Psychological Differences between Patients that Elect Operative or Nonoperative Treatment for Trapeziometacarpal Joint Arthrosis

Abstract

Among 44 consecutive patients electing operative treatment of trapeziometacarpal arthrosis, three age- and gender-matched controls that presented during the same time period but had not yet requested operative treatment were selected from billing records. Each patient and control was mailed a survey that included an upper extremity-specific health status measure (Disabilities of the Arm, Shoulder, and Hand questionnaire; DASH) and a set of questionnaires evaluating psychological factors including the Pain Anxiety Symptoms Scale (PASS), the Pain Catastrophizing Scale (PCS) and the Center for the Epidemiological Study of Depression (CES-D) instrument. Seventy-two patients (45%; 31 that elected operative and 41 nonoperative care) returned a completed questionnaire with usable data. Older age was the only significant predictor of choice for nonoperative treatment among survey responders. Arm-specific disability (DASH) correlated with the CES-D, PASS, and PCS scores, and the influence of radiographic severity was near significant (p=0.06). Stepwise multiple linear regression resulted in a model including the CES-D and PCS scores and accounting for 51% of the variability in DASH scores for patients from both cohorts. For both the operative and nonoperative cohorts, a model including CES-D alone accounted for 50% of the variability in DASH scores (p<0.01). This study suggests that depression, pain anxiety, and pain catastrophizing are strong correlates of arm-specific disability but do not predict election of operative treatment in patients with trapeziometacarpal arthrosis.