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Patient-Reported Disability 1 Year after Surgery for Adult Traumatic Brachial Plexus Injury is Correlated with Depression, Anxiety, and Pain Interference
Christopher J Dy, MD1; David M Brogan, MD, MSc2; Wilson Z Ray, MD2; Mihir J. Desai, MD3; Steve K Lee, MD4; R. Glenn Gaston, MD5; Bryan J. Loeffler, MD6; Sami H Tuffaha, MD7; * PLANeT Study Group, *8
1Washington University in St. Louis, St. Louis, MO; 2Washington University School of Medicine, St. Louis, MO; 3Vanderbilt Orthopaedics, Nashville, TN; 4Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY; 5OrthoCarolina, Charlotte, NC; 6Hand Center, OrthoCarolina, Charlotte, NC; 7Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; 8Lead Site: Washington University School of Medicine, St. Louis, MO

INTRODUCTION: Greater emphasis is being placed on use of patient-reported outcome measures (PROMs) after brachial plexus injuries (BPI). Given the devastating nature of BPI and its effects of multiple domains of patient lives, we have incorporated PROMs that assess not only physical symptoms after BPI but also emotional recovery, pain, depression, anxiety, and preoperative expectations. We hypothesized that pain, depression, and anxiety would be predictive of physical disability 1-year after BPI surgery.
METHODS: We enrolled 46 patients into a prospective multi-center cohort study for those undergoing surgery for adult traumatic BPI. Prior to surgery, participants completed PROMIS pain interference, anxiety, and depression questionnaires and validated BPI-specific measures of physical disability and expected improvement (Impact of BPI questionnaire). The same questionnaires were completed 1-year after surgery in 28 patients (5 were lost to follow-up; 13 not yet eligible for 1-year follow-up). We performed Pearson correlation analysis between pain interference, anxiety, and depression with disability before surgery and 1-year after surgery. We also used a paired t-test to compare preoperative expectations with postoperative/1-year patient-reported improvement. We performed a stratified analysis of patients comparing 1-year disability and 1-year improvement based on shoulder abduction and elbow flexion strength (M4 vs ?M3).
RESULTS: Prior to surgery, there were strong correlations between patient-reported disability and depression (r=0.62), anxiety (r=0.60), and pain (r=0.58). At 1-year follow-up, there were strong correlations with patient-reported disability with depression (r=0.79), anxiety (r=0.72), and pain interference (r=0.78). Expected recovery (assessed preoperatively) was significantly lower than improvement reported at 1-year after surgery (72.5 preop vs 47.9 postop; p<0.001). When stratifying patients by shoulder abduction strength or by elbow flexion strength at 1-year after surgery, there were no significant differences in 1-year patient-reported disability or 1-year improvement comparing those with M4 vs ?M3 strength.
CONCLUSIONS: Depression, anxiety, and pain were strongly correlated with patient-reported disability prior to surgery and at 1-year after surgery. Although intuitive, it is important to note because these are areas that can be treated during the entirety of the recovery process while waiting for nerve regeneration. Patients expected far greater improvement than the amount attained at the 1-year mark, reinforcing the need to counsel patients regarding timing of recovery and realistic expectations. Patient-reported outcome measures were not significantly different at 1-year even when stratifying for muscle strength, suggesting that PROMs may not be responsive for BPI at 1-year from surgery.


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