The influence of psychological factors on outcomes following wrist and hand musculoskeletal injuries: A systematic review.

BACKGROUND

Hand and wrist injuries are prevalent worldwide, impacting athletes and the general population, especially older adults, and may lead to long-term pain and disability. Psychological factors are increasingly recognized as key contributors to symptom persistence in various musculoskeletal conditions.

PURPOSE: To determine whether psychological factors influence pain intensity, disability, handgrip strength, range of motion (ROM) limitations, quality of life, return to work (RTW), and/or return to sports in adults with musculoskeletal traumatic injuries of the hand or wrist.

STUDY

DESIGN

Systematic review.

METHODS

This systematic review followed the PRISMA and the Cochrane Handbook for systematic reviews and meta-analysis guidelines. Two independent reviewers performed a search of MEDLINE, Cochrane Library, EMBASE, CINAHL, and PsycINFO from their inception until November 15th, 2024, carried out the study selection process and data extraction, and conducted the risk-of-bias assessment using the quality in prognosis studies (QUIPS) tool. Disagreements were resolved by a third researcher.

RESULTS

A total of 21 studies were included, comprising 3315 participants with hand or wrist musculoskeletal injuries. Risk of bias varied across studies, with high risk primarily in confounding, moderate risk in attrition, and low risk in other domains. High levels of self-efficacy were significantly associated with reduced pain and disability, greater handgrip strength, increased ROM, improved quality of life, and higher rates of RTW. Conversely, elevated levels of depression, anxiety, catastrophizing, and kinesiophobia were associated with worse outcomes. A meta-analysis was not carried out due to the heterogeneity of the included studies, so results should be interpreted with caution.

CONCLUSIONS

In line with findings from various musculoskeletal disorders, our results suggest that psychological factors play a crucial role in the recovery process following hand and wrist trauma. Clinicians are encouraged to identify these factors early, as comprehensive assessment and targeted management of psychological aspects should be integral components of care for wrist and hand injuries.

PROSPERO TRIAL REGISTRATION NUMBER: CRD42020164004.