title: Subjective cognitive dysfunction in rehabilitation outpatients with musculoskeletal disorders or chronic pain.
abstract: BACKGROUND
  Rehabilitation patients, without brain damage, sometimes complain about poor concentration and problems with their memory. The magnitude and associations, of this cognitive dysfunction, with different factors is unclear.
  
  
  OBJECTIVE
  To determine the magnitude of cognitive dysfunction in rehabilitation outpatient and to explore its associations with patient characteristics, diagnosis, surgery, pain, stress, anxiety and depression.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Rehabilitation outpatients.
  
  
  METHODS
  Between July 2009 and January 2012, 274 rehabilitation outpatients were included and divided in 8 different groups through diagnosis.
  
  
  METHODS
  Cognitive functioning was assessed using the cognitive failure questionnaire and compared with the general Dutch population. Associations of gender, age, diagnosis, recent surgery, pain and stress coping ability with cognitive function was explored. Mediation of depression and anxiety was explored.
  
  
  RESULTS
  The rehabilitation patients had a significantly higher score on the CFQ (mean 35.9±13.4) when compared to the general Dutch population (mean 31.8±11.1). Mean difference is 4.1, 95% confidence interval 2.60 to 5.60. In the stepwise linear regression analysis only gender, diagnosis and stress coping ability were significantly associated. A significant mediation effect was found of anxiety (P≤0.001) and depression (P≤0.005) between stress coping ability and cognitive function.
  
  
  CONCLUSIONS
  Rehabilitation outpatients experience more cognitive problems in comparison to the general Dutch population. Reported dysfunction of cognition in rehabilitation outpatients are associated with stress coping ability and for a small amount to gender and diagnosis. The association of stress coping ability and cognitive dysfunction is mediated by depression and anxiety. Women tend to report more dysfunctional cognition compared to men. Patient characteristics, surgery and experienced pain have no significant influence on the experienced cognitive dysfunction.
  
  
  CONCLUSIONS
  Cognitive problems reported by patients should be addressed by adapting the rehabilitation program, for instance write down instructions, repeat explanations and take more time for instructions. Cognitive problems in rehabilitation patients without brain damage is probably a stress coping problem and can be addressed by boosting resilience. Targeting depression or anxiety is another option of treatment cognition if those are mediating between stress coping and cognitive problems.
authors.affiliation: Center for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands - e.schrier@umcg.nl.
authors.forename: Ernst
authors.initials: E
authors.lastname: Schrier
authors.affiliation: Center for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jan H
authors.initials: JH
authors.lastname: Geertzen
authors.affiliation: Center for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Pieter U
authors.initials: PU
authors.lastname: Dijkstra
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D059350:Chronic Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation*; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation*; D009426:Netherlands; D010045:Outpatients / Q000523:psychology; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D016896:Treatment Outcome