815:Young Adult