Anxiety Symptoms After Orthopedic Injury: A Systematic Review.
Stephen Breazeale, Samantha Conley, Edward Gaiser and 1 others
PMID 33417403WHAT IT FOUND
After limb or pelvic fractures, clinically significant anxiety symptoms were common, from 11.5% to 55.7% during admission and 20% to 39% years later, and were associated with depression, PTSD, and pain.
Key findings
01During inpatient admission after orthopedic injury, 11.5% to 55.7% of participants had clinically significant anxiety symptoms, with a mean prevalence of 19.7%.
02From 19 months to ten years after injury, 20% to 39% of participants had clinically significant anxiety symptoms.
03More than one year after injury, anxiety symptom severity was associated with depression, PTSD, and chronic pain.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
The review could not perform a meta-analysis because included studies used four different anxiety instruments and multiple cutoff scores, making direct comparison difficult. Several timepoints were represented by single studies with relatively small sample sizes, limiting conclusions. The EQ-5D asks about anxiety and depression together, so anxiety could not be separated from depression in studies using it. The most common quality limitations were enrolling fewer than 50% of eligible patients, losing more than 20% of samples to follow-up, or not controlling for confounders. Eight studies used cross-sectional data and four used longitudinal data, so timepoint comparisons may not follow the same people.
The easy way to misread this
Do not read the prevalence and association findings as evidence that treating anxiety improves orthopedic recovery. The review included observational studies, did not test treatment, and could not combine studies in a meta-analysis.