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CompletedNCT03458013Updated Nov 3, 2020

Psychosocial Outcomes in Hand Therapy

An interventional study of Mindfulness Meditation in Hand Injuries, sponsored by University of Southern California. Completed at 2 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2020-11-03.

Sponsored by University of Southern California · Not applicable, Interventional, and Other

Phase
Not applicable
Study type
Interventional
Enrollment
40
Allocation
Non-randomized
Ages
18 Years and older
Sex
All
01

Study summary

Rationale: there is a need for psychosocial symptom management in hand therapy which has been understudied. Mindfulness-based interventions are used to address psychosocial symptoms in other settings such as chronic injury but have yet to be implemented or explored for patients in acute outpatient rehabilitation.

Intervention: a supplemental mindfulness-based intervention (MBI) will be provided to the experimental group while the control group will receive standard care. The MBI will begin with an explanation of the purpose of a mindfulness, how mindfulness relates to hand therapy, and lead to a 20-minute guided meditation using an audio recording.

Objectives: to establish the feasibility of providing a MBI in hand therapy and evaluate preliminary effects of the MBI on patients' stress, anxiety, and depression.

Population: adult patients at an outpatient hand therapy clinic in the Los Angeles area who have received a traumatic injury (e.g., tendon laceration, compound fracture, finger amputation).

Methodology: the study will use a mixed-methods, non-randomized, 2-group, comparative trial design with 40 participants in total. Quantitative data on psychosocial outcomes, including salivary cortisol, will be collected once a week for 4 weeks while patients are attending hand therapy and qualitative interviews will be conducted at the end of the study.

Study arms: the experimental group (n = 20) will receive the MBI just before regularly scheduled standard care visits. The control group (n = 20) will receive only standard care.

Outcomes: this pilot study will be used to inform a future fully powered trial on mindfulness-based interventions in hand therapy. Feasibility and preliminary psychosocial effects of MBIs will be evaluated and used to inform future work.

Analysis: (1) A repeated measures ANOVA for intervention group, time, and time by intervention group effects on the psychosocial outcomes (i.e., Cortisol, Anxiety, Depression, and Pain Catastrophizing). (2) A descriptive qualitative process will be used to analyze themes in participant interview responses.

02

Conditions studied

  • Hand Injuries

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Keywords

  • Mindfulness
  • Complementary Medicine
  • Integrative Health
  • Hand Therapy
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • At least 18 years old; newly entering hand therapy, having a diagnosis of distal radius fracture, flexor tendon injury and repair, extensor tendon injury and repair, tramatic finger amputation, or other traumatic injury; established therapy plan of care lasting at least 4 weeks; able to read and with in English; with regular access to a computer.

Exclusion criteria

Exclusion Criteria:

  • diagnosed with a severe mental illness; currently an expert in mindfulness practices
04

Study design

Phase
Not applicable
Primary purpose
Other
Allocation
Non-randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
40 participants (actual)

Study arms

  • Experimental
    Mindfulness Meditation plus Hand Therapy

    Participants will be recruited from patients suffering from a traumatic injury who are entering hand therapy at a community based clinic in the Los Angeles area.

    Behavioral: Mindfulness Meditation

  • No intervention
    Standard Care in Hand Therapy

    Participants will be recruited from patients suffering from a traumatic injury who are entering hand therapy at a community based clinic in the Los Angeles area.

Interventions

  • BehavioralMindfulness Meditation

    Guided using an mp3 player and noise cancelling headphones, participants will be led through a series of mindfulness meditations lasting approximately 20 minutes each.

05

What researchers measure

Primary outcomes

  1. Change in Baseline Salivary Cortisol Across 4 weeks

    Cortisol is a bio-marker for stress (Aardal \& Holm, 1995). Normal values in healthy adults are sensitive to time of day, but range from 3.5 to 27.0 nmol/l in the morning. Higher salivary cortisol levels are an indicator of higher levels of stress.

    Time frame: Baseline, 1 week, 2 weeks, 3 weeks, 4 weeks

Secondary outcomes

  1. Change in Baseline State Anxiety Across 4 weeks

    The State-Trait Anxiety Inventory: State subscale (Spielberger, Vagg, Barker, Donham, \& Westberry, 1980) is scored positively (higher scores equate to higher anxiety) with a minimum score of 20 and a maximum score of 80. Normative data for this scale indicates that a cut point score of 40 and above is considered clinically relevant.

    Time frame: Baseline, 1 week, 2 weeks, 3 weeks, 4 weeks

  2. Change in Baseline Depression Across 4 weeks

    Center for Epidemiologic Studies - Depression scale (CES-D; Radloff, 1977), is a 20-item depression scale that is positively scored (higher scores equate to higher depression) ranging from 0 to 60. It is intended for use with the general population with a conservative off is score being greater than 16.

    Time frame: Baseline, 1 week, 2 weeks, 3 weeks, 4 weeks

  3. Change in Baseline Pain Catastrophizing Baseline Across 4 weeks

    Pain Catastrophizing Scale (Sullivan, Bishop, \& Pivik, 1995) measures an individual's exaggerated negative psychological response to pain or the anticipation of pain. The scale is scored positively across 13 total items composing 3 subscales: rumination, magnification, and helplessness. These subscales are added together to get the total score from 0 to 52. The middle 50% of scores on this scale fall between 10 and 30 points.

    Time frame: Baseline, 1 week, 2 weeks, 3 weeks, 4 weeks

06

Study locations

2 sites
  • St. Jude Centers for Rehabilitation & Wellness
    Brea, California 92821, United States
  • University of Southern California
    Los Angeles, California 90089, United States
07

References and documents

Publications

  • Aardal E, Holm AC. Cortisol in saliva--reference ranges and relation to cortisol in serum. Eur J Clin Chem Clin Biochem. 1995 Dec;33(12):927-32. doi: 10.1515/cclm.1995.33.12.927. PubMed 8845424 ↗
  • Spielberger CD, Vagg PR, Barker LR, Donham GW, Westberry LG. The factor structure of the State-Trait Anxiety Inventory. In CD Spielberger & IG Sarason (Eds.), Stress and anxiety (pp. 244-279). Washington, DC: Hemisphere; 1980.
  • Radloff, LS. The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement 1(3): 385-401, 1977.
  • Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: Development and validation. Psychological Assessment 7(4): 524 - 532, 1995.

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT03458013
Lead sponsor
University of Southern California
Collaborators
Abbott Medical Devices, California Foundation for Occupational Therapy
Responsible party
Shawn Roll (Associate Professor, University of Southern California) — Principal investigator
First posted
Mar 8, 2018
Start date
May 1, 2018
Primary completion
Jan 22, 2020
Completion
Jan 22, 2020
Last update
Nov 3, 2020

Study contacts

Shawn C Roll, PhD
study chair · University of Southern California
Mark E Hardison, MS
principal investigator · University of Southern California

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
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