The Association of Education Level on Outcome after Distal Radius Fracture

Abstract

Background

Socioeconomic factors have been found to be predictors of outcome for other ailments. The purpose of this study was to evaluate the association of patient education level on pain and disability after distal radius fracture.

Methods

A series of patients with distal radius fractures (n = 335) were enrolled into a prospective research registry. Standard demographic information was obtained from patients, including a five-value categorical education variable. After treatment with closed reduction, external fixation, or internal fixation patients were evaluated for pain, function (Disability of the Arm, Shoulder, and Hand score [DASH]), range of motion (ROM), and grip strength at standard intervals until 12 months post-injury. A series of linear mixed effects models were developed to evaluate the relationship between time from injury and education level with each of the outcomes measured.

Results

Complete demographic and 12-month follow-up data were available on 227 patients (75 %). There were neither group differences in mode of injury, severity, nor treatment modality after stratification by education level. Mixed effects model analyses revealed a significant linear association between level of education and measured outcomes at each follow-up point. Overall, each increase in education level demonstrated a doubling of improvement in pain, ROM, grip strength, and DASH score.

Conclusions

Outcome of distal radius fracture depends on acute care and follow-up rehabilitation; however, patient-related factors indicative of socioeconomic status are becoming increasingly relevant as predictors of outcome and should be considered by the orthopaedist.

Keywords

Education Socio-economic status Distal radius fracture Function Outcome Pain Symptomscore

Get full access to this article

View all access options for this article.

References

Aaronson

Acquadro

Alonso

. International Quality of Life Assessment (IQOLA) Project. Qual Life Res. 1992;1(5):349–51.

Beaton

Katz

Fossel

. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001;14(2):128–46.

Blumenthal

Kagen

JMSJAMA

. The effects of socioeconomic status on health in rural and urban America. JAMA. 2002;287(1):109.

Catalano

3rd Cole

Gelberman

. Displaced intraarticular fractures of the distal aspect of the radius. Long-term results in young adults after open reduction and internal fixation. J Bone Joint Surg Am. 1997;79(9):1290–302.

Chen

Jupiter

. Management of distal radial fractures. J Bone Joint Surg Am. 2007;89(9):2051–62.

Chung

Kotsis

Kim

. Predictors of functional outcomes after surgical treatment of distal radius fractures. J Hand Surg Am. 2007;32(1):76–83.

Clarke

Schellenbaum

Rea

. Socioeconomic status and survival from out-of-hospital cardiac arrest. Acad Emerg Med. 2005;12(10):941–7.

Egol

Walsh

Tejwani

. Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius: a randomised, prospectivetrial. J Bone Joint Surg Br. 2008;90(9):1214–21.

Fanuele

Koval

Lurie

. Distal radial fracture treatment: what you get may depend on your age and address. J Bone Joint Surg Am. 2009;91(6):1313–9.

10.

Grewal

MacDermid

Pope

. Baseline predictors of pain and disability one year following extra-articular distal radius fractures. Hand (NY). 2007;2(3):104–11.

11.

Grewal

Perey

Wilmink

. A randomized prospective study on the treatment of intra-articular distal radius fractures: open reduction and internal fixation with dorsal plating versus mini openreduction, percutaneous fixation, and external fixation. J Hand Surg Am. 2005;30(4):764–72.

12.

Jupiter

Fernandez

Toh

. Operative treatment of volar intra-articular fractures of the distal end of the radius. J Bone Joint Surg Am. 1996;78(12):1817–28.

13.

Keegan

McClure

Foran

. Improvements in survival after follicular lymphoma by race/ethnicity and socioeconomic status: a population-based study. J Clin Oncol. 2009;27(18):3044–51.

14.

Knirk

Jupiter

. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68(5):647–59.

15.

Lozano Calderon

Paiva

Ring

. Patient satisfaction after open carpal tunnel release correlates with depression. J Hand Surg Am. 2008;33(3):303–7.

16.

Lozano-Calderon

Souer

Jupiter

. Psychological differences between patients that elect operative or nonoperative treatment for trapeziometacarpal joint arthrosis. Hand (N Y). 2008;3(3):271–5.

17.

MacDermid

Donner

Richards

. Patient versus injury factors as predictors of pain and disability six months after a distal radius fracture. J Clin Epidemiol. 2002;55(9):849–54.

18.

Mitchell

Stubbs

Eisenberg

. Socioeconomic status is associated with provision of bystander cardiopulmonary resuscitation. Prehosp Emerg Care. 2009;13(4):478–86.

19.

Owolabi

. What are the consistent predictors of generic and specific post-stroke health-related quality of life? Cerebrovasc Dis. 2009;29(2):105–10.

20.

Pickett

Pearl

. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health. 2001;55(2):111–22.

21.

Ponsford

Hill

Karamitsios

. Factors influencing outcome after orthopedic trauma. J Trauma. 2008;64(4):1001–9.

22.

Reinier

Stecker

Vickers

. Incidence of sudden cardiac arrest is higher in areas of low socioeconomic status: a prospective two year study in a large United States community. Resuscitation. 2006;70(2):186–92.

23.

Ring

Kadzielski

Fabian

. Self-reported upper extremity health status correlates with depression. J Bone Joint Surg Am. 2006;88(9):1983–8.

24.

Rozental

Blazar

Franko

. Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am. 2009;91(8):1837–46.

25.

Vaillancourt

Lui

De Maio

. Socioeconomic status influences bystander CPR and survival rates for out-of-hospital cardiac arrest victims. Resuscitation. 2008;79(3):417–23.

26.

Vandenplas

Toren

Blanc

. Health and socioeconomic impact of work-related asthma. Eur Respir J. 2003;22(4):689–97.

27.

Williamson

Epi

Gabbe

. Predictors of moderate or severe pain 6 months after orthopaedic injury: a prospective cohort study. J Orthop Trauma. 2009;23(2):139–44.

28.

Wright

Horodyski

Smith

. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation. J Hand Surg Am. 2005;30(2):289–99.