Preliminary Investigation of Cast Anxiety in General Orthopaedic Practice

Background: anxiety following casting is an unrecognised complication that results in frequent visits to fracture clinicin the uk. there is a paucity of research regarding this complication. failure to recognise cast anxiety (ca) leads toincreased visits, frequent cast changes and possible failure of treatment despite no objective problems with the cast. priorresearch has suggested a possible link between ca and claustrophobia but lacks statistical evidence. the diagnosticand statistical manual of psychiatric disorders (dsm-v) categorizes claustrophobia as a specific phobia (sp) andquestionnaires for both claustrophobia and sp exist. as such, the main purpose of this study is to examine the statisticalcorrelation between the sp questionnaire and the claustrophobia questionnaire to identify if a link exists between caand claustrophobia. the secondary goal is to develop a screening questionnaire to identify those at high risk of ca, thesignificance of which lies in possible prevention of failure of surgical treatment and frequent visits to fracture clinic.methods: self-report questionnaires were distributed to patients attending fracture clinic and accident emergencyfor review/ cast application/ problems with the cast over a one month period, no preference between upper or lowerlimb casts. this group completed both self-report questionnaires (n=157). from this group, patients were identified ashaving ca if they required frequent cast changes and frequent visits to fracture clinic despite no objective problems withthe cast, or had themselves described feelings of anxiety/ claustrophobia. follow up interviews with patients identifiedas having ca were undertaken. on the basis of the data gathered, a screening questionnaire was developed anddistributed to a second group of patients with the same inclusion and exclusion criteria (n=50).results: a correlation between the two questionnaires was found: n= 157, r= 0.522, p<0.001. three themes wereidentified as encompassing ca: anxiety, cognition and physiological responses and behaviour, evidencing an anxietybased disorder. the screening questionnaire identified over 80% of patients suffering from ca when scoring > 20/26.*any patient scoring = 20/26 should be considered high risk of ca. conclusion: based on this data, ca fits the criteria of an anxiety based condition. the modified screening tool permitsearly identification of individuals at high risk of ca. usage of the screening tool is encouraged prior to casting and forfuture research modifications. early identification will allow consideration of an alternative treatment option, anticipatoryconversation and could prevent the failure of treatment.