title: Expectancies Mediate the Relations Among Pain Catastrophizing, Fear of Movement, and Return to Work Outcomes After Whiplash Injury.
abstract: Pain catastrophizing and fear of movement have been identified as key predictors of prolonged work disability after whiplash injury. However, little is known about the processes by which pain catastrophizing and fear of movement affect return to work. This study investigated the mediating role of expectancies on the relations between pain catastrophizing and return to work, and between fear of movement and return to work after whiplash injury. The study sample consisted of 154 individuals with whiplash injury who were enrolled in a multidisciplinary pain rehabilitation program. Participants completed measures of pain catastrophizing, fear of movement, and return-to-work expectancies after admission to a rehabilitation program. A follow-up telephone interview was used to assess work status 1 year after discharge. Consistent with previous research, analyses revealed that expectancies, pain catastrophizing, and fear of movement were significant predictors of return to work at 1-year follow-up. Regression analyses (bootstrapping) revealed that expectancies partially mediated the relation between catastrophizing and return to work. Expectancies completely mediated the relation between fear of movement and return to work. The significant predictive and mediating role of expectancies on return to work argues for the inclusion of expectancies as a specific target of intervention for individuals with whiplash injury.
  
  
  CONCLUSIONS
  The findings suggest that expectancies might be part of the pathways by which pain catastrophizing and fear of movement affect return-to-work outcomes after whiplash injury. The findings argue for greater attention to return-to-work expectancies as a risk factor for problematic recovery outcomes as well as a target of intervention.
authors.affiliation: Department of Psychology, McGill University, Montreal, Quebec, Canada.
authors.forename: Junie S
authors.initials: JS
authors.lastname: Carriere
authors.affiliation: Department of Psychology, McGill University, Montreal, Quebec, Canada.
authors.forename: Pascal
authors.initials: P
authors.lastname: Thibault
authors.affiliation: CERE - Clinique d'Evaluation et de Readaptation de l'Est, Montreal, Quebec, Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Milioto
authors.affiliation: Department of Psychology, McGill University, Montreal, Quebec, Canada. Electronic address: michael.sullivan@mcgill.ca.
authors.forename: Michael J L
authors.initials: MJL
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D058443:Catastrophization / Q000209:etiology / Q000523:psychology*; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D019547:Neck Pain / Q000523:psychology / Q000534:rehabilitation*; D010147:Pain Measurement; D062707:Return to Work / Q000523:psychology*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014911:Whiplash Injuries / Q000150:complications* / Q000523:psychology; D055815:Young Adult
keywords: Catastrophizing; expectancies; fear of pain; return to work; whiplash