Language Barriers in Hispanic Patients: Relation to Upper-Extremity Disability

Abstract

Background

Although upper-extremity disability has been shown to correlate highly with various psychosocial aspects of illness (e.g., self-efficacy, depression, kinesiophobia, and pain catastrophizing), the role of language in musculoskeletal health status is less certain. In an English-speaking outpatient hand surgery office setting, we sought to determine (1) whether a patient's primary native language (English or Spanish) is an independent predictor of upper-extremity disability and (2) whether there are any differences in the contribution of measures of psychological distress to disability between native English- and Spanish-speaking patients.

Methods

A total of 122 patients (61 native English speakers and 61 Spanish speakers) presenting to an orthopaedic hand clinic completed sociodemographic information and three Patient-Reported Outcomes Measurement Information System (PROMIS)-based computerized adaptive testing questionnaires: PROMIS Pain Interference, PROMIS Depression, and PROMIS Upper-Extremity Physical Function. Bivariate and multivariable linear regression modeling were performed.

Results

Spanish-speaking patients reported greater upper-extremity disability, pain interference, and symptoms of depression than English-speaking patients. After adjusting for sociodemographic covariates and measures of psychological distress using multivariable regression modeling, the patient's primary language was not retained as an independent predictor of disability. PROMIS Depression showed a medium correlation (r=–0.35; p<0.001) with disability in English-speaking patients, while the correlation was large (r=–0.52; p<0.001) in Spanish-speaking patients. PROMIS Pain Interference had a large correlation with disability in both patient cohorts (Spanish-speaking: r=–0.66; p<0.001; English-speaking: r=–0.77; p<0.001). The length of time since immigration to the USA did not correlate with disability among Spanish speakers.

Conclusion

Primary language has less influence on symptom intensity and magnitude of disability than psychological distress and ineffective coping strategies. Interventions to optimize mood and to reduce pain interference should be considered in patients of all nationalities.

Type of study/level of evidence: Prognostic II.

Keywords

Language Disability Hispanic Latino Acculturation Immigration

Get full access to this article

View all access options for this article.

References

1 Amtmann

Cook

Jensen

. Development of a PROMIS item bank to measure pain interference. Pain. 2010;150(1):173–82.

2 Becker

Stuifbergen

Lee

. Reliability and validity of PROMIS cognitive abilities and cognitive concerns scales among people with multiple sclerosis. Int J MS Care. 2014;16(1):1–8.

3 Bhargava

Wartak

Friderici

. The impact of Hispanic ethnicity on knowledge and behavior among patients with diabetes. Diabetes Educ. 2014;40(3):336–43.

4 Blank

Grindler

Schulz

. Caregiver quality of life is related to severity of otitis media in children. Otolaryngol Head Neck Surg. 2014;151(2):348–353.

5 Bot

Doornberg

Lindenhovius

. Long-term outcomes of fractures of both bones of the forearm. J Bone Joint Surg Am. 2011;93(6):527–32.

6 Carrasquillo

Orav

Brennan

. Impact of language barriers on patient satisfaction in an emergency department. J Gen Intern Med. 1999;14(2):82–7.

7 Chakravarty

Bjorner

Fries

. Improving patient reported outcomes using item response theory and computerized adaptive testing. J Rheumatol. 2007;34(6):1426–31.

8 De Das

Vranceanu

Ring

. Contribution of kinesophobia and catastrophic thinking to upper-extremity-specific disability. J Bone Joint Surg Am. 2013;95(1):76–81.

9 Doornberg

Ring

Fabian

. Pain dominates measurements of elbow function and health status. J Bone Joint Surg Am. 2005;87(8):1725–31.

10.

10 Doring

Nota

Hageman

. Measurement of upper extremity disability using the patient-reported outcomes measurement information system. J Hand Surg Am. 2014;39(6):1160–5.

11.

11 Fiscella

Franks

Doescher

. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care. 2002;40(1):52–9.

12.

12 Flynn

Ridgeway

Wieland

. Primary care utilization and mental health diagnoses among adult patients requiring interpreters: a retrospective cohort study. J Gen Intern Med. 2013;28(3):386–91.

13.

13 Freedman

Bernstein

. The adequacy of medical school education in musculoskeletal medicine. J Bone Joint Surg Am. 1998;80(10):1421–7.

14.

14 Hacker

Choi

Trebino

. Exploring the impact of language services on utilization and clinical outcomes for diabetics. PLoS One. 2012;7(6):e38507.

15.

15 Hays

Spritzer

Amtmann

. Upper-extremity and mobility subdomains from the Patient-Reported Outcomes Measurement Information System (PROMIS) adult physical functioning item bank. Arch Phys Med Rehabil. 2013;94(11):2291–6.

16.

16 Hung

Baumhauer

Brodsky

. Psychometric comparison of the PROMIS physical function CAT with the FAAM and FFI for measuring patient-reported outcomes. Foot Ankle Int. 2014;35(6):592–599.

17.

17 Hung

Nickisch

Beals

. New paradigm for patient-reported outcomes assessment in foot & ankle research: computerized adaptive testing. Foot Ankle Int. 2012;33(8):621–6.

18.

18 Hung

Stuart

Higgins

. Computerized Adaptive Testing using the PROMIS physical function item bank reduces test burden with less ceiling effects compared to the short musculoskeletal function assessment in orthopaedic trauma patients. J Orthop Trauma. 2013. doi:10.1097/BOT.0000000000000059.

19.

19 Lavernia

Lee

Sierra

. Race, ethnicity, insurance coverage, and preoperative status of hip and knee surgical patients. J Arthroplasty. 2004;19(8):978–85.

20.

20 Lindenhovius

Buijze

Kloen

. Correspondence between perceived disability and objective physical impairment after elbow trauma. J Bone Joint Surg Am. 2008;90(10):2090–7.

21.

21 Macintyre

Hunt

. Socio-economic position, gender and health: how do they interact? J Health Psychol. 1997;2(3):315–34.

22.

22 Marmot

Syme

. Acculturation and coronary heart disease in Japanese-Americans. Am J Epidemiol. 1976;104(3):225–47.

23.

23 McCaffery

Holmes-Rovner

Smith

. Addressing health literacy in patient decision aids. BMC Med Inform Decis Mak. 2013;13 Suppl 2:S10.

24.

24 Menendez

Bot

Hageman

. Computerized adaptive testing of psychological factors: relation to upper-extremity disability. J Bone Joint Surg Am. 2013;95(20):e149.

25.

25 Niekel

Lindenhovius

Watson

. Correlation of DASH and QuickDASH with measures of psychological distress. J Hand Surg [Am]. 2009;34(8):1499–505.

26.

26 Ornelas

Perreira

. The role of migration in the development of depressive symptoms among Latino immigrant parents in the USA. Soc Sci Med. 2011;73(8):1169–77.

27.

27 Peterson

Campagna

Maravi

. Acculturation and outcomes among patients with heart failure. Circ Heart Fail. 2012;5(2):160–6.

28.

28 Pilkonis

Choi

Reise

. Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS(R)): depression, anxiety, and anger. Assessment. 2011;18(3):263–83.

29.

29 Ponce

Hays

Cunningham

. Linguistic disparities in health care access and health status among older adults. J Gen Intern Med. 2006;21(7):786–91.

30.

30 Potochnick

Perreira

. Depression and anxiety among firstgeneration immigrant Latino youth: key correlates and implications for future research. J Nerv Ment Dis. 2010;198(7):470–7.

31.

31 Rhodes

Martinez

Song

. Depressive symptoms among immigrant Latino sexual minorities. Am J Health Behav. 2013;37(3):404–13.

32.

32 Ring

Kadzielski

Fabian

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

33.

33 Vega

Amaro

. Latino outlook: good health, uncertain prognosis. Annu Rev Public Health. 1994;15:39–67.

34.

34 Wartak

Friderici

Lotfi

. Patients' knowledge of risk and protective factors for cardiovascular disease. Am J Cardiol. 2011;107(10):1480–8.

35.

35 Woolf

Erwin

March

. The need to address the burden of musculoskeletal conditions. Best Pract Res Clin Rheumatol. 2012;26(2):183–224.