title: Factors associated with pain intensity and physical limitations after lateral ankle sprains.
abstract: BACKGROUND
  Swelling, tenderness, and ecchymosis don't correlate with time to functional recovery in patients with a lateral ankle sprain. It is established that psychosocial factors such as symptoms of depression and low pain self-efficacy correlate with pain intensity and magnitude of limitations in patients with musculoskeletal disorders.
  
  
  OBJECTIVE
  We studied the correlation between pain self-efficacy or symptoms of depression and (1) ankle specific limitations and (2) pain intensity in patients with a lateral ankle sprain. Further we explored the correlation between estimation of sprain severity (grade) and (3) pain intensity or magnitude of ankle specific limitations.
  
  
  METHODS
  Eighty-four patients with a lateral ankle sprain prospectively completed the Pain Self Efficacy Questionnaire, the Olerud Molander Ankle Score, Ordinal scale of Pain and the Patient Health Questionnaire-2 at enrollment and the Olerud Molander Ankle Score and the Ordinal scale of Pain three weeks after the injury. Factors associated with higher ankle specific limitations and symptoms were investigated in bivariable and multivariable analysis.
  
  
  RESULTS
  When accounting for confounding factors, greater self-efficacy (p=0.01) and older age (p<0.01) were significantly associated with greater ankle specific symptoms and limitations three weeks after the injury and explained 22% of the variability in ankle specific limitations and symptoms. There was no correlation between the grade of the sprain and pain intensity or ankle specific limitations or symptoms.
  
  
  CONCLUSIONS
  Psychosocial factors (adaptiveness in response to pain in particular) explain more of the variation in symptoms and limitations after ankle sprain than the degree of pathophysiology. The influence of adaptive illness descriptions and recovery strategies based on methods for improving self-efficacy (i.e. cognitive behavioral therapy) might enhance and speed recovery from ankle injuries and merit additional investigation.
  
  
  METHODS
  Level 2 prospective cohort study.
authors.affiliation: Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582KE, Utrecht, The Netherlands. Electronic address: jp.briet@gmail.com.
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Briet
authors.affiliation: Utrecht Traumacenter, Utrecht, The Netherlands.
authors.forename: Roderick M
authors.initials: RM
authors.lastname: Houwert
authors.affiliation: Department of Orthopaedic surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, United States.
authors.forename: Michiel G J S
authors.initials: MGJS
authors.lastname: Hageman
authors.affiliation: Department of Surgery UMC Utrecht, Heidelberglaan 100, PO 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Falco
authors.initials: F
authors.lastname: Hietbrink
authors.affiliation: Department of Surgery and Perioperative Care, New Dell Medical Center, Austin, TX, United States.
authors.forename: David C
authors.initials: DC
authors.lastname: Ring
authors.affiliation: Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582KE, Utrecht, The Netherlands.
authors.forename: Egbert Jan J M
authors.initials: EJJM
authors.lastname: Verleisdonk
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D016512:Ankle Injuries / Q000503:physiopathology* / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010147:Pain Measurement; D020127:Recovery of Function; D020377:Self Efficacy; D013180:Sprains and Strains / Q000503:physiopathology* / Q000523:psychology
keywords: Ankle; Ankle sprain; Depression; Pain self-efficacy