Broken Bones, Broken Lives?

If you look only at the broken bone, you miss the whole picture, says new work from the University of Florida (UF) in Gainesville.

The study, “Patient-Reported Outcomes Measurement Information System Outcome Measures and Mental Health in Orthopaedic Trauma Patients During Early Recovery,” appears in the September 2018 edition of the Journal of Orthopaedic Trauma. This work was a secondary observational analysis from a randomized controlled study performed at a Level-1 trauma center. The study investigators followed a total of 101 patients from acute care to week 12 post-discharge.

Co-author Heather K. Vincent, Ph.D., with the UF Health Orthopaedics and Sports Medicine Institute explained the purpose of the study to OTW, “In the orthopedics trauma setting, patients are suddenly thrust into a scenario they never intended: a car accident, serious fall, assault or a blunt force incident. In a split second, their lives are changed forever.”

“Some face multiple fractures, amputations, have serious internal and orthopedic injuries that leave them bedridden for a while. Their lives are interrupted, and they have no control over their daily activities and they are worried about child care, eldercare, taking care of pets and the home, losing a job, paying bills and so on.”

“While surgical care is the first process they experience to mend the bones and joints, they are left with lingering psychological and social challenges especially after discharge.”

“Anecdotally, we have observed that the most challenging time for patients is after discharge when they leave the busy environment of the hospital and go home (usually 2-12 weeks). At this time, they have a much better understanding of their limitations and mental stress develops (depression, anxiety) and perceptions of satisfaction about themselves seems to worsen.”

“Within the first three months after surgical repair from orthopedic trauma injury, even among patients with no documented psychiatric conditions (like depression, anxiety) there is a relatively significant portion who develop depressive and anxious symptoms quickly after injury.”

“These patients self-report improvement in physical aspects of recovery similar to people without depressive or anxiety symptoms. But, these same patients report feeling worse about their psychosocial health and life aspects. This means we cannot assume that because a patient reports that their muscles and bones are feeling better, that they are actually fully recovered. There is a lasting scar mentally that prevents survivors from fully re-engaging back in life even as the physical body is healing.”

“Some patients who display higher anxiety or depression symptoms may need some tailored psychosocial support or an empathetic ear by the care team. Some opportunities could be peer support (by pairing up trauma survivors to help their peers navigate the process and answer questions or be a sounding board) engagement in social media outlets (seeing others who have gone through similar emotions and challenges may reduce feelings of isolation or anger) and providing resource avenues to help patients reduce stress (websites or contacts for pet care assistance, eldercare assistance for parents in the home, meals on wheels).”

“Clinicians need to think about the patient as a whole, not a ‘fracture case’ or ‘pelvic ring repair that needs to be discharged to rehab.’ Patients with orthopedic trauma are facing a major life change and this process of recovery extends far after the bones have been reduced and the joints are repaired. One does not need to be a psychologist or psychiatrist to validate feelings of anxiety or sadness or depression. Sometimes the simple acts of 1) asking how the patient is coping and is there anything else you can do in the hospital or at follow-up, and 2) verbalizing understanding of hardship allows the patient to feel acknowledged, valued and listened to.”