To the Editor,
We read the study by Loos et al. [2] with great interest. In their study, the authors created a machine-learning tool that could potentially predict pain improvement and hand function after surgery for carpometacarpal osteoarthritis. Although we appreciated this study, we believe the lack of consideration for the impact of specific mental health conditions on postoperative pain is a major limitation of this paper. Since anxiety, in our view, is a potential confounding variable, we would like to provide our perspective on this matter.
Anxiety is common in patients with osteoarthritis [3]. Prior research has suggested that patients with anxiety experience consistently higher levels of osteoarthritic pain [6]. Furthermore, patients with osteoarthritis who experience anxiety are more likely to have a longer postoperative recovery following a total hip replacement [3]. Additionally, one study found that compared to patients without symptoms of anxiety, those with symptoms of anxiety before surgery had poorer patient-reported outcomes and lower scores on a satisfaction survey at 3 and 12 months postoperatively [1].
Despite a widespread awareness of the importance of anxiety as a covariate in this context, Loos et al. [2] did not include anxiety in the model. They accounted for age, gender, occupation intensity, BMI, smoking, medical history, disease severity, quality of life, and general mental health. Although these are important factors, we believe certain mental health conditions such as anxiety should have been specifically investigated in this paper and considered for inclusion in the machine-learning tool the authors developed. We believe that the General Anxiety Disorder questionnaire (GAD-7) [5] might be particularly useful for this purpose.
Footnotes
(RE: Loos NL, Hoogendam L, Souer JS, et al. Machine learning can be used to predict function but not pain after surgery for thumb carpometacarpal osteoarthritis. Clin Orthop Relat Res. 2022;480:1271-1284).
The authors certify that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.
The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.
Contributor Information
Amir Reza Akbari, Email: amir.akbari1@nhs.net.
Benyamin Alam, Email: benalam@hotmail.co.uk.
References
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