Background & Aims

Traumatic orthopaedic injuries are among the most common causes of hospital visits in the U.S. [1]. The Toolkit for Optimal Recovery (TOR) is a brief mind-body intervention that directly targets catastrophic thinking about pain and pain anxiety following orthopaedic injury, and is designed to decrease risk for persistent pain and physical dysfunction [2]. We recently completed a multisite feasibility randomized controlled trial of TOR versus usual care at four geographically distinct Level 1 trauma centers. Given that orthopaedic trauma occurs in a highly diverse population [3-5], understanding the clinical presentation of these patients may help us further adapt the TOR intervention to better address varied patient needs. The present study examines the baseline presentation and pain management characteristics of adults with traumatic orthopaedic injuries, and whether this presentation varied by study site.

Methods

We recruited 181 adults (Mage = 44.16, SD = 16.5) from four Level I trauma centers located in the northeast (Site A; N=63), southwest (Site B; N=44), southeast (Site C; N=44), and southeast (Site D; N=30). Participants were English-speaking adults who sustained a traumatic orthopaedic injury within the last 1-2 months, were cleared by their orthopedic surgeon to participate, and scored ?20 on the Pain Catastrophizing Scale [6] or ?40 on the Pain Anxiety Scale Short Form 20 [7]. Sociodemographic information, current and prior pain management characteristics (e.g., physiotherapy attendance, pain medication usage, surgical intervention), information about pain-related psychosocial functioning (e.g., pain catastrophizing, pain-related anxiety), injury characteristics, and physical function information was collected during the baseline appointment of the larger, longitudinal study.

Results

The majority of the sample (88.4%) endorsed fracture as their primary injury type. The mean Abbreviated Injury Scale (AIS) score was 2.31 (SD=0.55). 63% of the sample received surgical management of their injury. 60.2% of participants endorsed taking non-narcotic pain medications, and 28.7% endorsed taking narcotic pain medications. We observed significant differences in patient characteristics by site. Site A and Site D had significantly higher AIS scores than Site C, p<.001. More patients at Sites B (75%) and D (96.7%) received surgery than did patients at sites A (41%) and C (61.4%), p<.001. More patients at Site D (53.3%) and Site B (40.9%%) reported narcotic usage the week prior to enrollment than patients at Site C and Site A, p<.001. More patients at Site A (44.4%) and Site D (40%) reported engaging in physiotherapy than patients at other sites, p=.007. Patients at Site D demonstrated significantly higher levels of functional impairment than patients at each of the other sites.

Conclusions

We reported on the baseline clinical characteristics and geographic site variation for a multisite feasibility RCT of the TOR program. We found that sites were largely comparable, with key differences in surgical versus non-surgical management, narcotic use, physiotherapy attendance, pain catastrophizing, and physical function, which may have important implications for treatment response. This baseline information will be used to interpret the results of the multisite feasibility RCT, iterate and refine the TOR intervention, and conduct a future multi-site efficacy clinical trial.

References

1. Jarman MP, Weaver MJ, Haider AH, Salim A, Harris MB. The National Burden of Orthopedic Injury: Cross-Sectional Estimates for Trauma System Planning and Optimization. J Surg Res. May 2020;249:197-204. doi:10.1016/j.jss.2019.12.023
2. Vranceanu AM, Jacobs C, Lin A, et al. Results of a feasibility randomized controlled trial (RCT) of the Toolkit for Optimal Recovery (TOR): a live video program to prevent chronic pain in at-risk adults with orthopedic injuries. Pilot Feasibility Stud. 2019;5(1):30. doi:10.1186/s40814-019-0416-7
3. Dy CJ, Lane JM, Pan TJ, Parks ML, Lyman S. Racial and Socioeconomic Disparities in Hip Fracture Care. J Bone Joint Surg Am. 2016;98(10):858-865. doi:10.2106/JBJS.15.00676
4. Gupta A, Singh P, Badin D, et al. Racial disparities in lower extremity orthopaedic injuries presenting to U.S. emergency departments from 2010 to 2020. Trauma. Published online July 10, 2023:14604086231186032. doi:10.1177/14604086231186032
5. Quah C, Boulton C, Moran C. The influence of socioeconomic status on the incidence, outcome and mortality of fractures of the hip. J Bone Joint Surg Br. 2011;93-B(6):801-805. doi:10.1302/0301-620X.93B6.24936
6. Sullivan M, Bishop S, Pivik J. The Pain Catastrophizing Scale: Development and Validation. Psychol Assess. 1995;7(4):524-532. doi.org/10.1037/1040-3590.7.4.524
7. McCracken LM, Dhingra L. A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain Res Manag. 2002;7(1):45-50. doi:10.1155/2002/517163

Presenting Author

Julia Hooker

Poster Authors

Julia Hooker

PhD

Massachusetts General Hospital/Harvard Medical School

Lead Author

E-mail

Kate Jochimsen

PhD

Massachusetts General Hospital/Harvard Medical School

Lead Author

E-mail

Ryan Mace

PhD

Massachusetts General Hospital/Harvard Medical School

Lead Author

E-mail

James Doorley

PhD

United States Olympic & Paralympic Committee, Department of Sports Medicine

Lead Author

E-mail

Julie Brewer

BA

Massachusetts General Hospital

Lead Author

E-mail

Ana-Maria Vranceanu

Massachusetts General Hospital/Harvard Medical School

Lead Author

E-mail

Topics

  • Mechanisms: Psychosocial and Biopsychosocial