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Background: The outcomes of orthopaedic trauma are not solely determined by injury severity or surgical treatment. Studies of numerous orthopaedic outcomes have found that psychosocial factors are also important. Symptoms of anxiety have been linked to long-term pain and disability. Although the existence of a relationship between psychosocial factors and functional outcomes is accepted across multiple disciplines, quantification of this association in patients who have experienced orthopaedic trauma has remained limited. Measuring the anxiety experienced by these individuals and the association with long-term functional outcomes remain poorly understood. Questions/purposes: (1) Is there an association between early postoperative anxiety symptoms and late recovery of self-reported physical function in patients with orthopaedic trauma? (2) What was the impact of other factors such as demographic variables and comorbidities on late recovery physical function scores, and how did the magnitude of these factors compare with the association with anxiety score? (3) Did patients who presented as trauma activations differ regarding their anxiety symptoms and late-recovery self-reported physical function? Methods: A total of 1550 patients with lower extremity fractures and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and physical function scores treated between January 1, 2014, and January 1, 2021, at an academic Level I trauma center in North America were assessed. We performed a bivariate regression between the initial PROMIS anxiety and physical function, as well as a multivariate regression including age, gender, BMI, and American Society of Anesthesiologists class to control for potential confounding variables. In a subgroup of 787 patients presenting as trauma activations, we performed a separate regression including Injury Severity Score. Results: PROMIS anxiety was associated with decreased late-recovery physical function (β = -2.64 [95% CI -3.006 to -2.205]; p < 0.001). The relationship between PROMIS anxiety and physical function remained after controlling for confounding variables in our overall cohort (β = -2.54 [95% CI -2.93 to -2.15]; p < 0.001) and in the trauma activation cohort (β = -2.71 [95% CI -3.19 to -2.23]; p < 0.001). Age and American Society of Anesthesiologists score were associated with worse PROMIS physical function scores, while being a man was associated with better PROMIS physical function scores (age: β= -1.26 [95% CI -1.50 to -1.02]; American Society of Anesthesiologists class: β=-2.99 [95% CI -3.52 to -2.46]; men: β = 0.95 [95% CI 0.16 to 1.75]). There were no differences in initial anxiety symptoms or late-recovery physical function between patients who presented as trauma activations and those who did not. Injury Severity Scores were independently associated with worse function (β = -1.45 [95% CI -2.11 to -0.79]. Conclusion: Initial patient self-reported anxiety is negatively associated with patient-reported physical function at the final follow-up interval in a broad cohort of patients with orthopaedic lower extremity injuries undergoing surgery. Identifying patients with high initial PROMIS anxiety scores may allow us to determine which patients will report lower functional scores at the final follow-up. Future investigations could focus on the effect of psychosocial interventions such as cognitive behavioral therapy and mindfulness on functional scores. Level of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Background: Feelings of imposter syndrome (inadequacy or incompetence) are common among physicians and are associated with diminished joy in practice. Identification of modifiable factors associated with feelings of imposter syndrome might inform strategies to ameliorate them. To this point, though, no such factors have been identified. Question/purpose: Are intolerance of uncertainty and confidence in problem-solving skills independently associated with feelings of imposter syndrome after accounting for other factors? Methods: This survey-based experiment measured the relationship between feelings of imposter syndrome, intolerance of uncertainty, and confidence in problem-solving skills among musculoskeletal specialist surgeons. Approximately 200 surgeons who actively participate in the Science of Variation Group, a collaboration of mainly orthopaedic surgeons specializing in upper extremity illnesses primarily across Europe and North America, were invited to this survey-based experiment. One hundred two surgeons completed questionnaires measuring feelings of imposter syndrome (an adaptation of the Clance Imposter Phenomenon Scale), tolerance of uncertainty (the Intolerance of Uncertainty Scale-12), and confidence in problem-solving skills (the Personal Optimism and Self-Efficacy Optimism questionnaire), as well as basic demographics. The participants were characteristic of other Science of Variation Group experiments: the mean age was 52 ± 5 years, with 89% (91 of 102) being men, most self-reported White race (81% [83 of 102]), largely subspecializing in hand and/or wrist surgery (73% [74 of 102]), and with just over half of the group (54% [55 of 102]) having greater than 11 years of experience. We sought to identify factors associated with greater feelings of imposter syndrome in a multivariable statistical model. Results: Accounting for potential confounding factors such as years of experience or supervision of trainees in the multivariable linear regression analysis, greater feelings of imposter syndrome were modestly associated with higher intolerance of uncertainty (regression coefficient [β] 0.34 [95% confidence interval (CI) 0.16 to 0.51]; p < 0.01) and with lower confidence in problem-solving skills (β -0.70 [95% CI -1.0 to -0.35]; p < 0.01). Conclusion: The finding that feelings of imposter syndrome may be modestly to notably associated with modifiable factors, such as difficulty managing uncertainty and lack of confidence in problem-solving, spark coaching opportunities to support and sustain a surgeon's mindset, which may lead to increased comfort and joy at work. Clinical Relevance: Beginning with premedical coursework and throughout medical training and continuing medical education, future studies can address the impact of learning and practicing tactics that increase comfort with uncertainty and greater confidence in problem solving on limiting feelings of imposter syndrome. [ABSTRACT FROM AUTHOR]

The article offers information on importance of patient reported outcome measures (PROMs). Topics discussed include information on the Patient Activation Measure (PAM) which is a validated scoring tool that measures a patient's level of activation or self-efficacy; need for surgeons to improve their interpersonal communication skills; and need for courses teaching effective communication skills in medical schools.

Introduction: Educational interventions to promote patients' self-management of chronic medical conditions can lead to better health outcomes. However, it is unclear what patient factors affect their response to such interventions in the management of hypertension. Hypothesis: We hypothesized that more activated patients would have a greater improvement in systolic blood pressure (SBP). Methods: We implemented two educational interventions in 404 veterans with hypertension. They had a similar impact on SBP, decreasing by a mean of 4.4 mm Hg and 10.1 mm Hg among those with uncontrolled BP (>/=140/90 mm Hg). We used validated scales to measure factors that might influence patient response to education, including self-efficacy, Patient Activation Measure (PAM), healthcare attitudes, hypertension knowledge and medication adherence. Our primary outcome was a decrease in SBP (ΔSBP). We first examined the association of each factor with ΔSBP. We then repeated this analysis after adjusting for baseline SBP, which was the most powerful predictor. Finally, we used stepwise linear regression to identify factors that were independently associated with ΔSBP. We did not adjust results for multiple comparisons; all p-values are 2-sided. Results: We obtained 12-month SBP data from 379 participants. Each 10 mm Hg increase in baseline SBP was associated with a 5.6 mm Hg larger ΔSBP (95% CI, 4.8-6.5). While age, education and medical comorbidities were unrelated to ΔSBP, self-efficacy and PAM were associated in bivariate analysis. Measures of healthcare attitudes, hypertension knowledge and medication adherence all lacked statistical significance. After adjusting for baseline SBP, each standard deviation (SD) change in self-efficacy was associated with a 1.6 mm Hg larger ΔSBP (95% CI, 0.25-2.9). Similarly, each SD change in PAM was associated with 0.9 mm Hg larger ΔSBP (95% CI, -0.4-2.3). In multivariate analysis, only baseline SBP and self-efficacy were associated with ΔSBP. Effect size was the same as in bivariate analysis. Conclusions: In conclusion, among this population of veterans, self-efficacy, as measured by the General Self-Efficacy scale, was associated with a greater impact of education on SBP. Strategies to enhance self-efficacy may aid in successful chronic management of hypertension. [ABSTRACT FROM AUTHOR]