Department of Orthopaedic Surgery, University Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Orthopedic Surgery, Dell Medical School, the University of Texas at Austin, Austin, Texas.
Clin Orthop Relat Res. 2022 Feb 1;480(2):276-283. doi: 10.1097/CORR.0000000000002006.
Among people with musculoskeletal disorders, much of the variation in magnitude of incapability and pain intensity is accounted for by mental and social health opportunities rather than severity of pathology. Current questionnaires seem to combine distinct aspects of mental health such as unhelpful thoughts and distress regarding symptoms, and they can be long and burdensome. To identify personalized health strategies, it would be helpful to measure unhelpful thoughts and distress regarding symptoms at the point of care with just a few questions in a way that feels relevant to a person's health.
QUESTIONS/PURPOSES: (1) Do questions that address unhelpful thoughts and distress regarding symptoms independently account for variation in accommodation of pain? (2) Which questions best measure unhelpful thoughts and distress regarding symptoms?
This is a cross-sectional questionnaire study of people seeking care regarding upper and lower extremity conditions from one of eight specialist clinicians (one upper extremity, one arthroplasty, and one sports surgeon and their three nurse practitioners and two physician assistants) in one urban office. Between June 2020 and September 2020, 171 new and returning patients were approached and agreed to participate, and 89% (153) of patients completed all questionnaires. The most common reason for noncompletion was the use of a pandemic strategy allowing people to use their phone to finish the questionnaire, with more people leaving before completion. Women and divorced, separated, or widowed people were more likely to not complete the survey, and we specifically account for sex and marital status as potential confounders in our multivariable analysis. Forty-eight percent (73 of 153) of participants were women, with a mean age 48 ± 16 years. Participants completed demographics and the validated questionnaires: Pain Catastrophizing Scale, Negative Pain Thoughts Questionnaire, Tampa Scale of Kinesiophobia, Intolerance of Uncertainty Scale, and Pain Self-Efficacy Questionnaire (a measure of accommodation to pain). In an exploratory factor analysis, we found that questions group together on four topics: (1) distress about symptoms (unhelpful feelings of worry and despair), (2) unhelpful thoughts about symptoms (such as worst-case thinking and pain indicating harm), (3) being able to plan, and (4) discomfort with uncertainty. We used a multivariable analysis, accounting for potential confounding demographics, to determine whether the identified question groupings account for variation in accommodation of pain-and thus are clinically relevant. Then, we used a confirmatory factor analysis to determine which questions best represent clinically relevant groupings of questions.
After accounting for sex, marital status, work, and income, we found that distress and unhelpful thoughts about symptoms were independently associated with accommodation of pain, and together, they explained 60% of its variation (compared with 52% for distress alone and 40% for unhelpful thoughts alone). Variation in symptoms of distress was best measured by the question "I feel I can't stand it anymore" (76%). Variation in unhelpful thoughts was best addressed by the question "I wouldn't have this much pain if there wasn't something potentially dangerous going on in my body" (64%).
We found that distress (unhelpful feelings) and unhelpful thoughts about symptoms are separate factors with important and comparable associations with accommodation to pain. It also appears that these two factors can be measured with just a few questions. Being attentive to the language people use and the language of influential questions might improve clinician identification of mental health opportunities in the form of distress and unhelpful thoughts about symptoms, which in turn might contribute to better accommodation and alleviation of symptoms.
Level II, prognostic study.
在患有肌肉骨骼疾病的人群中，疼痛强度和失能程度的变化在很大程度上归因于心理健康和社会健康机会，而不是疾病的严重程度。目前的问卷似乎将心理健康的不同方面（如对症状的无益想法和痛苦）结合在一起，而且可能会很长且繁琐。为了确定个性化的健康策略，在护理点使用几个问题来测量对症状的无益想法和痛苦，这将有助于识别个人的健康状况。
问题/目的：（1）单独针对症状的无益想法和痛苦的问题是否可以解释疼痛适应能力的变化？（2）哪些问题最能衡量对症状的无益想法和痛苦？
这是一项横断面问卷调查研究，研究对象为来自 8 位专科临床医生（1 位上肢、1 位关节置换和 1 位运动外科医生及其 3 位护士从业者和 2 位医生助理）的上肢和下肢疾病就诊者。2020 年 6 月至 2020 年 9 月，共有 171 名新老患者被邀请并同意参与，其中 89%（153 人）的患者完成了所有问卷。未完成的最常见原因是使用允许人们使用手机完成问卷的大流行策略，更多的人在完成前离开。女性和离婚、分居或丧偶的人更有可能不完成调查，我们在多变量分析中特别考虑了性别和婚姻状况作为潜在的混杂因素。48%（73/153）的参与者为女性，平均年龄为 48±16 岁。参与者完成了人口统计学和验证后的问卷：疼痛灾难化量表、负性疼痛思维问卷、坦帕运动恐惧量表、不确定容忍量表和疼痛自我效能问卷（衡量对疼痛的适应能力）。在探索性因素分析中，我们发现问题可以分为四个主题：（1）对症状的担忧（无益的担忧和绝望感）；（2）对症状的无益想法（如最坏情况的想法和疼痛表明存在伤害）；（3）能够计划；（4）对不确定性的不适。我们使用多变量分析，考虑了潜在的混杂人口统计学因素，以确定识别出的问题分组是否可以解释疼痛适应能力的变化，从而具有临床相关性。然后，我们使用验证性因素分析来确定哪些问题最能代表具有临床相关性的问题分组。
在考虑了性别、婚姻状况、工作和收入后，我们发现症状的痛苦和无益的想法与疼痛适应能力独立相关，两者共同解释了 60%的变化（相比之下，仅痛苦的解释率为 52%，无益的想法为 40%）。症状痛苦变化最好通过问题“我觉得我无法忍受了”来衡量（76%）。无益的想法变化最好通过问题“如果我的身体没有潜在的危险，我就不会有这么多的疼痛”来衡量（64%）。
我们发现痛苦（无益的感觉）和对症状的无益想法是独立的因素，与疼痛适应能力有重要且可比的关联。似乎这两个因素可以通过几个问题来衡量。关注人们使用的语言和有影响力的问题的语言可能会提高临床医生识别痛苦和对症状的无益想法的心理健康机会，这反过来又可能有助于更好地适应和缓解症状。
二级，预后研究。
