European journal of pain (London, England) · 2026
Hospital Anxiety and Depression Scale Trajectories and Risk of Complex Regional Pain Syndrome in Middle-Aged Women After Surgical Treatment of Acute Distal Radial Fracture: A Prospective Longitudinal Cohort Study.
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Gao Meihui, Xiong Jun, Gao Ran, Shen Yun, Lu Shengdi, Yang Xiaoru
Аннотация
OBJECTIVE: To identify Hospital Anxiety and Depression Scale-Anxiety (HADS-A) trajectories after surgical treatment of distal radius fracture (DRF) in middle-aged women, and their association with complex regional pain syndrome (CRPS).
DESIGN: Prospective longitudinal cohort study.
SETTING: Tertiary hospital, China.
PARTICIPANTS: One thousand eight hundred seventy-five consecutive women aged 40-65 years undergoing surgical fixation of acute unilateral DRF (January 2019-December 2022).
MAIN OUTCOME MEASURES: Primary outcome was CRPS diagnosed by the Budapest Clinical Criteria at 3 months. HADS-A was measured at baseline and 1, 2, 3 and 6 months, with CRPS assessed at each follow-up. Latent class trajectory modelling (LCTM) defined trajectory classes; time in target range (TTR) was the proportion of assessments with HADS-A < 8.
RESULTS: During 6-month follow-up, 150 women (8.0%) developed CRPS. LCTM identified four trajectories: low-stable (n = 983, 52.4%), moderate-recovering (n = 448, 23.9%), high-persistent (n = 265, 14.1%) and delayed-onset (n = 179, 9.5%). Incidence was 19.2% (high-persistent) versus 4.9% (low-stable). After adjustment, the high-persistent trajectory was associated with CRPS (odds ratio [OR] 4.85, 95% confidence interval [CI] 1.85-12.71; p = 0.001). TTR showed a graded exposure-response relationship: 0% versus 100% TTR carried higher risk (adjusted OR: 4.97, 95% CI: 2.51-9.86; p < 0.001; p for trend < 0.001). Subgroup interactions were non-significant.
CONCLUSIONS: Persistently elevated postoperative anxiety, rather than transient distress confined to the perioperative period, was associated with CRPS after DRF surgery, with a graded exposure-response relationship between cumulative anxiety burden (HADS-A TTR) and risk. Serial psychological monitoring beyond baseline may help identify at-risk patients.
SIGNIFICANCE STATEMENT: This study provides the first evidence that longitudinal anxiety trajectory patterns, not single-timepoint assessments, independently predict complex regional pain syndrome after distal radius fracture surgery. By introducing the "time in target range" concept to psychological measurement, we demonstrate a dose-response relationship between cumulative anxiety burden and CRPS risk. These findings reframe the longstanding debate on psychological contributors to CRPS and support serial anxiety monitoring as a clinically actionable strategy for early identification of at-risk patients.
DESIGN: Prospective longitudinal cohort study.
SETTING: Tertiary hospital, China.
PARTICIPANTS: One thousand eight hundred seventy-five consecutive women aged 40-65 years undergoing surgical fixation of acute unilateral DRF (January 2019-December 2022).
MAIN OUTCOME MEASURES: Primary outcome was CRPS diagnosed by the Budapest Clinical Criteria at 3 months. HADS-A was measured at baseline and 1, 2, 3 and 6 months, with CRPS assessed at each follow-up. Latent class trajectory modelling (LCTM) defined trajectory classes; time in target range (TTR) was the proportion of assessments with HADS-A < 8.
RESULTS: During 6-month follow-up, 150 women (8.0%) developed CRPS. LCTM identified four trajectories: low-stable (n = 983, 52.4%), moderate-recovering (n = 448, 23.9%), high-persistent (n = 265, 14.1%) and delayed-onset (n = 179, 9.5%). Incidence was 19.2% (high-persistent) versus 4.9% (low-stable). After adjustment, the high-persistent trajectory was associated with CRPS (odds ratio [OR] 4.85, 95% confidence interval [CI] 1.85-12.71; p = 0.001). TTR showed a graded exposure-response relationship: 0% versus 100% TTR carried higher risk (adjusted OR: 4.97, 95% CI: 2.51-9.86; p < 0.001; p for trend < 0.001). Subgroup interactions were non-significant.
CONCLUSIONS: Persistently elevated postoperative anxiety, rather than transient distress confined to the perioperative period, was associated with CRPS after DRF surgery, with a graded exposure-response relationship between cumulative anxiety burden (HADS-A TTR) and risk. Serial psychological monitoring beyond baseline may help identify at-risk patients.
SIGNIFICANCE STATEMENT: This study provides the first evidence that longitudinal anxiety trajectory patterns, not single-timepoint assessments, independently predict complex regional pain syndrome after distal radius fracture surgery. By introducing the "time in target range" concept to psychological measurement, we demonstrate a dose-response relationship between cumulative anxiety burden and CRPS risk. These findings reframe the longstanding debate on psychological contributors to CRPS and support serial anxiety monitoring as a clinically actionable strategy for early identification of at-risk patients.