• Pepijn O Sun, Erik T Walbeehm, Ruud W Selles, Harm P Slijper, UlrichDietmar J ODJOFrom the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center; the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC; the Hand and Wrist Center, Xpert Clinic, Jarry T Porsius, and Hand Wrist Study Group.
• From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center; the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC; the Hand and Wrist Center, Xpert Clinic; and the Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School.
• Plast. Reconstr. Surg. 2021 Jan 1; 147 (1): 66e-75e.

BackgroundDepression and pain catastrophizing are aspects of the patient's mindset that have been shown to be important in relation to the outcome of carpal tunnel release. However, other factors of the patient's mindset have been understudied, such as treatment expectations and illness perceptions. The aim of the present study was to investigate the influence of these mindset aspects on outcome of carpal tunnel release, in addition to psychological distress and pain catastrophizing.MethodsA total of 307 patients with carpal tunnel syndrome who visited outpatient hand surgery clinics and who completed online questionnaires regarding demographic and psychosocial characteristics and carpal tunnel syndrome severity were included. The patient mindset was measured with the Patient Health Questionnaire-4, the Pain Catastrophizing Scale, the Credibility Expectancy Questionnaire, and the Brief Illness Perception Questionnaire. Hierarchical linear regression models were used to examine the relation between self-reported severity 6 months after carpal tunnel release, as measured with the Boston Carpal Tunnel Questionnaire, and psychosocial aspects of mindset, adjusting for preoperative Boston Carpal Tunnel Questionnaire score, patient characteristics, and comorbidities.ResultsIndependent associations with better self-reported outcome were found for higher treatment expectations (β = -0.202; p < 0.001) and illness comprehensibility (β = -0.223; p < 0.001). The additional explained variance in Boston Carpal Tunnel Questionnaire scores by the patient's mindset was 13.2 percent (psychological distress and pain catastrophizing together, 2.1 percent; treatment expectations and illness perceptions together, 11.1 percent).ConclusionTreatment outcome expectations and comprehensibility of illness are both independently associated with the outcome of carpal tunnel release, showing the importance of these aspects of the patient's mindset for the outcome of carpal tunnel release.Clinical Question/Level Of EvidenceRisk, III.Copyright © 2020 by the American Society of Plastic Surgeons.

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