Psychosocial Factors Related to Functional Restoration Treatment Completion and Return-to-Function for Patients With Chronic Disabling Occupational Musculoskeletal Disorders

Howard, Krista; Castaneda, Ricardo A.; Gray, Avia; Haskard‐Zolnierek, Kelly B.; Jordan, Krista

doi:10.1097/jom.0000000000000953

Cited by 12 publications

(5 citation statements)

References 30 publications

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“…The findings that greater pain intensity in the injured leg and lower accommodation of pain are associated with unhelpful thinking regarding symptoms—and the finding that magnitude of incapability was associated with symptoms of depression in sensitivity analyses—are consistent with prior studies of people with musculoskeletal disorders [10, 11, 23, 24]. Unhelpful thoughts such as catastrophic thinking and kinesiophobia are common during recovery from injury.…”

Section: Discussionsupporting

confidence: 83%

Is Pain in the Uninjured Leg Associated With Unhelpful Thoughts and Distress Regarding Symptoms During Recovery From Lower Extremity Injury?

Romere

Ramtin

Nunziato

et al. 2023

Clin Orthop Relat Res

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BackgroundPatients recovering from lower extremity injuries often interpret discomfort associated with increased use of the uninjured leg as a potential indication of harm. If expressed concerns regarding contralateral leg pain are associated with unhelpful thinking regarding symptoms, they can signal orthopaedic surgeons to gently reorient these thoughts to help improve comfort and capability during recovery.Questions/purposesWe asked: (1) Among people recovering from isolated traumatic lower extremity injury, is pain intensity in the uninjured leg associated with unhelpful thoughts and feelings of distress regarding symptoms, accounting for other factors? (2) Are pain intensity in the injured leg, magnitude of capability, and accommodation of pain associated with unhelpful thoughts and feelings of distress regarding symptoms?MethodsBetween February 2020 and February 2022, we enrolled 139 patients presenting for an initial evaluation or return visit for any traumatic lower extremity injury at the offices of one of three musculoskeletal specialists. Patients had the option to decline filling out our surveys, but because of the cross-sectional design, required fields on the electronic survey tools, and monitored completion, there were few declines and few incomplete surveys. The median age of participants was 41 years (IQR 32 to 58), and 48% (67 of 139) were women. Fifty percent (70 of 139) injured their right leg. Sixty-five percent (91 of 139) had operative treatment of their fracture. Patients completed measures of pain intensity in the uninjured leg, pain intensity in the injured leg, lower extremity–specific magnitude of capability, symptoms of depression, symptoms of health anxiety, catastrophic thinking, and accommodation of pain. Multivariable analysis sought factors independently associated with pain intensity in the uninjured leg, pain intensity in the injured leg, magnitude of capability, and pain accommodation, controlling for other demographic and injury-related factors.ResultsGreater pain intensity in the uninjured leg (regression coefficient [RC] 0.09 [95% CI 0.02 to 0.16]; p < 0.01) was moderately associated with more unhelpful thinking regarding symptoms. This indicates that for every one-unit increase in unhelpful thinking regarding symptoms on the 17-point scale we used to measure pain catastrophizing, pain intensity in the uninjured leg increases by 0.94 points on the 11-point scale that we used to measure pain intensity, holding all other independent variables constant. Greater pain intensity in the injured leg (RC 0.18 [95% CI 0.08 to 0.27]; p < 0.01) was modestly associated with more unhelpful thinking regarding symptoms. Greater pain accommodation (RC -0.25 [95% CI -0.38 to -0.12]; p < 0.01) was modestly associated with less unhelpful thinking regarding symptoms. Greater magnitude of capability was not independently associated with less unhelpful thinking regarding symptoms.ConclusionA patient’s report of concerns regarding pain in the uninjured limb (such as, “I’m overcompensating f...

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Section: Discussionsupporting

confidence: 83%

Is Pain in the Uninjured Leg Associated With Unhelpful Thoughts and Distress Regarding Symptoms During Recovery From Lower Extremity Injury?

Romere

Ramtin

Nunziato

et al. 2023

Clin Orthop Relat Res

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“…Many psychological and social factors are associated with symptom intensity and the magnitude of incapability; these metrics of symptom intensity can be quantified using patient-reported outcome measures (PROMs). For instance, unhelpful thoughts and distress account for a large amount of the variation in symptom intensity and magnitude of capability measured by PROMs [15]. Unhelpful thoughts about symptoms include worst-case thinking (commonly measured using the Pain Catastrophizing Scale) [22], fear of painful movement (Tampa Scale of Kinesiophobia) [18,20], and misinterpretation of symptoms (cognitive errors or negative pain thoughts) [10].…”

Section: Introductionmentioning

confidence: 99%

Do Unhelpful Thoughts or Confidence in Problem Solving Have Stronger Associations with Musculoskeletal Illness?

Rossano

Salman

Ring

et al. 2021

Clin Orthop Relat Res

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Background Measures of unhelpful thoughts and distress correlate with the intensity of pain and the magnitude of incapability among people seeking musculoskeletal specialty care. In this evolving knowledge area, we want to be sure we have not neglected other important mental health factors. This study addressed how measures of confidence in problem solving as well as past and current ability to achieve goals account for variation in symptoms and capability independent of unhelpful thoughts and distress. Questions/purposes (1) Are measures of confidence in problem solving ability and past and current ability to achieve goals regarding future outcomes associated with variation in capability, independent of measures of symptoms of depression and anxiety (distress) and measures of unhelpful thoughts (worst-case thinking, negative pain thoughts)? (2) Are these measures

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“…A number of recent studies of patients with chronic MSK injuries have demonstrated the effectiveness of identifying psychosocial risk factors and incorporating the biopsychosocial model of care into treatment to improve functionality and help restore a worker to their livelihood (K. J. Howard et al, 2017). The importance of recognizing this paradigm shift cannot be stressed enough.…”

Section: Management Of Acute and Chronic Painmentioning

confidence: 99%

Occupational and environmental medicine and the occupational health psychology interface.

Pompei,

Williams,

Newman

2024

Handbook of Occupational Health Psychology (3rd Ed.).

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Occupational and environmental medicine (OEM) is a clinical branch of medicine dedicated to the diagnosis, treatment, and prevention of injuries and illnesses resulting from exposures to hazards in the workplace. In the United States, OEM physicians provide much of their medical care through the workers' compensation insurance system. The OEM physician essentially works as the primary care physician limited to that portion of patient care related to work injury or illness. In addition to direct clinical care of workers, the OEM physician is trained to serve as a consultant, helping employers prevent occupational injuries and illnesses and promote health and well-being. Physicians receive training in public health and receive OEM board certification as one of the preventive medicine specialties. The spectrum of research conducted in OEM is vast, including epidemiology, hazardous exposure-related health effects, medical surveillance, substance use disorder treatment, injury prevention, health promotion, Total Worker Health ® , clinical trials, observational studies, and intervention science, among other fields.With growing numbers of workers, an aging workforce, and an increasing prevalence of chronic health conditions among workers, OEM physicians have begun to broaden their scope to address how personal health conditions contribute to work-related injuries and delayed recovery and affect a worker's ability to return to work. Reciprocally, researchers increasingly address how

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Psychosocial Factors Related to Functional Restoration Treatment Completion and Return-to-Function for Patients With Chronic Disabling Occupational Musculoskeletal Disorders

Abstract: Psychosocial and functional factors contribute to both functional restoration completion and 3-month return-to-function outcomes.

Cited by 12 publications

References 30 publications

Is Pain in the Uninjured Leg Associated With Unhelpful Thoughts and Distress Regarding Symptoms During Recovery From Lower Extremity Injury?

Is Pain in the Uninjured Leg Associated With Unhelpful Thoughts and Distress Regarding Symptoms During Recovery From Lower Extremity Injury?

Do Unhelpful Thoughts or Confidence in Problem Solving Have Stronger Associations with Musculoskeletal Illness?

Occupational and environmental medicine and the occupational health psychology interface.

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