title: Does perceived injustice correlate with pain intensity and disability in orthopaedic trauma patients?
abstract: BACKGROUND
  Individuals who experience musculoskeletal trauma may construe the experience as unjust and themselves as victims. Perceived injustice is a cognitive construct comprised by negative appraisals of the severity of loss as a consequence of injury, blame, injury-related loss, and unfairness. It has been associated with worse physical and psychological outcomes in the context of chronic health conditions. The purpose of this study is to explore the association of perceived injustice to pain intensity and physical function in patients with orthopaedic trauma.
  
  
  METHODS
  A total of 124 orthopaedic trauma patients completed the Injustice Experience Questionnaire (IEQ), the PROMIS Physical Function Computer Adaptive Testing (CAT), the PROMIS Pain Intensity instruments, the short form Patient Health Questionnaire for depression (PHQ-2), the short form Pain Self-Efficacy Questionnaire (PSEQ-2), and the short form Pain Catastrophizing Scale (PCS-4) on a tablet computer. A stepwise linear regression model was used to identify the best combination of predictors explaining variance in PROMIS Physical Function and PROMIS Pain Intensity.
  
  
  RESULTS
  The IEQ was associated with PROMIS Physical Function (r=-0.36; P<0.001) and PROMIS Pain Intensity (r=0.43; P<0.001). In multivariable analysis, however, Caucasian race (β=5.1, SE: 2.0, P=0.013, 95% CI: 1.1-9.2), employed work status (β=5.1, SE: 1.5, P=0.001, 95% CI: 2.1-8.2), any cause of injury other than sports, mvc, or fall (β=7.7, SE: 2.1, P<0.001, 95% CI: 3.5-12), and higher self-efficacy (PSEQ-2; β=0.93, SE: 0.23, P<0.001, 95% CI: 0.48-1.4) were selected as part of the best model predicting variance in PROMIS Physical Function. Only a higher degree of catastrophic thinking (PCS-4; β=1.2, SE: 0.12, P<0.001, 95% CI: 0.99 to 1.5) was selected as important in predicting higher PROMIS Pain Intensity.
  
  
  CONCLUSIONS
  Perceived injustice was associated with both physical function and pain intensity in bivariate correlations, but was not deemed as an important predictor when assessed along with other demographic and psychosocial variables in multivariable analysis. This study confirms prior research on the pivotal role of catastrophic thinking and self-efficacy in reports of pain intensity and physical function in patients with acute traumatic musculoskeletal pain.
authors.affiliation: Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, United States of America. Electronic address: wouter.f.vanleeuwen@gmail.com.
authors.forename: Wouter F
authors.initials: WF
authors.lastname: van Leeuwen
authors.affiliation: Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, United States of America. Electronic address: q.m.j.vandervliet@gmail.com.
authors.forename: Quirine M J
authors.initials: QM
authors.lastname: van der Vliet
authors.affiliation: Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, United States of America. Electronic address: steinjanssen@gmail.com.
authors.forename: Stein J
authors.initials: SJ
authors.lastname: Janssen
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Trauma Service, Massachusetts General Hospital, Harvard Medical School, United States of America. Electronic address: mheng@mgh.harvard.edu.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Heng
authors.affiliation: Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, United States of America. Electronic address: david.ring@austin.utexas.edu.
authors.forename: David
authors.initials: D
authors.lastname: Ring
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States of America. Electronic address: avranceanu@mgh.harvard.edu.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Vranceanu
mesh_terms: D058443:Catastrophization / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000503:physiopathology / Q000523:psychology*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000503:physiopathology / Q000523:psychology*; D010146:Pain / Q000503:physiopathology / Q000523:psychology*; D010147:Pain Measurement; D011594:Psychometrics; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: Disability; Orthopaedic; Pain intensity; Perceived injustice; Physical function; Trauma