A Preliminary Investigation of Cast Anxiety in General Orthopaedic Practice

Document Type: RESEARCH PAPER

Authors

1 University of Manchester Faculty of Medicine and Biological Sciences Manchester NHS Foundation Trust Hospital

2 Manchester NHS Foundation Trust Hospital

Abstract

Cast Anxiety (CA) is an unrecognised complication that results in frequent visits to fracture clinic in the UK. Failure to recognise CA leads to increased visits, frequent cast changes and possible failure of treatment despite no objective problems with the cast. Prior research has suggested a possible link between CA and claustrophobia. The Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-V) categorizes claustrophobia as a Specific Phobia (SP) and questionnaires for both claustrophobia and SP exist. The main purpose of this study is to examine the correlation between the SP Questionnaire and the Claustrophobia Questionnaire to identify if a link exists between CA and claustrophobia. The secondary goal is to develop a screening questionnaire to identify those at high risk of CA, the significance of which lies in possible prevention of CA and its associated complications.

Self-report questionnaires were distributed to patients attending fracture clinic and accident emergency (N=157). Patients were identified as having CA if they required frequent cast changes and frequent visits to fracture clinic despite no objective problems with the cast, or had themselves described feelings of anxiety/ claustrophobia. Subsequently, a screening questionnaire was developed and distributed to a second group of patients with the same inclusion and exclusion criteria (N=50).

A correlation between the two questionnaires was found: N= 157, r= 0.522, p < 0.001. Three themes were identified as encompassing CA: Anxiety, Cognition and Physiological responses and Behaviour. The screening questionnaire identified over 80% of patients suffering from CA when scoring > 20/26.

CA appears to be an anxiety based condition. The screening tool permits early identification of CA. Usage of the screening tool is encouraged prior to casting and for future research modifications. Early identification will allow consideration of an alternative treatment option, anticipatory conversation and could prevent the failure of treatment.

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