title: The correlation of cognitive flexibility with pain intensity and magnitude of disability in upper extremity illness.
abstract: Cognitive flexibility - the ability to restructure one's knowledge, incorporate new facts, widen perspective, and adapt to the demands of new and unexpected conditions - can help one adapt to illness. The aim of this study was to assess the relationship between cognitive flexibility and hand and upper extremity specific disability in patients presenting to a hand surgeon. Secondarily, we determined predictors of cognitive flexibility and pain. Eighty-nine consecutive outpatients completed the Cognitive flexibility questionnaire (CFS), Short Health Anxiety Inventory-5 (SHAI-5), Pain Self-Efficacy Questionnaire (PSEQ), Disabilities of Arm, Shoulder and Hand, short form (QuickDASH), and Patient Health Questionnaire for Depression-2 (PHQ-2) in a cross-sectional study. CFS did not correlate with disability or pain intensity. Disability correlated with PSEQ (r = -0.66, p < 0.01), PHQ-2 (r = 0.38, p = <0.01), and SHAI-5 (r = 0.33, p < 0.01). Pain intensity correlated with PSEQ (r = -0.51 p < 0.01) and PHQ-2 (r = 0.41 p < 0.01). There was a small correlation between the CFS and PSEQ (r = 0.25, p = 0.02). The best multivariable models for QuickDASH and pain intensity included PSEQ and PHQ and explained 35 % and 28 % of the variability respectively. Upper extremity specific disability and pain intensity are limited more by self-efficacy than cognitive flexibility. Interventions to improve self-efficacy might help patients with upper extremity illness.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114 USA ; Behavioral Medicine Service, Clinical Psychologist, Harvard Medical School, Massachusetts General Hospital, One Bowdoin Square, 7th floor, Boston, MA 02114 USA.
authors.forename: Michiel G J S
authors.initials: MG
authors.lastname: Hageman
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114 USA ; Behavioral Medicine Service, Clinical Psychologist, Harvard Medical School, Massachusetts General Hospital, One Bowdoin Square, 7th floor, Boston, MA 02114 USA.
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Briet
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114 USA ; Behavioral Medicine Service, Clinical Psychologist, Harvard Medical School, Massachusetts General Hospital, One Bowdoin Square, 7th floor, Boston, MA 02114 USA.
authors.forename: Thijs C H
authors.initials: TC
authors.lastname: Oosterhoff
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114 USA ; Behavioral Medicine Service, Clinical Psychologist, Harvard Medical School, Massachusetts General Hospital, One Bowdoin Square, 7th floor, Boston, MA 02114 USA.
authors.forename: Arjan G
authors.initials: AG
authors.lastname: Bot
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114 USA ; Behavioral Medicine Service, Clinical Psychologist, Harvard Medical School, Massachusetts General Hospital, One Bowdoin Square, 7th floor, Boston, MA 02114 USA.
authors.forename: David
authors.initials: D
authors.lastname: Ring
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114 USA ; Behavioral Medicine Service, Clinical Psychologist, Harvard Medical School, Massachusetts General Hospital, One Bowdoin Square, 7th floor, Boston, MA 02114 USA.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Vranceanu
keywords: Cognitive flexibility scale; Disability; Pain intensity; Self-efficacy; Upper extremity