ABSTRACT

The musculoskeletal community is increasingly recognizing the importance of addressing mental and social health opportunities and incorporating psychosocial support in outpatient care. This secondary analysis of a longitudinal study evaluating the management of upper extremity conditions in a musculoskeletal integrated practice unit involving 102 adult patients (63% women, mean age 49 ± 13 years), aimed to identify demographic, clinical and psychosocial variables associated with involvement of an immediately available social worker. Additionally, we assess factors associated with patients seeking second opinions and level of self-efficacy. The only factor independently associated with meeting a social worker was greater symptoms of depression. There were no factors associated with presenting for advice from a second specialist. Self-efficacy score below 10 was independently associated with higher BMI, conditions involving the shoulder or upper arm compared to the hand or wrist, and greater symptoms of depression. When a social worker is available in an upper extremity practice, they are most welcomed and helpful for people with notable symptoms of depression, likely because a depression screen was used as a trigger for involvement. Less adaptive response to painful illness may be easier to measure and discuss, with the potential to increase attention to mental and social health.

摘要

肌肉骨骼社区越来越认识到解决心理和社会健康机会以及将心理社会支持纳入门诊护理的重要性。这项对一项纵向研究的二次分析评估了肌肉骨骼综合实践单元中上肢疾病的管理，该研究涉及 102 名成年患者（63% 的女性，平均年龄 49 ± 13 岁），旨在确定与参与的人口学、临床和社会心理变量相关的立即可用的社会工作者。此外，我们评估与寻求第二意见的患者和自我效能水平相关的因素。与社会工作者会面独立相关的唯一因素是更严重的抑郁症状。没有与向第二位专家寻求建议相关的因素。自我效能评分低于 10 分与较高的 BMI、与手或腕部相比涉及肩部或上臂的状况以及更严重的抑郁症状独立相关。当社会工作者在上肢实践中可用时，他们最受欢迎并为有明显抑郁症状的人提供帮助，这可能是因为抑郁筛查被用作参与的触发器。对疼痛疾病的适应性较差的反应可能更容易衡量和讨论，并有可能增加对心理和社会健康的关注。对于有明显抑郁症状的人来说，它们最受欢迎和帮助，可能是因为抑郁筛查被用作参与的触发器。对疼痛疾病的适应性较差的反应可能更容易衡量和讨论，并有可能增加对心理和社会健康的关注。对于有明显抑郁症状的人来说，它们最受欢迎和帮助，可能是因为抑郁筛查被用作参与的触发器。对疼痛疾病的适应性较差的反应可能更容易衡量和讨论，并有可能增加对心理和社会健康的关注。