{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T09:40:39Z","timestamp":1792489239076,"version":"4.5.0"},"reference-count":33,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify Hospital Anxiety and Depression Scale\u2013Anxiety (HADS\u2010A) trajectories after surgical treatment of distal radius fracture (DRF) in middle\u2010aged women, and their association with complex regional pain syndrome (CRPS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective longitudinal cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Tertiary hospital, China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>One thousand eight hundred seventy\u2010five consecutive women aged 40\u201365\u2009years undergoing surgical fixation of acute unilateral DRF (January 2019\u2013December 2022).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Primary outcome was CRPS diagnosed by the Budapest Clinical Criteria at 3\u2009months. HADS\u2010A was measured at baseline and 1, 2, 3 and 6\u2009months, with CRPS assessed at each follow\u2010up. Latent class trajectory modelling (LCTM) defined trajectory classes; time in target range (TTR) was the proportion of assessments with HADS\u2010A &lt;\u20098.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During 6\u2010month follow\u2010up, 150 women (8.0%) developed CRPS. LCTM identified four trajectories: low\u2010stable (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009983, 52.4%), moderate\u2010recovering (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009448, 23.9%), high\u2010persistent (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009265, 14.1%) and delayed\u2010onset (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009179, 9.5%). Incidence was 19.2% (high\u2010persistent) versus 4.9% (low\u2010stable). After adjustment, the high\u2010persistent trajectory was associated with CRPS (odds ratio [OR] 4.85, 95% confidence interval [CI] 1.85\u201312.71;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). TTR showed a graded exposure\u2013response relationship: 0% versus 100% TTR carried higher risk (adjusted OR: 4.97, 95% CI: 2.51\u20139.86;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001;\n                      <jats:italic>p<\/jats:italic>\n                      for trend &lt;\u20090.001). Subgroup interactions were non\u2010significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Persistently elevated postoperative anxiety, rather than transient distress confined to the perioperative period, was associated with CRPS after DRF surgery, with a graded exposure\u2013response relationship between cumulative anxiety burden (HADS\u2010A TTR) and risk. Serial psychological monitoring beyond baseline may help identify at\u2010risk patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance Statement<\/jats:title>\n                    <jats:p>This study provides the first evidence that longitudinal anxiety trajectory patterns, not single\u2010timepoint assessments, independently predict complex regional pain syndrome after distal radius fracture surgery. By introducing the \u201ctime in target range\u201d concept to psychological measurement, we demonstrate a dose\u2013response relationship between cumulative anxiety burden and CRPS risk. These findings reframe the longstanding debate on psychological contributors to CRPS and support serial anxiety monitoring as a clinically actionable strategy for early identification of at\u2010risk patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.70422","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:26:27Z","timestamp":1791966387000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hospital Anxiety and Depression Scale Trajectories and Risk of Complex Regional Pain Syndrome in Middle\u2010Aged Women After Surgical Treatment of Acute Distal Radial Fracture: A Prospective Longitudinal Cohort Study"],"prefix":"10.1002","volume":"30","author":[{"given":"Meihui","family":"Gao","sequence":"first","affiliation":[{"name":"Department of Orthopaedics Hainan People's Hospital  Haikou 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