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Predictors of chronic pain and disability in patients treated conservatively after distal radius fracture: a prospective cohort study

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Abstract   

Purpose

To determine predictors of chronic pain and disability among patients with distal radius fractures (DRF) treated conservatively with closed reduction and cast immobilization.

Methods

This was a prospective cohort study. Information on patient characteristics, post-reduction radiographic parameters, finger and wrist range of motion, psychological status (Hospital Anxiety and Depression Scale or HADS), pain (Numeric Rating Scale or NRS), and self-perceived disability (Disabilities of the Arm, Should, and Hand or DASH) were taken at baseline, cast removal, and 24 weeks. Differences in outcomes between time points were determined using analysis of variance. Multiple linear regressions were used to determine predictors of pain and disability at 24 weeks.

Results

One hundred forty patients with DRF (70% women, age: 67.0 ± 17.9) completed 24 weeks of follow-up and were included in the analysis. NRS (off-cast), range of ulnar deviation (off-cast), and greater occupational demands were significant predictors of pain at week 24 (adjusted R2 = 0.331, p < 0.001). Significant predictors of perceived disability at week 24 were HADS (off cast), sex (female), dominant-hand injury, and range of ulnar deviation (off cast) (adjusted R2 = 0.265, p < 0.001).

Conclusions

Off-cast NRS and HADS scores are important modifiable predictors of patient-reported pain and disability at 24 weeks in patients with DRF. These factors should be targeted in the prevention of chronic pain and disability post-DRF.

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Data availability

Data are available upon request.

Code availability

Not applicable. No custom written code/program was used. SPSS (version 26, IBM Corp., Armonk, NY, USA) is commercially available software. G*Power (version 3.1.2, Franz Faul, University of Kiel, Germany) is freely available open source software.

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Acknowledgements

This research did not receive any specific grants from funding agencies in the public, commercial, or non-profit sectors. Support of manpower and infrastructure were provided by Queen Elizabeth Hospital.

Author information

Authors and Affiliations

  1. Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China

    May Lai Mei Luk, Tiev Miller & Marco Yiu Chung Pang

  2. Department of Physiotherapy, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR, China

    May Lai Mei Luk, Andy Chi Ming Chan, Jocelyn Sau Yee Cho, Daisy Mei Ting Ng & Isa Chui Yi Lam

  3. Department of Orthopaedics & Traumatology, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR, China

    Edmund Leung Kai Yau

  4. International Collaboration On Repair Discoveries, Faculty of Medicine, University of British Columbia (UBC), Vancouver, Canada

    Tiev Miller

  5. Division of Physical Medicine and Rehabilitation, Faculty of Medicine, The University of British Columbia, Vancouver, Canada

    Tiev Miller

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Contributions

All authors contributed to the conception and design of the study. Material preparation, data collection, and analysis were performed by May Lai Mei Luk, Andy Chi Ming Chan, Jocelyn Sau Yee Cho, Daisy Mei Ting Ng, Isa Chui Yi Lam, Edmund Leung Kai Yau, Tiev Miller, and Marco Yiu Chung Pang. The initial manuscript was drafted by May Lai Mei Luk. Subsequent versions of the manuscript were drafted by Tiev Miller and Marco Yui Chung Pang. All authors commented on previous versions and have approved the final manuscript.

Corresponding author

Correspondence to Marco Yiu Chung Pang.

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Ethical approval

Ethical approval was granted by the Hong Kong Polytechnic University Research Committee (HSEARS20160624002) and the Kowloon Central Cluster/Kowloon East Cluster Research Ethics Committee (KC/KE-16–0208/ER-3).

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Informed consent was obtained from all participants prior to data collection.

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Luk, M.L.M., Chan, A.C.M., Cho, J.S.Y. et al. Predictors of chronic pain and disability in patients treated conservatively after distal radius fracture: a prospective cohort study. International Orthopaedics (SICOT) 47, 1535–1543 (2023). https://doi.org/10.1007/s00264-023-05785-y

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