Sports Medicine Research: In the Lab & In the Field: Identifying Risk of Persistent Symptoms Following Acute Musculoskeletal Injury (Sports Med Res)
Friday, October 14, 2016

Identifying Risk of Persistent Symptoms Following Acute Musculoskeletal Injury

The Traumatic Injuries Distress Scale: A New Tool That Quantifies Distress and Has Predictive Validity With Patient-Reported Outcomes

Walton DM, Krebs D, Moulden D, Wade P, Levesque L, Elliott J, MacDermid JC. J Orthop Sports Phys Ther. 2016 Sep 3:1-19.

Take Home Message: The Traumatic Injuries Distress Scale (TIDS) may be a short (12-item) tool to assess early risk for persistent symptoms following acute musculoskeletal injury.

Outcomes following an acute musculoskeletal injury is suboptimal for up to 50% of patients. A succinct and focused patient-reported outcome tool geared toward emotional lability, sense of uncontrollability, and intrusion or hyperarousal may allow clinicians to identify a patient with an acute injury who is at risk for persistent symptoms. The purpose of this study was to develop and evaluate the utility of the Traumatic Injuries Distress Scale (TIDS) among individuals within 30 days of an acute musculoskeletal injury. The new instrument is intended to help identify patients at risk for persistent problems following a variety of acute injuries (e.g., ankle sprain, low back pain). After initial testing, a 100-item prototype was reduced to a 17-item scale that was used among adult patients from physical therapy clinics and emergency departments. The investigators included 206 patients (~11 days post injury). A subset of 76 patients completed the TIDS at 1 week and 12 weeks following the initial TIDS delivery. Injury region specific questionnaires were also administered at the initial time point, including the Roland Morris Disability Questionnaire for low back pain and the Lower Extremity Functional Scale for knee and ankle injuries. Participants also completed measures of pain catastrophizing (Pain Catastrophizing Scale), health-related satisfaction (Satisfaction and Recovery Index), and pain intensity (0 to 10 scale). The investigators removed 5 items from the TIDS because they failed to contribute to overall scale. Next, they examined the common themes within the TIDS. The investigators found 3 factors: negative affect (6 items), uncontrolled pain (4 items), and intrusion or hyperarousal (2 items; see table below). The total TIDS score and the sub-scores for the common themes related with the other patient-reported outcomes, which the participants completed at the same visit. Furthermore, the baseline TIDS score was related with health-related satisfaction and other health outcomes 12 weeks later within the subgroup.

Table. Items within the 3 factors from the Traumatic Injuries Distress Scale
Negative Affect
Uncontrolled Pain
Intrusion/Hyperarousal
Loss of interest in appearance
Overwhelmed by pain
Feeling agitated/scared when in a place that reminds them of the accident
Disengaged
Ruminating on pain
Flashbacks that feel real
Loss of motivation
Constant pain

Difficulty doing enjoyed activities
Frustration at inability to control pain

Concentration problems


Anger



Gaining a better grasp on whether a patient will end up having persistent symptoms when they report to clinicians for the first or second time would allow for a more informed and comprehensive treatment strategy. The authors introduced the TIDS, which they narrowed down to 12 items, as a possible strategy to identify patients at risk for persistent symptoms after a variety of acute musculoskeletal injuries. However, the TIDS is only in the initial stages of testing. The authors acknowledged the need for a future study to test the more region specific utility of the TIDS because this would assist clinicians and researchers in making the decision to incorporate the TIDS into practice. Overall, early identification of patients that are at risk for persistent symptoms is very important to care providers. Based on the authors’ findings, clinicians should incorporate patient-reported outcomes at initial visits to assess factors related to feeling overwhelmed by pain, loss of interest in appearance, or feeling agitated or scared in a place reminiscent of the accident. The implications of understanding more about a patient’s anxiety and pain perception after an acute musculoskeletal injury are pronounced and lend themselves toward a prognosis-based assessment approach.

Questions for Discussion: What role does kinesiophobia play in addition to the items covered by the TIDS? Do you think that patients with concussions should have been included as a subcategory of injuries in this initial analysis?

Written by: L. Colby Mangum, MEd, ATC
Reviewed by: Jeffrey Driban

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For Better or Worse: Predicting Quality of Life After an ACL Injury



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