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  • Association of psychological distress, quality of life and costs with carpal tunnel syndrome severity: a cross-sectional analysis of the PALMS cohort

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Health services research
Research
Association of psychological distress, quality of life and costs with carpal tunnel syndrome severity: a cross-sectional analysis of the PALMS cohort
  1. Christina Jerosch-Herold1,
  2. Julie Houghton1,
  3. Julian Blake2,3,
  4. Anum Shaikh4,
  5. Edward CF Wilson4,
  6. Lee Shepstone5
  1. 1 Faculty of Medicine and Health Sciences, School of Health, Sciences, University of East Anglia, Norwich, UK
  2. 2 Department of Clinical Neurophysiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  3. 3 Department of Clinical Neurophysiology, MRC Centre for Neuromuscular Diseases, London, UK
  4. 4 Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK
  5. 5 Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
  1. Correspondence to Professor Christina Jerosch-Herold; c.jerosch-herold{at}uea.ac.uk

Abstract

Objectives The Prediciting factors for response to treatment in carpal tunnel syndrome (PALMS) study is designed to identify prognostic factors for outcome from corticosteroid injection and surgical decompression for carpal tunnel syndrome (CTS) and predictors of cost over 2 years. The aim of this paper is to explore the cross-sectional association of baseline patient-reported and clinical severity with anxiety, depression, health-related quality of life and costs of CTS in patients referred to secondary care.

Methods Prospective, multicentre cohort study initiated in 2013. We collected baseline data on patient-reported symptom severity (CTS-6), psychological status (Hospital Anxiety and Depression Scale), hand function (Michigan Hand Questionnaire) comorbidities, EQ-5D-3L (3-level version of EuroQol-5 dimension) and sociodemographic variables. Nerve conduction tests classified patients into five severity grades (mild to very severe). Data were analysed using a general linear model.

Results 753 patients with CTS provided complete baseline data. Multivariable linear regression adjusting for age, sex, ethnicity, duration of CTS, smoking status, alcohol consumption, employment status, body mass index and comorbidities showed a highly statistically significant relationship between CTS-6 and anxiety, depression and the EQ-5D (p<0.0001 in each case). Likewise, a significant relationship was observed between electrodiagnostic severity and anxiety (p=0.027) but not with depression (p=0.986) or the EQ-5D (p=0.257). National Health Service (NHS) and societal costs in the 3 months prior to enrolment were significantly associated with self-reported severity (p<0.0001) but not with electrodiagnostic severity.

Conclusions Patient-reported symptom severity in CTS is significantly and positively associated with anxiety, depression, health-related quality of life, and NHS and societal costs even when adjusting for age, gender, body mass index, comorbidities, smoking, drinking and occupational status. In contrast, there is little or no evidence of any relationship with objectively derived CTS severity. Future research is needed to understand the impact of approaches and treatments that address psychosocial stressors as well as biomedical factors on relief of symptoms from carpal tunnel syndrome.

  • neurological pain
  • neurophysiology
  • musculoskeletal disorders
  • primary care

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2017-017732

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    Footnotes

    • Contributors CJH conceived the PALMS cohort study and obtained funding. CJH, JB, LS and ECFW developed the protocol. JH conducted data collection and data entry. LS, AS and ECFW undertook the statistical analyses. All authors contributed to the drafting of the manuscript and have read and approved the final manuscript.

    • Funding CJH was funded by the National Institute for Health Research (NIHR) through an NIHR Senior Research Fellowship. ECFW was funded by the NIHR Cambridge Biomedical Research Centre. The funders of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health.

    • Competing interests We affirm that we have no financial affiliation (including research funding) or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript, except as disclosed in an attachment and cited in the manuscript.

    • Ethics approval Ethical approval was given by the NRES Committee East of England-Norfolk on 22 April 2013 (reference13/EE/0106) and local research governance approval at each participating trust was obtained prior to recruitment.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.