Development of a cumulative psychosocial factor index for problematic recovery following work-related musculoskeletal injuries.
BACKGROUND
Psychosocial variables such as fear of movement, depression, and pain catastrophizing have been shown to be important prognostic factors for a wide range of pain-related outcomes. The potential for a cumulative relationship between different elevated psychosocial factors and problematic recovery following physical therapy has not been fully explored.


OBJECTIVE
The purpose of this study was to determine whether the level of risk for problematic recovery following work-related injuries is associated with the number of elevated psychosocial factors.


METHODS
This was a prospective cohort study.


METHODS
Two hundred two individuals with subacute, work-related musculoskeletal injuries completed a 7-week physical therapy intervention and participated in testing at treatment onset and 1 year later. An index of psychosocial risk was created from measures of fear of movement, depression, and pain catastrophizing. This index was used to predict the likelihood of experiencing problematic recovery in reference to pain intensity and return-to-work status at the 1-year follow-up.


RESULTS
Logistic regression analysis revealed that the number of prognostic factors was a significant predictor of persistent pain and work disability at the 1-year follow-up. Chi-square analysis revealed that the risk for problematic recovery increased for patients with elevated levels on at least 1 psychosocial factor and was highest when patients had elevated scores on all 3 psychosocial factors.


CONCLUSIONS
The physical therapy interventions used in this study were not standardized. This study did not include a specific measure for physical function.


CONCLUSIONS
The number of elevated psychosocial factors present in the subacute phase of recovery has a cumulative effect on the level of risk for problematic recovery 1 year later. This research suggests that a cumulative prognostic factor index could be used in clinical settings to improve prognostic accuracy and to facilitate clinical decision making.
T.H. Wideman, Department of Psychology, McGill University, Montreal, Quebec, Canada.
Timothy H
TH
Wideman
Michael J L
MJ
Sullivan
D000062:Accidents, Occupational / Q000523:psychology*; D000328:Adult; D019567:Back Injuries / Q000503:physiopathology / Q000523:psychology* / Q000534:rehabilitation*; D058443:Catastrophization; D016009:Chi-Square Distribution; D003863:Depression / Q000523:psychology; D004185:Disability Evaluation; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D019838:Neck Injuries / Q000503:physiopathology / Q000523:psychology* / Q000534:rehabilitation*; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D020127:Recovery of Function; D018570:Risk Assessment; D016896:Treatment Outcome