title: Disability and depression after orthopaedic trauma.
abstract: BACKGROUND
  Musculoskeletal injury is a common cause of impairment (pathophysiology), but the correlation of impairment with pain intensity and magnitude of disability is limited. Psychosocial factors explain a large proportion of the variance in disability for various orthopaedic pathologies. The aim of this study is to prospectively assess the relationship between psychological factors and magnitude of disability in a sample of orthopaedic trauma patients in The Netherlands.
  
  
  METHODS
  One hundred and one adult patients between 1 and 2 months after one or more fractures, tendon or ligament injuries were enrolled. Four eligible patients refused to participate. Thirty-five women and 30 men with an average age of 50 years (range, 22-92 years) completed the follow-up evaluation between 5 and 8 months after their injury and their data was analyzed. The patients completed a measure of disability (the Short Musculoskeletal Function Assessment-Netherlands, SMFA-NL), the Dutch Centre for Epidemiologic Study of Depression-scale (CES-D), the Dutch Impact of Event Scale (SVL), and the Dutch Pain Catastrophizing Scale (PCS) at the time of enrollment and again 5-8 months after injury.
  
  
  RESULTS
  There were moderate correlations between symptoms of depression (CES-D, r=0.48, p<0.001) and symptoms of PTSD (SVL, r=0.35, p=0.004) at enrollment and magnitude of disability 5-8 months after trauma. Catastrophic thinking (PCS) at enrollment and magnitude of disability 5-8 months after trauma showed a small correlation (PCS, r=0.26, p=0.034). The Pain Catastrophizing Scale (Beta=0.29; p=0.049), surgery (Beta=0.26; p=0.034), additional surgery (Beta=0.26; p=0.019) and other pain conditions (Beta=0.31; p=0.009) were the significant predictors in the final model (adjusted R-squared=0.35; p<0.001) for greater disability 5-8 months after trauma.
  
  
  CONCLUSIONS
  In The Netherlands, symptoms of depression measured 1-2 months after musculoskeletal trauma correlate with disability 5-8 months after this trauma. The psychological aspects of recovery from musculoskeletal injury merit greater attention.
  
  
  METHODS
  Level II, Prognostic study.
authors.affiliation: Harvard Medical School, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: spnota@hotmail.com.
authors.forename: Sjoerd P F T
authors.initials: SP
authors.lastname: Nota
authors.affiliation: Department of Orthopaedic Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands. Electronic address: a.g.j.bot@gmail.com.
authors.forename: Arjan G J
authors.initials: AG
authors.lastname: Bot
authors.affiliation: Harvard Medical School, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: dring@partners.org.
authors.forename: David
authors.initials: D
authors.lastname: Ring
authors.affiliation: Department of Orthopaedic Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands. Electronic address: p.kloen@amc.uva.nl.
authors.forename: Peter
authors.initials: P
authors.lastname: Kloen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D058443:Catastrophization / Q000523:psychology*; D003863:Depression / Q000175:diagnosis* / Q000209:etiology; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009141:Musculoskeletal System / Q000293:injuries* / Q000601:surgery; D009426:Netherlands / Q000453:epidemiology; D010147:Pain Measurement; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology; D014947:Wounds and Injuries / Q000150:complications / Q000523:psychology* / Q000601:surgery
chemical_list: D000701:Analgesics, Opioid
keywords: Depression; Injury; Orthopaedic trauma; PTSD; Psychosocial