Journal Club September 2020

Quantitating our gut feelings about a patient’s prognosis

Ryota I et al: Kinematic Analyses Using Finger-Tapping Task for Patients After Surgery With Distal Radius Fracture at Acute Phase. September 2020 Hand (N Y). 2020 Aug 31;1558944720949952. doi: 10.1177/1558944720949952. Online ahead of print.

Japanese investigators have published intriguing work regarding a method to predict early on which patients will recover poorly following surgical treatment for distal radius fractures.
Standard measurements include DASH scores and VAS pain scores, but neither assess movement or fear of movement. Early intervention for patients demonstrating catastrophic thinking regarding pain and/or fear of movement might reduce disability and the development of chronic pain, including chronic regional pain syndrome.
The investigators prospectively studied 20 patients who underwent surgery for distal radius fractures. They used visual analog scale scores for pain intensity at rest, for pain with movement, and for fear of movement. They used DASH scores to assess wrist function and at one month divided the patients into two groups according to whether their DASH score was greater than 40 (slight improvement) or less than 40 (good improvement).
The researchers assessed movement characteristics by means of a finger tapping task. Electronic sensors were attached to the patient’s thumb and index finger. The patient was instructed to quickly and repeatedly oppose the index finger and thumb, beginning with the largest possible space between them. Both treated and uninjured hands were tested, and the uninjured hand served as a control. An electronic tracking system measured the widest opening of the digits, the speed of movement, and the hesitation time between each switch in the direction of movement.
The pain and fear of movement scores and the kinematic tests were administered on post-operative days 1, 3, 4, 7, 14, 21, and 30. DASH scores were collected on days 1, 7, 14, 21, and 30.
RESULTS: The 30-day DASH scores (good vs. slight improvement) were significantly correlated with the hesitation time and fear of movement VAS scores recorded on the first day after surgery. Similarly, the movement velocity at day 7 was statistically correlated with the DASH score at 30 days.
DISCUSSION: Quantitating a patient’s movement hesitation on the first day after surgery and their movement velocity six days later indicates, according to their 30-day DASH score, how well they will be recovering a month after surgery. Range of motion and questionnaire determinations alone are not sufficient.
COMMENT: I like this study. The patient numbers were small, but the study was novel, well designed, executed, and reported. With a rather simple set-up, they were able to quantitate what we, to one degree or another, assess qualitatively; but quantitative analysis is less biased and therefore better. I encourage the authors of this paper (and you, too) to continue this investigation into other upper extremity disorders and to further show that if early intervention for patients showing prolonged hesitation movements and slow velocities actually improves their outcome and reduces the scourge of problems such as CRPS.