Department of Orthopedics, New York University Langone Orthopedic Hospital, New York, NY 10014, USA.
Department of Orthopedics, New York University Grossman School of Medicine, New York, NY 10016, USA.
Mil Med. 2024 Aug 19;189(Suppl 3):12-17. doi: 10.1093/milmed/usae019.
Musculoskeletal injuries (MSIs) are a leading cause of separation from the U.S. Navy. Data have shown that several psychological responses to MSI are associated with treatment outcomes. Yellow flags are maladaptive psychological responses to injury and predict delayed recovery, whereas pink flags indicate resilience after MSI and are associated with good treatment outcomes. Identifying these factors in patients with MSI would permit early targeted care to address factors that may delay their readiness for deployment and enhance factors that support recovery.
Active duty service members with MSI who reported to physical therapy outpatient services at a naval hospital were recruited for the study. Yellow flags were assessed at baseline as part of a larger study. Participants completed the Fear Avoidance Beliefs Questionnaire (with two subscales, physical activity and work), the Pain Catastrophizing Scale, and the Hospital Anxiety and Depression Scale. Clinically relevant cut-off scores were used to indicate risk factors of delayed recovery. Pink flags were assessed with the Pain Self-Efficacy Questionnaire and a measure of positive outcome expectations for recovery.
Two hundred and ninety participants responded to some or all of the questionnaires. Of these, 82% exceeded the cut-off scores on the physical activity subscale of the Fear Avoidance Beliefs Questionnaire, and 39% did so on the work subscale. Pain catastrophizing exceeded the cut-off in only 4.9% of the sample. Forty-three percent of these exceeded the cut-off for the anxiety subscale of the Hospital Anxiety and Depression Scale; 27% exceeded the cut-off on the depression subscale of the Hospital Anxiety and Depression Scale. Additionally, 54% endorsed scores greater than 40 on the Pain Self-Efficacy Questionnaire, and 53% endorsed a high score on the positive outcome expectations.
A substantial portion of the sample endorsed elevated scores on one or more indicators of delayed recovery from MSI. Most participants showed a fear of physical activity, and approximately half reported pain-related distress (anxiety and depression). In addition, feelings of self-efficacy and positive outcome expectations of treatment were endorsed by only about half of the participants, indicating that the remaining half did not report adaptive responses to MSI. Early identification of these risk factors will allow for targeted treatment approaches that incorporate these yellow flags into treatment and support a psychologically informed approach to physical therapy. This approach is likely to reduce delayed recovery and improve deployment readiness.
肌肉骨骼损伤（MSI）是导致美国海军人员分离的主要原因。数据表明，对 MSI 的几种心理反应与治疗结果有关。黄码是对损伤的适应不良的心理反应，预示着恢复延迟，而粉码则表示 MSI 后的韧性，并与良好的治疗结果相关。在患有 MSI 的患者中识别这些因素可以允许早期进行有针对性的护理，以解决可能导致他们准备部署的延迟的因素，并增强支持康复的因素。
向海军医院的物理治疗门诊服务报到的患有 MSI 的现役军人被招募参加这项研究。黄码是作为更大规模研究的一部分在基线时进行评估的。参与者完成了恐惧回避信念问卷（包括两个子量表，身体活动和工作）、疼痛灾难化量表和医院焦虑抑郁量表。使用临床相关的临界值分数来表示恢复延迟的危险因素。粉码是通过疼痛自我效能问卷和对恢复的积极结果期望的衡量来评估的。
290 名参与者回答了部分或全部问卷。其中，82%的人在恐惧回避信念问卷的身体活动子量表上超过了临界值，39%的人在工作子量表上超过了临界值。疼痛灾难化在样本中仅 4.9%的人超过临界值。其中 43%的人超过了医院焦虑抑郁量表焦虑子量表的临界值；27%的人超过了医院焦虑抑郁量表抑郁子量表的临界值。此外，54%的人在疼痛自我效能问卷上的得分大于 40，53%的人对积极的结果期望有较高的评分。
样本中的很大一部分人在从 MSI 中恢复的一个或多个指标上的得分较高。大多数参与者表现出对身体活动的恐惧，大约一半的人报告了与疼痛相关的痛苦（焦虑和抑郁）。此外，只有大约一半的参与者表示对治疗的自我效能感和积极的结果期望，这表明另一半人没有对 MSI 做出适应性反应。早期识别这些危险因素将允许采用针对性的治疗方法，将这些黄码纳入治疗，并支持对物理治疗进行心理知情的方法。这种方法可能会减少恢复延迟并提高部署准备。
