Tim Kobes (Utrecht / NL; Boston, MA / US), Sandra Wilson (Boston, MA / US), Ruben Hoepelman (Utrecht / NL), Yassine Ochen (Utrecht / NL; Nieuwegein / NL), Michael Weaver (Boston, MA / US), Marijn Houwert (Utrecht / NL), Falco Hietbrink (Utrecht / NL), Rolf Groenwold (Leiden / NL), Marilyn Heng (Miami, FL / US)
Abstract text (incl. references and figure legends)
Introduction: Treatment outcome measures for proximal humerus fracture patients emphasize physical function rather than quality of life (QoL). QoL in elderly patients is a broad concept that includes physical function. Therefore, QoL questionnaires might be of more resilience to evaluate treatment effect. We set out to investigate the associations of physical function, patient expectations, and surgical treatment with QoL in patients with a proximal humerus fracture.
Material & Methods: All patients (≥18y) with a proximal humerus fracture were eligible for inclusion. We stratified by age (i.e., elderly (≥65y) or non-elderly (<65y)) and treatment. Patients completed the EQ-5D, DASH, and PROMIS Physical Function, Upper Extremity, Social Isolation, and Global Health questionnaires at multiple time points up to 12 months after injury. We used linear mixed effect models to assess associations over time.
Results: Between 2018-2021, 392 patients were eligible, and 73 were analyzed (85% female). Thirty-two patients (44%) were 65 years or older, one- and two-part fractures accounted for 68% of fractures, and 59 patients (78%) were treated conservatively. EQ-5D and mental health were significantly associated with physical function, with a similar association between age groups. At baseline, high expectations of improvement in ADL appeared to be substantially associated with a decline in QoL (b-coefficient -0.2, 95%CI -0.4–0.0) and mental health over time (b-coefficient -14.3, 95%CI -27.2–-1.4), whereas ROM increased mental health (b-coefficient 5.2, 95%CI -1.9–12.3). Surgery was not associated with change in QoL or mental health.
Conclusions: In elderly and non-elderly patients with a proximal humerus fracture, QoL is associated with physical function, a broad concept. High patient expectations for ADL seemed to have a powerful, adverse effect on the quality of life and mental health. In contrast, high expectations of improved ROM positively affected mental health outcome.
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