Psychosocial Factors Predict Pain and Physical Health After Lower Extremity Trauma

被引:81
作者
Archer, Kristin R. [1 ,2 ]
Abraham, Christine M. [1 ,3 ]
Obremskey, William T. [1 ]
机构
[1] Vanderbilt Univ, Med Ctr, Dept Orthopaed Surg, Nashville, TN 37232 USA
[2] Vanderbilt Univ, Med Ctr, Dept Phys Med & Rehabil, Nashville, TN 37232 USA
[3] Lehigh Univ, Dept Educ & Human Serv, Bethlehem, PA 18015 USA
关键词
LOW-BACK-PAIN; COGNITIVE-BEHAVIORAL THERAPY; FEAR-AVOIDANCE BELIEFS; PERSISTENT PAIN; CATASTROPHIZING SCALE; MUSCULOSKELETAL PAIN; CURRENT STATE; TAMPA SCALE; DISABILITY; PREVALENCE;
D O I
10.1007/s11999-015-4504-6
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
100224 [整形外科学];
摘要
There has been increasing evidence to support the importance of psychosocial factors to poor outcomes after trauma. However, little is known about the contribution of pain catastrophizing and fear of movement to persistent pain and disability. Therefore, we aimed to determine whether (1) high pain catastrophizing scores are independently associated with pain intensity or pain interference; (2) high fear of movement scores are independently associated with decreased physical health; and (3) depressive symptoms are independently associated with pain intensity, pain interference, or physical health at 1 year after accounting for patient characteristics of age and education. Of 207 eligible patients, we prospectively enrolled 134 patients admitted to a Level I trauma center for surgical treatment of a fracture to the lower extremity. Sixty percent of patients (80 of 134) had an isolated lower extremity injury and the remainder sustained additional minor injury to the head/spine, abdomen/thorax, or upper extremity. Pain catastrophizing was measured with the Pain Catastrophizing Scale, fear of movement with the Tampa Scale for Kinesiophobia, and depressive symptoms with the Patient Health Questionnaire. Pain and physical health outcomes were assessed with the Brief Pain Inventory and the SF-12, respectively. Assessments were completed at 4 weeks and 1 year after hospitalization. Multiple variable hierarchical linear regression analyses were used to address study hypotheses. One hundred ten patients (82%) completed the 1-year followup. Pain catastrophizing at 4 weeks was associated with pain intensity (beta = 0.67; p < 0.001) and pain interference (beta = 0.38; p = 0.03) at 1 year. No association was found between fear of movement and physical health (beta = 0.15; p = 0.34). Depressive symptoms at 4 weeks were associated with pain intensity (beta = 0.49; p < 0.001), pain interference (beta = 0.51; p < 0.001), and physical health (beta = -0.32; p = 0.01) at 1 year. Catastrophizing behavior patterns and depressive symptoms are associated with more severe pain and worse function after traumatic lower extremity injury. Cognitive and behavioral strategies that have proven effective for chronic pain populations may be beneficial for trauma patients. Future research is needed to determine whether the early identification and treatment of subgroups of at-risk patients based on catastrophizing behavior or depressive symptoms can improve long-term outcomes. Level I, prognostic study.
引用
收藏
页码:3519 / 3526
页数:8
相关论文
共 67 条
[1]
Airey CM, 2001, DISABIL REHABIL, V23, P509
[2]
[Anonymous], 1990, Classical and modern regression with applications
[3]
Early postoperative fear of movement predicts pain, disability, and physical health six months after spinal surgery for degenerative conditions [J].
Archer, Kristin R. ;
Seebach, Caryn L. ;
Mathis, Shannon L. ;
Riley, Lee H., III ;
Wegener, Stephen T. .
SPINE JOURNAL, 2014, 14 (05) :759-767
[4]
Cognitive-Behavioral-Based Physical Therapy to Improve Surgical Spine Outcomes: A Case Series [J].
Archer, Kristin R. ;
Motzny, Nicole ;
Abraham, Christine M. ;
Yaffe, Donna ;
Seebach, Caryn L. ;
Devin, Clinton J. ;
Spengler, Dan M. ;
McGirt, Matthew J. ;
Aaronson, Oran S. ;
Cheng, Joseph S. ;
Wegener, Stephen T. .
PHYSICAL THERAPY, 2013, 93 (08) :1130-1139
[5]
Pain and satisfaction in hospitalized trauma patients: The importance of self-efficacy and psychological distress [J].
Archer, Kristin R. ;
Castillo, Renan C. ;
Wegener, Stephen T. ;
Abraham, Christine M. ;
Obremskey, William T. .
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 2012, 72 (04) :1068-1077
[6]
Cognitive-behavioral determinants of pain and disability two years after traumatic injury: A cross-sectional survey study [J].
Archer, Kristin R. ;
Abraham, Christine M. ;
Song, Yanna ;
Obremskey, William T. .
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 2012, 72 (02) :473-479
[7]
The Effect of Fear of Movement Beliefs on Pain and Disability After Surgery for Lumbar and Cervical Degenerative Conditions [J].
Archer, Kristin R. ;
Wegener, Stephen T. ;
Seebach, Caryn ;
Song, Yanna ;
Skolasky, Richard L. ;
Thornton, Colleen ;
Khanna, A. Jay ;
Riley, Lee H., III .
SPINE, 2011, 36 (19) :1554-1562
[8]
An analysis of outcomes of reconstruction or amputation of leg-threatening injuries [J].
Bosse, MJ ;
MacKenzie, EJ ;
Kellam, JF ;
Burgess, AR ;
Webb, LX ;
Swiontkowski, MF ;
Sanders, RW ;
Jones, AL ;
McAndrew, MP ;
Patterson, BM ;
McCarthy, ML ;
Travison, TG ;
Castillo, RC .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 347 (24) :1924-1931
[9]
Fear of movement: Factor structure of the Tampa Scale of Kinesiophobia in patients with fibromyalgia syndrome [J].
Burwinkle, T ;
Robinson, JP ;
Turk, DC .
JOURNAL OF PAIN, 2005, 6 (06) :384-391
[10]
The empirical status of cognitive-behavioral therapy: A review of meta-analyses [J].
Butler, AC ;
Chapman, JE ;
Forman, EM ;
Beck, AT .
CLINICAL PSYCHOLOGY REVIEW, 2006, 26 (01) :17-31