Do orthopaedic patients need mental health support embedded in their treatment plan?

Appiah Poku Yankyera

Orthopaedic problems can generally be classified as those issues pertaining to the disorders of or injuries to musculoskeletal system which comprise the bones, joints, ligaments, tendons, muscles and nerves. This complex system is basically responsible for movement of our body parts. A damage to this system may occur as a result of a congenital diseases such as kyphosis or an injury to a part of the brain that is responsible for coordination and movement. On the other hand, injury or fracture to the bone, also referred to as trauma injuries, is a major factor associated with orthopaedic problems [1]. Even though we are all prone to injury or fracture of a bone, there are certain risk factors that needs to be highlighted here;

Age is a major risk factor – whereas young persons are more likely to have orthopaedic problems as a result of some risky lifestyles such as driving at top speeds (be it a motor bike or car) or even through sports injures and battlefield injuries, older people are likely to break their bones as result of falls and the weak nature of their bones.
Degenerative disease such as osteoporosis, osteoarthritis or rheumatoid arthritis are more likely to lead to orthopaedic problems since these conditions are disorders of the bones, joints and ligaments
Persons with diabetes may end up being classified as orthopaedic patients as a result of diabetic foot ulcer which may lead to amputation of the infected foot
Certain types of stroke or injury to the brain may lead to damage within the musculoskeletal system
A bone fracture occurs when a force exerted against a bone is stronger than it can structurally withstand. Severe limb injuries remain a frequent and significant occurrence notwithstanding better safety awareness; pedestrians, motorcyclists and car occupants remain vulnerable [1].The most common sites for bone fractures are the wrist, ankle and hip. Treatments include setting the limb in a plaster cast or surgically pinning the bone ends back together [2]. Orthopaedic surgeons may resort to amputation in the event of the failure of possible treatments aimed at salvaging fractured limbs. Another procedure used is through knee or hip replacement procedures for osteoarthritis or osteoporosis patients. The aim of all orthopaedic treatments is to restore bones and to reduce further complications and morbidity in patients; ultimately it seeks to make patients gain personal independence and mobility after the rehabilitation process.

Although orthopaedic problems, specifically trauma injuries, are considered as purely a physical or biological problem, there is much evidence to show that patients go through emotional and psychological distress which are very complex to deal with compared to the physical problems associated with the injury itself [3]. The distress arises as people encounter challenges such loss of mobility, perceived altered body image, pain, and reduced physical functioning during and after the rehabilitation process. Similarly, a number of people may have anxiety about the kind of surgery they will be having and may tend to be depressed because of the fear of not being able to live a normal life (such as returning to work, hanging out with friends and family, having to change their diet among other things) as they used to prior to their injury. In addition to this, people who had their injuries as a result of vehicular accidents or in battlefield/combat situation are more likely to exhibit post-traumatic stress disorders where flashes of how the injury occurred arouse in them a certain level of anxiety which consequently makes them depressed and anxious. The issue of pain and infection during and after the rehabilitation period is also a major concern to patients. Lastly, the perception of having an altered body image because limbs may not look the same after the rehabilitation process or the fact that patients may have to wear a cast or fixator during the rehabilitation process or even the thought of being wheelchair bound. This perceived altered body image leads to personal distress, low self-esteem, poor coping strategies and even a sense of social stigma among these patients [4].

From the above, it is clear that orthopaedic patients especially those who suffer trauma injuries do need some level of mental health support in the form of psychosocial support/interventions that targets the specific psychological, emotional, behavioural and social needs of patients. Providing psychosocial support is very crucial to the recovery process and patients’ general health before, during and after the rehabilitation process because psychosocial problems among patients can lead to poor quality of life, non-adherence to treatment, and frequent hospital visits as a result poor physical functioning [5,6]. This support should be offered both to in-patients and out-patients. Clinical Health psychologists can therefore play a substantial role in the care of orthopaedic patients as they will provide support in helping them to adjust and cope well with their condition so as to reduce the overall impact of the injury on their lives and also help improve their quality of life. The support to be provided by the Clinical Health Psychologists include assisting individuals to deal with their depression and feelings of loss, anxiety and avoidance, family difficulties, relationship challenges, adjusting to their injury and helping them to effectively cope with pain. They can also work with the orthopaedic staff by offering them the training and skills to enable them manage the stress associated with the job. Lastly, Clinical Health Psychologists can collaborate with the clinical team to ensure the provision of patient-centred care as well as the availability and easy access to bespoke self-help materials.

References
1. Saleh, M., Yang, L. and Sims, M. (1999). Limb reconstruction after high energy trauma. British Medical Bulletin, 55 (4), 870-884
2. Bone Fractures (2016) Retrieved from “http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Bone_fractures?open”>Bone fractures – Better Health Channel

3. Starr, A. J., Smith, W. R., Frawley, W. H., Borer, D. S., Morgan, S. J., Reinert, C. M., & Mendoza-Welch, M. (2004). Symptoms of posttraumatic stress disorder after orthopaedic trauma. Journal of Bone and Joint Surgery, 86(6), 1115–1121.
4. Price, B. (1995). Assessing altered body image. Journal of Psychiatric and Mental Health Nursing, 2, 169–175.
5. DeSouza, M. S. (2002). Effectiveness of nursing interventions in alleviating perceived problems among orthopaedics patients. Journal of Orthopaedic Nursing, 6,
211–219.
6. Dheensa, S., & Thomas, S. (2012). Investigating the relationship between coping, quality of life and depression/anxiety in patients with external fixation devices. International Journal of Orthopaedic and Trauma Nursing,16, 30-38. doi:10.1016/j.ijotn.2011.06.003

By: Appiah Poku Yankyera (Health Psychology, MSc.), Founder, Life Developers Movement (Building a Health Conscious Society)

©2016 Scientect e-mag | Volume 1 (1): A2

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