S150 S290
Poster 29:
Psychosocial Intervention and the Use of Pain
Medication in Orthopaedic Trauma Patients
Alexandra Dluzniewski, MS (University of Florida, Gainesville, FL,
United States), Laura Ann Zdziarski, LAT, PhDc, Jennifer Hagen, MD,
Terrie Vasilopoulos, PhD, Kalia K. Sadasivan, MD, MaryBeth Horodyski,
EdD, LAT, ATC, FNATA, Heather K. Vincent, PhD, MS
Disclosures:
Alexandra Dluzniewski: I Have No Relevant Financial
Relationships To Disclose
Objective:
To identify factors that influence pain medication use
(PMU) post-operatively among orthopaedic trauma patients who
received either an integrative care 10-step psychosocial intervention
(Icare) or standard trauma care (UScare).
Design:
An ongoing single-blinded, randomized, controlled trial.
Setting:
Level I trauma center at an academic institution.
Participants:
Patients admitted to the orthopaedic trauma service
(N
¼
89; 40.4% female, 29.7 7.9 kg/m
2
, 42.9 16.6 yrs).
Interventions:
Investigators implemented Icare during the hospital
stay and at follow-up visits. The program provided coping strategies
and supportive material that were tailored to each patient’s needs;
goal setting, physical movement, reducing psychological stressors, and
others. Follow-up visits occurred at weeks 2, 6 and 12.
Main Outcome Measures:
Hospital length of stay (LOS), and 12-week
values for post-traumatic stress disorder (PTSD), number of pain
medications and patient-reported average pain severity.
Results:
Of the 89 patients, 50 were using pain medication at 12 weeks
(20 females, 30 males). There were no significant differences in PMU at
12 weeks between Icare and UScare. Despite similar pain severity as
males, females were twice as likely to be using pain medication at 12
weeks if their LOS was greater than seven days. Regression analysis was
used to determine which factors contributed to the variance of PMU at
week 12. The model was adjusted for age, sex, LOS and study group
(model R2
¼
0.244). The addition of patient-reported pain and PTSD
scores contributed an additional 15.7% and 23.1% to the variance of the
model, respectively (model R2
¼
0.673; p
<
.05).
Conclusions:
While both Icare and UScare decreased PMU over time,
women used pain medicines for longer during recovery especially if the
hospital LOS was longer than a week. A possibility exists that PTSD may
be disproportionately impacting women after orthopaedic trauma.
The findings suggest PTSD coping strategies could be useful in reducing
medication use during follow-up.
Level of Evidence:
Level III
Poster 30:
Telerehabilitation with Haptics: Result of Usability
and Feasibility Study in Patients with Upper
Extremity Impairment
Thiru Annaswamy, MD, FAAPMR (VA North Texas Health Care System,
UT Southwestern Medical Center, Dallas, TX), Aleksander Borresen,
Medical Student
Disclosures:
Thiru Annaswamy: I Have No Relevant Financial Re-
lationships To Disclose
Objective:
To investigate the usability and feasibility of a new VIR-
tual-reality based Telerehabilitation System with Haptics (VIRTESH) by
comparing in-person evaluation of range of motion (ROM) and strength
with similar evaluation performed remotely using VIRTESH.
Design:
Usability and feasibility study of a new VIRTESH system.
Setting:
VR laboratory in a rehabilitation department at a Veterans
Affairs medical center.
Participants:
Veterans with upper extremity impairments due to
musculoskeletal or neurological diagnosis.
Interventions:
Physical evaluation of ROM and isometric strength of
the affected upper extremity in-person, followed by a similar evalu-
ation performed remotely using VIRTESH, which was designed and
developed in collaboration with computer science scientists and
engineers.
Main Outcome Measures:
The main outcome measure was usability,
which was assessed via a 7-point (strongly disagree to strongly agree)
questionnaire completed by the patient and remote evaluator. The sec-
ondary outcome was feasibility which was assessed by comparing remote
evaluation to in-person evaluation findings. A convenience sample of 15
patients were each evaluated first by an onsite physician followed by a
remote evaluator using VIRTESH. Passive ROM and maximum isometric
strength were assessed for 10 upper extremity movements. Movements
were scored as either normal or impaired, with or without pain.
Results:
The “ease and simplicity” and “quality of experience” us-
ability survey results showed strong agreement that the system was
easy to use and a pleasurable experience (5.97/7 and 5.88/7). The
“comparison to in-person evaluation” and “therapist evaluation” sur-
vey showed modest agreement with statements comparing VIRTESH to
in-person evaluations (4.81/7 and 5.29/7). Comparing remote and in-
person clinical evaluations showed a 76.6% 19.8% concordance for
passive ROM, and a 83.3% 22.3% concordance for maximum isometric
strength. Pain decreased concordance rates slightly.
Conclusions:
Using a virtual-reality based telerehabilitation system
with haptic feedback allows patients and care-providers to interact
remotely and has strong potential to provide meaningful clinical en-
counters including audio, video and the sense of touch.
Level of Evidence:
Level III
Poster 31:
Diagnostic Value of Segmental Study with
Distoproximal Latency Ratio for Carpal Tunnel
Syndrome
Ki Un Jang (Gangnam Sacred Heart Hosp., Hallym University Medical
College, Seoul, South Korea, Korea, Republic Of), Jee Hee Jo, MD
Disclosures:
Ki Un Jang: I Have No Relevant Financial Relationships To
Disclose
Objective:
The purpose of this study is to compare parameters of
supplementary segmental study to estimate clinical usefulness.
Although patients meet clinical criteria for carpal tunnel syndrome
(CTS), precise diagnosis can be overlooked when the routine study is
found to be within the normal range.
Design:
Cross-sectional design with control group.
Setting:
University hospital setting.
Participants:
We evaluated 50 hands of CTS patients comparing to
normal group.
Interventions:
Not applicable.
Main Outcome Measures:
In all subjects, routine nerve conduction
study was performed, and supplementary electrodiagnostic parame-
ters including third finger distoproximal latency ratio (3DPLR), 4th
finger median ulnar latency difference (4MULD), median ulnar motor
latency difference (MUMLD), lumbricalis interosseus latency differ-
ence (LILD) were analyzed with the sensitivity, specificity, positive
prognostic value to compare with each other.
Results:
The mean of 3DPLR in CTS was 1.40ms, the sensitivity was 89.5%,
specificity 66.7% in criteria of 3DPLR
>
1.1, the sensitivity was 42.1%,
specificity 45.0% in criteria of 3DPLR
>
1.5 (p
<
.5). The mean of 4MULD in
CTSwas 1.06ms, the sensitivitywas 84.2%, specificity 76.9% (p
<
.5). MUMLD
in CTS subjects was 3.03ms, sensitivity of MUMLDwas 93.3%, specificitywas
80% (p
<
.5). LILD in CTS was 1.80ms, sensitivity of LILD was 84.6%, speci-
ficity 42.9% (p
<
.5). Phalen test was revealed the sensitivity 79.3%, speci-
ficity 53.8%. Carpal compression test showed sensitivity 79.3%, specificity
50% (p
<
.5). Rate of no response was high in 3DPLR as 36.7%, in 4MULD as
33.3%, and lower inMUMLD as 3.3%, in LILD as 0%. The positive predict value
was high in parameters of MUMLD, 4MULD, 3DPLR, LILD.
Conclusions:
Our study revealed that the parameter MUMLD, 3DPLR
(1.1), 4MULD could be recommended as a high sensitivity and high
specificity rather than 3DPLR (1.5), LILD.
Level of Evidence:
Level II
S150
Abstracts / PM R 9 (2017) S131-S290