Psychosocial Factors Predict Pain and Physical Health After Lower Extremity Trauma

Archer, Kristin R.; Abraham, Christine M.; Obremskey, William T.

doi:10.1007/s11999-015-4504-6

Cited by 116Musculoskeletal pain and rehabilitationPediatric Pain Management TechniquesBone fractures and treatments

Psychosocial Factors Predict Pain and Physical Health After Lower Extremity Trauma

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Archer, Kristin R., Abraham, Christine M., Obremskey, William T.·2015·Clinical Orthopaedics & Related Research

DOI 10.1007/s11999-015-4504-6PMC PMC4586200

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Abstract

BACKGROUND: There has been increasing evidence to support the importance of psychosocial factors to poor outcomes after trauma. However, little is known about the contribution of pain catastrophizing and fear of movement to persistent pain and disability. QUESTIONS/PURPOSES: Therefore, we aimed to determine whether (1) high pain catastrophizing scores are independently associated with pain intensity or pain interference; (2) high fear of movement scores are independently associated with decreased physical health; and (3) depressive symptoms are independently associated with pain intensity, pain interference, or physical health at 1 year after accounting for patient characteristics of age and education. METHODS: Of 207 eligible patients, we prospectively enrolled 134 patients admitted to a Level I trauma center for surgical treatment of a fracture to the lower extremity. Sixty percent of patients (80 of 134) had an isolated lower extremity injury and the remainder sustained additional minor injury to the head/spine, abdomen/thorax, or upper extremity. Pain catastrophizing was measured with the Pain Catastrophizing Scale, fear of movement with the Tampa Scale for Kinesiophobia, and depressive symptoms with the Patient Health Questionnaire. Pain and physical health outcomes were assessed with the Brief Pain Inventory and the SF-12, respectively. Assessments were completed at 4 weeks and 1 year after hospitalization. Multiple variable hierarchical linear regression analyses were used to address study hypotheses. One hundred ten patients (82%) completed the 1-year followup. RESULTS: Pain catastrophizing at 4 weeks was associated with pain intensity (β = 0.67; p < 0.001) and pain interference (β = 0.38; p = 0.03) at 1 year. No association was found between fear of movement and physical health (β = 0.15; p = 0.34). Depressive symptoms at 4 weeks were associated with pain intensity (β = 0.49; p < 0.001), pain interference (β = 0.51; p < 0.001), and physical health (β = -0.32; p = 0.01) at 1 year. CONCLUSIONS: Catastrophizing behavior patterns and depressive symptoms are associated with more severe pain and worse function after traumatic lower extremity injury. Cognitive and behavioral strategies that have proven effective for chronic pain populations may be beneficial for trauma patients. Future research is needed to determine whether the early identification and treatment of subgroups of at-risk patients based on catastrophizing behavior or depressive symptoms can improve long-term outcomes. LEVEL OF EVIDENCE: Level I, prognostic study.

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The majority of research with yellow flag screening has been conducted in select patient populations.
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From Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation. (2023) · cites this paper as Archer et al., 2015

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Beyond the Knife—Reviewing the Interplay of Psychosocial Factors and Peripheral Nerve Lesions
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Health Literacy and Patient Participation in Shared Decision-Making in Orthopedic Surgery
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Cognitive-Behavioral–Based Physical Therapy for Improving Recovery After Traumatic Orthopaedic Lower Extremity Injury (CBPT-Trauma)
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Effect of Mental Health Conditions on Complications, Revision Rates, and Readmission Rates Following Femoral Shaft, Tibial Shaft, and Pilon Fracture
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Unique Contributions of Body Diagram Scores and Psychosocial Factors to Pain Intensity and Disability in Patients With Musculoskeletal Pain
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Understanding patient experience of distal tibia or ankle fracture: a qualitative systematic review
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The 12-Month Effects of the Trauma Collaborative Care Intervention
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Psychosocial Predictors of Chronic Pain 12 Months After Surgical Fixation for Lower Extremity Fracture: A Prospective Study
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Interventional Efforts to Reduce Psychological Distress after Orthopedic Trauma: A Systematic Review
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Relationship of Self-Reported Ability to Weight-Bear Immediately After Injury as Predictor of Stability for Ankle Fractures
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Investigation of Kinesiophobia, State and Trait Anxiety Levels in Patients with Lower Extremity Ligament Injury or Fracture History
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Physical activity behavior in the first month after mild traumatic brain injury is associated with physiological and psychological risk factors for chronic pain
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Can an Integrative Care Approach Improve Physical Function Trajectories after Orthopaedic Trauma? A Randomized Controlled Trial
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The Impact of Childhood Emotional Abuse on Pain Interference Among People with Chronic Pain who Inject Drugs in Vancouver, Canada
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Agreement and screening accuracy between physical therapists ratings and the Ӧrebro Musculoskeletal Pain Questionnaire in screening for risk of chronic pain during Musculoskeletal evaluation
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Influencia de los factores psicosociales en la experiencia de dolor musculoesquelético: una revisión de la literatura
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PTSD symptoms, pain catastrophizing, and pain outcomes after acute orthopedic injury
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Trajectory of Recovery in PROMIS Global Physical Health After Surgical Fracture Fixation
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Trauma recidivism is reduced with engagement in psychosocial programming following orthopaedic trauma
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Early Pain Catastrophizing Exacerbates Impaired Limb Loading and 6-Minute Walk Test Distance 12 Months After Lower Extremity Fracture
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Pain during physical examination of a healing upper extremity fracture
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Effects of Psychological Factors on the Clinical Outcomes of Fifth Metacarpal Neck Fractures and Relation to Injury Aetiology
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Racial Differences in Head Pain and Other Pain-Related Outcomes After Mild Traumatic Brain Injury
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Poor patient-reported mental health correlates with inferior patient-reported outcome measures following cervical disc replacement
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Biobehavioral Predictors of Pain Intensity, Pain Interference, and Chronic Pain Episodes: A Prospective Cohort Study of African-American Adults
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Outpatient Physical Therapy Use Following Tibial Fractures: A Retrospective Commercial Claims Analysis
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Analysis of effect of high-quality nursing on pain of emergency orthopedic trauma patients and related factors affecting postoperative pain.
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Reliability and Validity Evidence of the STarT-Lower Extremity Screening Tool for Patients With Lower Extremity Fracture: A Prospective Study
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The influence of pain-related comorbidities on pain intensity and pain-related psychological distress in patients presenting with musculoskeletal pain.
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Mental health resources for orthopaedic trauma patient care: a survey of orthopaedic trauma association members
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STarT-Lower Extremity Screening Tool at Six-weeks Predicts Pain and Physical Function 12-months after Traumatic Lower Extremity Fracture
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Effect of Severe Distal Tibia, Ankle, and Mid- to Hindfoot Trauma on Meeting Physical Activity Guidelines 18 Months After Injury
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Predictors of the transition from acute to persistent musculoskeletal pain in children and adolescents: a prospective study
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Enhancing the Evaluation of Physical Function Following Orthopaedic Trauma Care: Comparison of PROMIS Computerized Adaptive Testing and Short Musculoskeletal Function Assessment
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Pain Catastrophizing, Beliefs and Perception, and Their Association With Profiling Characteristics in Athletes.
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Psychosocial reactions to upper extremity limb salvage: A cross-sectional study
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Prevalence and Risk Factors of Postoperative Falls Following Foot and Ankle Surgery
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Functional Outcomes for Elderly Patients After ORIF for Distal Femur Fractures Are Similar to Outcomes for Patients After Primary Total Knee Arthroplasty
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Feasibility and acceptability of telephone‐delivered cognitive‐behavioral‐based physical therapy for patients with traumatic lower extremity injury
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Should high-power posing be integrated in physical therapy?
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Alt Ekstremitenin Kronik Ortopedik Problemlerinde Ağrı, Hareket Korkusu ve Kaygı Düzeyi Arasındaki İlişkinin Araştırılması
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Cognitive-Behavioral-Based Physical Therapy for Improving Recovery After a Traumatic Lower-Extremity Injury
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Persistent postsurgical pain in hip fracture patients. A prospective longitudinal study with multifaceted assessment
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Risk Factors for Prolonged Opioid Use after Orthopedic Trauma: Inner-City Hospital versus Community Hospital
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Odinofonía: una actualización clínica
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Screening for Mental Health Conditions in Athletes
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Reliability and validity of the Tampa Scale for Kinesiophobia in patients with traumatic hand–forearm injuries
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Patients’ and staffs’ experiences of clinical support after a lower limb reconstruction: An interview study
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Epidemiology of Pediatric Lower-Extremity Injuries in the 5 Most Popular US Sports: A 10-Year Analysis of National Injury Data (2015-2024)
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Kinesiophobia and knee biomechanical characteristics in patients with postoperative tibial plateau fractures across body mass index categories: a cross-sectional mediation analysis
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Which orthopaedic trauma patients need psychiatry consultation? A single institution pilot survey study
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CORR Insights®: What Factors Are Associated With Outcomes Scores After Surgical Treatment of Ankle Fractures With a Posterior Malleolar Fragment
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A cohort study of psychosocial factors in relationship to pain in patients with Spinal Cord Injury and Stroke in New Zealand
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Foot Injuries Outcomes Analysis
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Non-opioid Strategies for Pain Management of the Mangled Limb
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PRINCIPLE OF REHABILITATION & COMPLICATION PREVENTION AFTER MUSCULOSKELETAL TRAUMA
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Describing characteristics clinicians believe predictive of patient reported outcomes after adult's ankle fracture – A modified Delphi study
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Authors: Archer, K. R., Abraham, C. M., & Obremskey, W. T.
Affiliations: Vanderbilt University Medical Center (US)
Lehigh University (US)
ORCID: Archer, Kristin R.
Obremskey, William T.
Venue: Clinical Orthopaedics & Related Research
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2015-11
Volume: 473
Issue: 11
Pages: 3519-3526
ISSN: 0009-921X (ISSN-L)
DOI: 10.1007/s11999-015-4504-6
PMC: PMC4586200
OpenAlex: W2163029039
Cited by: 116
References: 68
Citations by year: 2026: 11 · 2025: 8 · 2024: 11 · 2023: 13 · 2022: 10 · 2021: 17 · 2020: 13 · 2019: 14 · 2018: 6 · 2017: 8 · 2016: 5
FWCI: 4.57
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Clinical Orthopaedics and Related Research (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Health Sciences › Medicine › Epidemiology › Bone fractures and treatments
Keywords: pain catastrophizing, kinesiophobia, depressive symptoms, lower limb fractures, traumatic injury, chronic pain, pain interference, physical health, post-traumatic depression
MeSH terms: Adaptation, Psychological, Adult, Depression, Disability Evaluation, Fear, Female, Health Status, Humans, Male, Mental Health, Middle Aged, Pain Measurement, Prognosis, Prospective Studies, Risk Factors, Multivariate Analysis, Linear Models, Lower Extremity, Fractures, Bone, Catastrophization, Musculoskeletal Pain

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Psychosocial Factors Predict Pain and Physical Health After Lower Extremity Trauma

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