Academic journal article Physical Therapy

Development of a Cumulative Psychosocial Factor Index for Problematic Recovery Following Work-Related Musculoskeletal Injuries

Academic journal article Physical Therapy

Development of a Cumulative Psychosocial Factor Index for Problematic Recovery Following Work-Related Musculoskeletal Injuries

Article excerpt

Work-related musculoskeletal injuries are a leading cause of prolonged pain and occupational disability. Clinical practice guidelines commonly recommend activity-based interventions, such as physical therapy, for individuals with subacute musculoskeletal pain conditions. (1-4) Although most individuals with these conditions make a full recovery, an estimated 10% to 20% will go on to develop chronic pain and disability. (5) This relatively small but significant group accounts for the large majority of the workers' compensation expenditures that are associated with these conditions. (5) Previous research suggests that psychosocial factors measured in the early stages of recovery can help predict patients' prognoses for long-term rehabilitation. (6-9)

Factors such as fear of movement, depression, and pain catastrophizing have been shown to be important predictors of a wide range of rehabilitation and work-related outcomes. For example, previous research has shown that these psychosocial factors prospectively predict measures of pain severity, physical function, and return-to-work status, even after controlling for baseline levels of pain. (10-13) Related research has shown that these prognostic factors are modifiable and that their treatment-related reduction is associated with improved rehabilitation outcomes. (14-18) In response to these findings, there have been calls in the literature to address psychosocial factors in physical therapist practice. (9,16,19-21)

Despite the established clinical importance of different psychosocial factors, there is a lack of research that facilitates the clinical interpretation of these measures by physical therapists. One challenge is that previous research exploring the clinical implications of psychosocial factors has typically reported results in the form of regression coefficients. Although high in statistical and theoretical utility, regression coefficients are relatively low in clinical utility. For instance, previous studies that have used regression coefficients alone have not provided adequate information about the clinical implications of patients with a varying number of elevated scores on different psychosocial factors. For the practicing clinician, therefore, it remains a challenge to understand the prognostic implications of patients who have elevated scores on more than one psychosocial factor.

To date, there is only limited research exploring the cumulative relationship among different psychosocial factors. Recent findings suggest that different psychosocial factors might have an additive effect on patients' prognoses for problematic outcomes. (22) For instance, a recent study suggests that patients seen for physical therapy with high scores on measures of both pain catastrophizing and depression are more likely to have a problematic recovery than individuals with elevated scores on just one measure. (23) This research suggests that information regarding the number of elevated psychosocial factors may help physical therapists better determine their patients' prognoses for recovery. This line of research, however, remains in its infancy. For instance, previous research exploring the cumulative effect of different psychosocial factors among patients seen for physical therapy has yet to consider the effects of fear of movement. There is a compelling body of research in the field of physical therapy linking pain-related fear to a wide variety of clinical outcomes. (24-27) Also, the fear-avoidance model (FAM) of pain suggests that, in addition to pain catastrophizing and depression, fear of movement is an important determinant of prolonged pain and pain-related disability. (28) Further research exploring the cumulative relationship among these 3 psychosocial factors may help guide physical therapists in the clinical management of patients with pain conditions. (23)

The purpose of this study was to determine whether the risk for problematic recovery following work-related injuries varies as a function of the number of elevated psychosocial factors. …

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