No abstract

This study examined the relationships between self-report of depressive symptoms, perceived disability, and physical performance among 267 persons with chronic pain. Prior research has reported a relationship between depression and disability using self-report measures. However, self-report instruments may be prone to biases associated with depression as depressed persons with pain may have an exaggerated negative view of their level of function. In addition, we examined whether the relationship between depression and functional activity was mediated by physiologic effort (as measured by heart rate). The results indicated that self-report of depressive symptoms (using the Center for Epidemiological Studies-Depression Scale (CES-D)) was significantly correlated with self-report of disability on the Quebec Back Pain Disability Scale (QBPDS) and physical performance on the Progressive Isoinertial Lifting Evaluation (PILE). Regression analyses revealed that depression assessed by the CES-D significantly contributed to the prediction of QBPDS scores and PILE performance even when controlling for age, gender, site of pain, and pain intensity. The magnitude of the relationships between depression and self-report and functional activity were similar, suggesting that a self-report bias associated with depression is not responsible for an observed relationship between depression and disability. Physiologic effort partially mediated the relationship between depression and physical performance. The findings further highlight the importance of depression in the experience of chronic pain.

The data suggests that the process is complex, that customization did occur, and that at least one team decision led to better outcomes. While derived qualitatively, this decision-making tree provides a road map for less experienced teams and a precedent for researchers who wish to study individualized treatment.

Purpose/Objective: Adverse outcomes after traumatic spinal cord injury (TSCI) are not ubiquitous; that is, it is possible to thrive in the years after injury. Accordingly, we examined both the association between various factors and psychological flourishing, or ideal mental health, after TSCI, as well as the characteristics of adults with average or higher levels of psychological flourishing in terms of personality, social support, and executive functioning. Research Design: This study included two phases. In Phase 1, we collected information on demographic, health, and psychosocial variables from 449 adults with chronic TSCI using a mail survey. In Phase 2, we completed individual in-person assessments with a subset of 58 individuals from Phase 1 who had endorsed at least average levels of psychological flourishing and collected data using standardized measures of personality, social support, and executive functioning. Results: Phase 1 data indicated that being married, viewing oneself favorably in comparison to others, and reporting better subjective health ratings were significantly associated with higher levels of psychological flourishing. Phase 2 data suggested that, as a cohort, participants tended to display a resilient personality profile, report high-average levels of social support, and perform grossly within normal limits on a measure of executive functioning. Conclusion/ Implications: Our findings highlight factors associated with positive psychological outcomes after TSCI. A resilient personality profile, good social support, and unimpaired executive functioning capabilities appear to characterize adults who flourish with chronic TSCI. Impact and ImplicationsOur data indicated that, among adults with chronic TSCI, psychosocial factors (i.e., social comparison and health self-perception) are more strongly associated with psychological flourishing than either injury-related factors (i.e., NLI, injury completeness, and time since injury), medical complications (i.e., secondary conditions), or socioeconomic factors (i.e., household income, employment), underscoring the importance of evidence-based psychotherapies that directly target these psychosocial factors (e.g., cognitive-behavioral therapy; CBT) as a key approach for achieving positive outcomes. Adults who flourish with chronic TSCI appear to display distinct psychological attributes characterized by a resilient personality profile, high levels of social support, and at least adequate levels of executive functioning. Future studies of quality of life among adults with TSCI and other disabilities should include standardized measures of personality, social support, and cognitive functioning to explore the role these potentially modifiable variables have in influencing outcomes.

Deconditioning, psychosocial factors and functional deficits are common, complex, and variable among chronic back pain patients. This description of the STA provides a potentially reproducible standard for research into individualized treatment. The work provides benchmark data for independent multidisciplinary assessments.