title: Psychological Distress Mediates the Relationship Between Pain and Disability in Hand or Wrist Fractures.
abstract: Upper limb fracture is a common musculoskeletal injury and can lead to marked pain-related disability. Unlike other common painful musculoskeletal conditions, such as low back pain, little consideration has been given to the role that psychological variables may play in explaining the relationship between pain and disability during early fracture recovery. This cross-sectional study aimed to determine if psychological distress (symptoms of depression, anxiety, and/or stress) mediate the relationship between pain and disability in acute hand/wrist fractures. Self-reported data from a consecutive sample of 594 patients with acute hand/wrist fracture were used. Mediation analyses were conducted to determine the role of depression, anxiety, and stress in the relationship between pain and disability, controlling for relevant demographic and fracture-related variables. Depression and stress, but not anxiety, significantly mediated the relationship between pain and disability. That is, although each psychological distress variable was associated with pain (P < .001), only depression (b1 = 0.27, P = .03) and stress (b3 = .23, P = .02) were significantly associated with disability and fulfilled recommended criteria for establishing a mediating variable. Increased depression and stress, but not anxiety, explain the relationship between pain and disability and may be novel targets for interventions designed to reduce pain-related disability after upper limb fracture. Perspective: This study presents the mediating effect of psychological distress on the relationship between pain and disability in acute upper limb fracture. These factors may be novel targets for interventions designed to reduce pain-related disability after acute fracture.
authors.affiliation: Neuroscience Research Australia, Sydney, Australia; University of California San Francisco, Madison Clinic for Pediatric Diabetes, San Francisco, California.
authors.forename: Cassie
authors.initials: C
authors.lastname: Ross
authors.affiliation: Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, University of Sydney, NSW, Australia.
authors.forename: Ilona
authors.initials: I
authors.lastname: Juraskova
authors.affiliation: Neuroscience Research Australia, Sydney, Australia; University of New South Wales Clinical School, Sydney, Australia.
authors.forename: Hopin
authors.initials: H
authors.lastname: Lee
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Luke
authors.initials: L
authors.lastname: Parkitny
authors.affiliation: Neuroscience Research Australia, Sydney, Australia; University of South Australia, PainAdelaide, Adelaide, Australia.
authors.forename: Tasha R
authors.initials: TR
authors.lastname: Stanton
authors.affiliation: Neuroscience Research Australia, Sydney, Australia; University of South Australia, PainAdelaide, Adelaide, Australia.
authors.forename: G Lorimer
authors.initials: GL
authors.lastname: Moseley
authors.affiliation: Neuroscience Research Australia, Sydney, Australia; University of New South Wales Clinical School, Sydney, Australia.
authors.forename: James H
authors.initials: JH
authors.lastname: McAuley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006230:Hand Injuries / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010146:Pain / Q000150:complications*; D013223:Statistics as Topic; D013315:Stress, Psychological / Q000209:etiology*; D014954:Wrist Injuries / Q000150:complications*; D055815:Young Adult
keywords: Depression; disability; fracture; pain; psychological distress; stress