How Prevalent Are Intimate Partner Violence Patients in Ortho?

From 20% to 50% of women experience intimate partner violence during their lifetimes^1,2—and the pandemic exacerbated those statistics.

From that evidentiary platform, a team of investigators from Columbia University Irving Medical Center, The Ohio State University College of Medicine, Miami Valley Hospital and Novant Health Orthopaedics designed a systematic review of the current literature to update prevalence and impact of intimate partner violence statistics among orthopedic patients.

The research team also tackled the question of training for treating this patient population, looking specifically for its prevalence and current best practices for detection of and response to intimate partner violence in orthopedics.

The study, “Intimate Partner Violence in the Orthopaedic Patient Population: What Surgeons Need to Know,” appears in The Journal of Bone and Joint Surgery Reviews. The study authors were Jennifer A. Kunes, B.A., Marisa N. Ulrich, B.S., Charlotte E. Orr, M.D., Lisa K. Cannada, M.D. and Christen M. Russo, M.D.

Jennifer Kunes, a 4th year medical student at Columbia University Irving Medical Center in New York, told OTW, “After coming to Columbia for medical school I joined the Sexual Violence Response office. There, I became a Department of Health certified Rape Crisis Counselor in order to volunteer for the local 24/7 helpline. At the hospital, I saw patient after patient in need of that same support, and I saw this tremendous opportunity to begin conversations about intimate partner violence in that setting.”

The research team found 48 studies and articles that met the study inclusion criteria. One study, in particular, found that 1 in 6 female patients had experienced intimate partner violence in the past year, 1 in 3 had experienced intimate partner violence during their lifetimes, and 1 in 50 were presenting for treatment of injuries that resulted directly from intimate partner violence.³

In two studies, the authors noted, women presenting to emergency departments with confirmed intimate partner violence-related injuries reports were asked about intimate partner violence by their physician only 20% to 55% of the time.^4,5

Furthermore, even when women revealed intimate partner violence to someone on their care team, less than half were referred to a support service.⁶

On the education front, much is lacking, say the researcher team in their study.

A 2013 study of 153 members of the Orthopaedic Trauma Association found misconceptions, including:

• survivors must be getting something out of the abusive relationships (16%);
• some women have personalities that cause the abuse (20%); and
• the battering would stop if the batterer quit abusing alcohol (40%).⁷

For those programs that do undertake an educational program on intimate partner violence, however, the results can be promising. The authors note one study’s finding that after taking a half-day course, orthopedic surgical trainees maintained their changes in knowledge and attitudes three months later.⁸

When OTW asked if there are things that we can take from child abuse assessments in the orthopedic setting and apply to intimate partner violence, Kunes responded, “Yes. Both rely on the principles of recognizing mistreatment, building trust, and asking direct and open questions.”

“There has been substantial research on the recognition of child abuse injuries in orthopedics. This topic has also been integrated into medical education in both medical school and residency programs.”

“Education and research about intimate partner violence in orthopedics have been inconsistent, and studies have shown that there are pervasive misconceptions about the prevalence and recognition of intimate partner violence.”

“There is a lot to learn from the field of child abuse assessment in terms of general awareness, education, and protocol development. When it comes to intimate partner violence, it’s important to uplift a patient’s sense of autonomy, helping them feel in control of the situation whenever possible.”

Furthermore, said Kunes, “There is still a lot of work to be done in optimizing screening for intimate partner violence, so more research (especially prospective) on this topic is needed. There are large disparities in the prevalence estimates found by retrospective studies and prospective studies, likely owing in part to issues of inconsistent screening and documentation.”

“So, further studies that compare using these screening tools to asking patients directly are necessary. Furthermore, there are data to suggest that patients who screen negatively for intimate partner violence during an initial visit may well screen positive on follow-up visits, so asking patients about abuse over repeat visits may be beneficial in establishing a true ‘gold standard’ to which these screening tools can be compared.”

“I would strongly encourage anyone interested in developing their skill set in this area to take any opportunity to practice asking about intimate partner violence and responding to a disclosure with a standardized patient.”

“I’ve been lucky that my medical school curriculum provides us with in-person standardized patient encounters for everything from breaking bad news to asking about abuse. It takes a lot of practice to find your own voice in discussing the topic of intimate partner violence with patients, and it looks different for different people.”

References

1. https://pubmed.ncbi.nlm.nih.gov/17348778/
2. https://pubmed.ncbi.nlm.nih.gov/23768757/
3. https://pubmed.ncbi.nlm.nih.gov/23768757/
4. https://pubmed.ncbi.nlm.nih.gov/7769770/
5. https://pubmed.ncbi.nlm.nih.gov/33823142/
6. https://pubmed.ncbi.nlm.nih.gov/12432696/
7. https://pubmed.ncbi.nlm.nih.gov/23283672/
8. https://pubmed.ncbi.nlm.nih.gov/25917425/