title: Contribution of kinesophobia and catastrophic thinking to upper-extremity-specific disability.
abstract: BACKGROUND
  Upper-extremity-specific disability correlates with mood and coping strategies. The aim of this study was to determine if two psychological factors, kinesiophobia (fear of movement) and perceived partner support, contribute significantly to variation in upper-extremity-specific disability in a model that included factors known to contribute to variation such as depression, pain anxiety, and catastrophic thinking.
  
  
  METHODS
  We performed an observational cross-sectional study of 319 patients who each had one of the following conditions: trigger finger (n = 94), carpal tunnel syndrome (n = 29), trapeziometacarpal arthrosis (n = 33), Dupuytren contracture (n = 31), de Quervain syndrome (n = 28), wrist ganglion cyst (n = 32), lateral epicondylosis (n = 41), and a fracture of the distal part of the radius treated nonoperatively six weeks previously (n = 31). Each patient completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and questionnaires measuring symptoms of depression, pain anxiety, catastrophic thinking, kinesiophobia, and perceived level of support from a partner or significant other. Stepwise multiple linear regression was used to determine significant independent predictors of the DASH score.
  
  
  RESULTS
  Men had significantly lower (better) DASH scores than women (21 versus 31; p < 0.01). DASH scores also differed significantly by diagnosis (p < 0.01), marital status (p = 0.047), and employment status (p < 0.01). The DASH score correlated significantly with depressive symptoms (p < 0.01), catastrophic thinking (p < 0.01), kinesiophobia (p < 0.01), and pain anxiety (p < 0.01) but not with perceived partner support. The best multivariable model of factors associated with greater arm-specific disability (according to the DASH score) included sex, diagnosis, employment status, catastrophic thinking, and kinesiophobia and accounted for 55% of the variation.
  
  
  CONCLUSIONS
  In this sample, kinesiophobia and catastrophic thinking were the most important predictors of upper-extremity-specific disability in a model that accounted for symptoms of depression, anxiety, and pathophysiology (diagnosis) and explained more than half of the variation in disability. Perceived partner support was not a significant factor. The consistent and predominant role of several modifiable psychological factors in disability suggests that patients may benefit from a multidisciplinary approach that optimizes mindset and coping strategies.
authors.affiliation: Department of Orthopaedic Surgery, MGH Orthopaedic Hand & Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Soumen
authors.initials: S
authors.lastname: Das De
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Vranceanu
authors.forename: David C
authors.initials: DC
authors.lastname: Ring
mesh_terms: D000328:Adult; D000368:Aged; D001168:Arthritis / Q000523:psychology; D002349:Carpal Tunnel Syndrome / Q000523:psychology; D058443:Catastrophization / Q000523:psychology*; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D004387:Dupuytren Contracture / Q000523:psychology; D005239:Fear / Q000523:psychology; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008663:Metacarpus; D008875:Middle Aged; D009068:Movement; D009135:Muscular Diseases / Q000523:psychology*; D010698:Phobic Disorders / Q000523:psychology*; D011795:Surveys and Questionnaires; D013716:Tennis Elbow / Q000523:psychology; D051222:Trapezium Bone; D052582:Trigger Finger Disorder / Q000523:psychology; D034941:Upper Extremity