Background & Aims

Recovery from proximal humeral fracture is associated with reduced fears of movement-related pain within a week after injury and increased self-efficacy within a month (JAYAKUMAR et al., 2019). Kinesiophobia is more strongly linked to pre-operative shoulder pain, while anxiety and depression are more associated with postoperative pain and disability, respectively (GEORGE et al., 2016). The impact of psychological factors seems to vary depending on the timing of the injury and may differ between conservative and surgical treatment. Therefore, this study aims to investigate the influence of psychological factors among individuals undergoing conservative and surgical treatments for proximal humeral fractures, taking into account the time elapsed since the injury or surgery.

Methods

This cross-sectional observational study included 62 individuals with proximal humeral fracture within 12 months’ post-injury from an Orthopedics and Traumatology outpatient clinic and a tertiary-level physiotherapy service. Participants were assessed for psychological factors, including movement avoidance using the Avoidance Daily Activities Photo Scale (ADAP Shoulder Scale), catastrophizing using the Pain Catastrophizing Scale (PCS), self-efficacy using the Pain-Related Self-Efficacy Beliefs scale (PSEQ-10), and depression using the Patient Health Questionnaire (PHQ-9). One-way analysis of variance (ANOVA) and Tukey’s post hoc test were conducted to compare psychological factors among four groups: conservative treatment within 3 months’ post-injury (TC, n=12), conservative treatment beyond 3 months’ post-injury (TC3, n=8), surgical treatment within 3 months’ post-surgery (TS, n=26), and surgical treatment beyond 3 months’ post-surgery (TSM3, n=16).

Results

One-way ANOVA indicated a group effect only for movement avoidance behaviors (F (3,58) = 6.717; P = 0.001). Movement avoidance was similar between conservative treatment groups (Mean Difference [TC – TCM3] = 0.08, P = 1.000) and between conservative and surgical treatment within 3 months’ post-injury or post-surgery (Mean Difference [TC – TS] = -8.90, P = 0.626). However, the more recent post-surgery group exhibited higher movement avoidance compared to the group beyond 3 months post-surgery (Mean Difference [TS – TS3] = 30.02, P < 0.001) and was similar to the conservative treatment group beyond 3 months post-injury (Mean Difference [TS – TC3] = 8.98, P = 0.721).

Conclusions

This study demonstrated that movement avoidance behavior in individuals with proximal humeral fracture may vary based on treatment type and time since injury or surgery.

References

JAYAKUMAR, P; TEUNIS, T.; WILLIAMS, M; LAMB, S. E., et al. Factors associated with the magnitude of limitations during recovery from a fracture of the proximal humerus-predictors of limitations after proximal humerus fracture. Bone Joint J 2019;101-B:715–723.

STEVEN Z. GEORGE, SAMUEL S. WU, MARGARET R. WALLACE, MICHAEL W. MOSER, et al. Biopsychosocial influence on shoulder pain: genetic and psychological combinations are predictive of 12-month post-operative pain and disability outcomes. Arthritis Care Res (Hoboken). 2016; 68(11): 1671–1680. doi:10.1002/acr.22876.

Presenting Author

Jaqueline Martins Priuli

Poster Authors

Jaqueline Martins Priuli

M.Sc

University of São Paulo, Ribeirão Preto, São Paulo/Brazil

Lead Author

E-mail

Topics

  • Mechanisms: Psychosocial and Biopsychosocial