Article

Psychosocial variables such as fear of movement, depression, and pain
catastrophizing have been shown to be important prognostic factors for a wide
range of pain-related outcomes. The potential for a cumulative relationship
between different elevated psychosocial factors and problematic recovery
following physical therapy has not been fully explored. OBJECTIVE: The purpose of
this study was to determine whether the level of risk for problematic recovery
following work-related injuries is associated with the number of elevated
psychosocial factors. DESIGN: This was a prospective cohort study. METHODS: Two
hundred two individuals with subacute, work-related musculoskeletal injuries
completed a 7-week physical therapy intervention and participated in testing at
treatment onset and 1 year later. An index of psychosocial risk was created from
measures of fear of movement, depression, and pain catastrophizing. This index
was used to predict the likelihood of experiencing problematic recovery in
reference to pain intensity and return-to-work status at the 1-year follow-up.
RESULTS: Logistic regression analysis revealed that the number of prognostic
factors was a significant predictor of persistent pain and work disability at the
1-year follow-up. Chi-square analysis revealed that the risk for problematic
recovery increased for patients with elevated levels on at least 1 psychosocial
factor and was highest when patients had elevated scores on all 3 psychosocial
factors. LIMITATIONS: The physical therapy interventions used in this study were
not standardized. This study did not include a specific measure for physical
function. CONCLUSIONS: The number of elevated psychosocial factors present in the
subacute phase of recovery has a cumulative effect on the level of risk for
problematic recovery 1 year later. This research suggests that a cumulative
prognostic factor index could be used in clinical settings to improve prognostic
accuracy and to facilitate clinical decision making.

Langue : ANGLAIS