Impact of Keeping a Personal Recovery Diary on Upper Extremity Disability

Primary null hypothesis:

• Keeping a personal diary has no effect on upper-extremity disability (assessed w/ PROMIS [Patient Reported Outcome Measurement Information System] upper extremity) 8 weeks after injury.

Secondary null hypotheses:

• Keeping a personal diary has no effect on avoidance of painful activities (assessed w/ PROMIS pain interference) 8 weeks after injury.
• Keeping a personal diary has no effect on symptoms of depression (assessed w/ PROMIS depression) 8 weeks after injury.
• There are no factors associated with upper-extremity disability 8 weeks after injury.

Study Overview

• Status: Terminated
• Conditions: Acute Injury of Upper Extremity
• Intervention / Treatment: Other: Diary

Detailed Description

Recovery from injury can be counterintuitive and taxing. It is natural to feel protective and prepare for the worst. Healthy exercises can seem unwise. It can seem like things are taking too long or getting off track. We have noticed that small improvements such as being able to resume a cherished activity (e.g. knitting or swimming) or achieving some success with exercises (e.g. obtaining full supination after fracture of the distal radius), can help patients feel like things are going to be okay. That feeling seems to make it easier to do exercises and resume function activities.

We wonder if awareness of this process (mindfulness) would help patients recover more rapidly. Keeping a journal is one method for encouraging mindfulness. It allows patients to express themselves and tell their stories. There is evidence that such "narrative medicine" can be healing. We anticipate that patients who perceive little or no progress will be able to look back on how they were feeling earlier on and appreciate that things are moving in the right direction. We also hope that their journal material might be useful for other patients that are having trouble seeing the "light at the end of the tunnel", so as part of this study, we will get permission to use their quotes anonymously in future patient care materials and future research. To our knowledge, research on the impact of keeping a personal diary/journal of recovery is scant, particularly pertaining to recovery from upper extremity trauma.

Explanatory variables:

• Diary or no Diary
• Diagnosis (fracture, sprain, contusion, skin laceration, complex laceration [tendon, nerve])
• Location (hand, wrist, forearm, elbow, arm, shoulder)
• Sex
• Age
• Education
• Work status
• Insurance (worker's compensation, private, public, other)
• Visit type
• Prior treatment received
• Other pain conditions
• Smoking status
• Marital status
• Physical or Occupational Therapy

• Study Type: Interventional
• Enrollment (Actual): 9
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• All new patients (>18 years) with an acute injury of the upper extremity (fracture, laceration, sprain, contusion)
• English fluency and literacy
• Able to take informed consent

Exclusion Criteria:

• Pregnant women

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Diary; Subjects that are randomized to the diary group will be told to keep a diary of their recovery. The study is focusing on the effect of keeping a diary on disability, rather than the content of the diary.	Other: Diary; Subject keeps diary of recovery
No Intervention: No Diary; Control Group

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Upper Extremity Disability Measured by PROMIS Upper Extremity	Upper Extremity Disability measured by PROMIS Upper Extremity	8 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Avoidance of Painful Activities Measured by PROMIS Pain Interference	Avoidance of painful activities measured by PROMIS Pain Interference	8 weeks
Symptoms of Depression Measured by PROMIS Depression	Symptoms of depression measured by PROMIS Depression	8 weeks

Collaborators and Investigators

• Sponsor: Massachusetts General Hospital

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2015
• Primary Completion (Actual): January 1, 2016
• Study Completion (Actual): January 1, 2016

Study Registration Dates

• First Submitted: February 6, 2015
• First Submitted That Met QC Criteria: February 10, 2015
• First Posted (Estimate): February 11, 2015

Study Record Updates

• Last Update Posted (Actual): March 28, 2017
• Last Update Submitted That Met QC Criteria: February 8, 2017
• Last Verified: February 1, 2017

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Wounds and Injuries; Arm Injuries
• Other Study ID Numbers: 2014P002781