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A Prospective Study of Factors Affecting Recovery from Musculoskeletal Injuries

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Abstract

Purpose Research suggests the importance of psychosocial factors in recovery from musculoskeletal injuries. The objective of this study was to identify predictors of recovery among U.S. Marines who had musculoskeletal injuries of the back, knee, or shoulder. Methods A sample of 134 participants was assessed at baseline and followed for 1 year to determine outcome information. Results The strongest predictor of injury recovery at the 1-year follow-up was recovery expectations. In a multivariate logistic model with key demographic and psychosocial factors controlled, individuals who had high recovery expectations at baseline were over five times as likely to be recovered at follow-up as individuals who had low expectations (OR = 5.18, p < .01). Conclusions This finding is consistent with a large body of research that has linked recovery expectations with better recovery outcomes in patients with musculoskeletal injuries as well as with research linking recovery expectations with better outcomes across a wide range of medical conditions. Applied to military populations, interventions designed to modify recovery expectations may have the potential to improve rates of return to duty and to reduce rates of disability discharge.

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References

  1. Walter Reed Army Institute of Research. AMSARA: Accession medical standards analysis and research activity annual report 2009. Silver Spring, MD: WRAIR; 2010.

    Google Scholar 

  2. Walter Reed Army Institute of Research. AMSARA: accession medical standards analysis and research activity tri-service disability evaluation systems database review: annual report 2010. Silver Spring, MD: WRAIR; 2011.

    Google Scholar 

  3. Fransen M, Woodward M, Norton R, Coggan C, Dawe M, Sheridan N. Risk factors associated with the transition from acute to chronic occupational pain. Spine. 2002;27:92–8.

    Article  PubMed  Google Scholar 

  4. Krause N, Frank JW, Dasinger LK, Sullivan TJ, Sinclair SJ. Determinants of duration of disability and return-to-work after work-related injury and illness: challenges for future research. Am J Ind Med. 2001;40:464–84.

    Article  CAS  PubMed  Google Scholar 

  5. Pincus T, Burton AK, Vogel S, Field AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine. 2002;27:E109–20.

    Article  PubMed  Google Scholar 

  6. Dionne CE, Bourbonnais R, Fremont P, Rossignol M, Stock SR, Larocque I. A clinical return-to-work rule for patients with back pain. CMAJ. 2005;172:1559–67.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Iles RA, Davidson M, Taylor NF. Psychosocial predictors of failure to return to work in non-chronic non-specific low back pain: a systematic review. Occup Environ Med. 2009;65:507–16.

    Article  Google Scholar 

  8. Schultz IZ, Crook J, Meloche GR, Berkowitz J, Milner R, Zuberbier OA, Meoche W. Psychosocial factors predictive of occupational low back disability: towards development of a return-to-work model. Pain. 2004;107:77–85.

    Article  CAS  PubMed  Google Scholar 

  9. Booth-Kewley S, Larson GE, Highfill-McRoy RM. Psychosocial predictors of return to duty among Marine recruits with musculoskeletal injuries. Mil Med. 2009;174:139–52.

    Article  PubMed  Google Scholar 

  10. Vickers RR, Gordon TM, Donaldson S, Bischoff CW, Hervig LK. Medical rehabilitation program: III. Psychological factors related to program effectiveness. NHRC technical report no. 91–30. San Diego, CA: Naval Health Research Center; 1992.

    Google Scholar 

  11. Dionne CE, Bourbonnais R, Fremont P, Rossignol M, Stock SR, Nouwen A, Larocque I, Demers E. Determinants of “return to work in good health” among workers with back pain who consult in primary care settings: a 2-year prospective study. Eur Spine J. 2007;16:641–55.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Fritz JM, George SZ, Delitto A. The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status. Pain. 2001;94(1):7–15.

    Article  CAS  PubMed  Google Scholar 

  13. Hiebert R, Campello MA, Weiser S, Ziemke GW, Fox BA, Nordin M. Predictors of short-term work-related disability among active duty U.S. Navy personnel: a cohort study in patients with acute and subacute low back pain. Spine J. 2012 (Epub ahead of print).

  14. Turner J, Franklin J, Fulton-Kehoe D, Sheppard L, Wickizer TM, Wu R, Gluck J, Egan K. Worker recovery expectations and fear-avoidance predict work disability in a population-based workers’ compensation back pain sample. Spine. 2006;31:682–9.

    Article  PubMed  Google Scholar 

  15. Sullivan MJ, Bishop SR, Pivik J. The Pain Catastrophizing Scale: development and validation. Psychol Assess. 1995;7:524–32.

    Article  Google Scholar 

  16. Picavet HS, Vlaeyen JW, Schouten JS. Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. Am J Epidemiol. 2002;156:1028–34.

    Article  PubMed  Google Scholar 

  17. Sullivan MJ, Ward C, Tripp D, French DJ, Adams H, Stanish WD. Secondary prevention of work disability: community-based psychosocial intervention for musculoskeletal disorders. J Occup Rehabil. 2005;15:377–92.

    Article  PubMed  Google Scholar 

  18. Crook J, Milner R, Schultz IZ, Stringer B. Determinants of occupational disability following a low back injury: a critical review of the literature. J Occup Rehabil. 2002;12:277–95.

    Article  PubMed  Google Scholar 

  19. Lanier DC, Stockton P. Clinical predictors of outcome of acute episodes of low back pain. J Fam Pract. 1998;27:483–9.

    Google Scholar 

  20. King RB, Rowe MA, Kimble LP, Zerwic JJ. Optimism, coping, and long-term recovery from coronary artery surgery in women. Res Nurs Health. 1998;21:15–26.

    Article  CAS  PubMed  Google Scholar 

  21. Rosenberger P, Kerns R, Jokl P, Icovics JR. Mood and attitude predict pain outcomes following arthroscopic knee surgery. Ann Behav Med. 2009;37:70–6.

    Article  PubMed  Google Scholar 

  22. Scheier MF, Matthews KA, Owens JF, Magovern GJ, Lefebvre RC, Abbott RA, Carver CS. Dispositional optimism and recovery from coronary artery bypass surgery: the beneficial effects on physical and psychological well-being. J Pers Soc Psychol. 1989;57:1024–40.

    Article  CAS  PubMed  Google Scholar 

  23. Maruta T, Colligan RC, Malinchoc M, Offord KP. Optimists vs. pessimists: survival rate among medical patients over a 30-year period. Mayo Clin Proc. 2000;75:140–3.

    Article  CAS  PubMed  Google Scholar 

  24. Scheier MF, Carver CS. Dispositional optimism and physical well-being: the influence of generalized outcome expectancies on health. J Pers. 1987;55:169–210.

    Article  CAS  PubMed  Google Scholar 

  25. Braveman B. The model of human occupation and prediction of return to work: a review of related empirical research. Work. 1999;12:25–35.

    PubMed  Google Scholar 

  26. Marhold C, Linton SJ, Melin L. Identification of obstacles for chronic pain patients to return to work: evaluation of a questionnaire. J Occup Rehabil. 2002;12:65–75.

    Article  PubMed  Google Scholar 

  27. Krause N, Dasinger LK, Deegan LJ, Rudolph L, Brand RJ. Psychosocial job factors and return-to-work after compensated low back injury: a disability phase-specific analysis. Am J Ind Med. 2001;40:374–92.

    Article  CAS  PubMed  Google Scholar 

  28. Feuerstein M, Berkowitz SM, Haufler AJ, Lopez MS, Huang GD. Working with low back pain: workplace and individual psychosocial determinants of limited duty and lost time. Am J Ind Med. 2001;40:627–38.

    Article  CAS  PubMed  Google Scholar 

  29. Heymans MW, de Vet HC, Knol DL, Bongers PM, Koes BW, van Mechelen W. Workers’ beliefs and expectations affect return to work over 12 months. J Occup Rehabil. 2006;16:685–95.

    Article  PubMed  Google Scholar 

  30. van der Giezen AM, Bouter LM, Nijhuis FJ. Prediction of return-to-work of low back pain patients sicklisted for 3–4 months. Pain. 2000;87:285–94.

    Article  PubMed  Google Scholar 

  31. Den Boer JJ, Oostendorp RA, Beems T, Munneke M, Evers AW. Reduced work capacity after lumbar disc surgery: he role of cognitive-behavioral and work-related risk factors. Pain. 2006;126:72–8.

    Article  Google Scholar 

  32. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23:129–38.

    CAS  PubMed  Google Scholar 

  33. Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psych Meas. 1977;1:385–401.

    Article  Google Scholar 

  34. Beekman AT, Deeg DJ, Van Limbeek J, Braam AW, De Vries MZ, Van Tilburg W. Criterion validity of the Center for Epidemiologic Studies Depression Scale (CES-D): results from a community-based sample of older subjects in The Netherlands. Psychol Med. 1997;27:231–5.

    Article  CAS  PubMed  Google Scholar 

  35. Osman A, Barrios FX, Gutierrez PM, Kopper BA, Merrifield T, Grittman L. The Pain Catastrophizing Scale: further psychometric evaluation with adult samples. J Behav Med. 2000;23:351–65.

    Article  CAS  PubMed  Google Scholar 

  36. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52:157–68.

    Article  CAS  PubMed  Google Scholar 

  37. Scheier MF, Carver CS, Bridges MW. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery and self-esteem): a reevaluation of the Life Orientation Test. J Pers Soc Psychol. 1994;67:1063–78.

    Article  CAS  PubMed  Google Scholar 

  38. Judge TA, Bono JE, Locke EA. Personality and job satisfaction: the mediating role of job characteristics. J Appl Psychol. 2000;85:237–49.

    Article  CAS  PubMed  Google Scholar 

  39. Brayfield AH, Rothe HF. An index of job satisfaction. J Appl Psychol. 1951;35:307–11.

    Article  Google Scholar 

  40. Eisenberger S, Stinglhamber F, Vandenberghe C, Sucharski IL, Rhoades L. Perceived supervisor support: contributions to perceived organizational support and employee relations. J Appl Psychol. 2002;87:565–73.

    Article  PubMed  Google Scholar 

  41. Eisenberger S, Huntington R, Hutchison S, Sowa D. Perceived organizational support. J Appl Psychol. 1987;71:500–7.

    Article  Google Scholar 

  42. Mondloch MV, Cole DC, Frank JW. Does how you do depend on how you think you’ll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes. CMAJ. 2001;165:174–9.

    CAS  PubMed Central  PubMed  Google Scholar 

  43. Jamison RN, Parris WC, Maxon WS. Psychological factors influencing recovery from outpatient surgery. Behav Res Ther. 1987;25:31–7.

    Article  CAS  PubMed  Google Scholar 

  44. Diederiks JP, van der Sluijs H, Weeda HW, Schobre MG. Predictors of physical activity one year after myocardial infarction. Scand J Rehabil Med. 1983;15:103–7.

    CAS  PubMed  Google Scholar 

  45. Barefoot JC, Brummett BH, Williams RB, Siegler IC, Helms MJ, Boyle SH, Clapp-Channing NE, Mark DB. Recovery expectations and long-term prognosis of patients with coronary heart disease. Arch Intern Med. 2011;171:929–35.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Ozegovic D, Carroll LJ, Cassidy JD. Does expecting mean achieving? The association between expecting to return to work and recovery in whiplash associated disorders: a population-based prospective cohort study. Eur Spine J. 2009;18:893–9.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Mahomed NN, Liang MH, Cook EF, Daltroy LH, Fortin PR, Fossel AH, Katz JN. The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol. 2002;29:1273–9.

    PubMed  Google Scholar 

  48. Hansson L, Berglund M. Factors influencing treatment outcome and patient satisfaction in a short-term psychiatric ward: a path analysis study of the importance of patient involvement in treatment planning. Eur Arch Psychiatry Clin Neurosci. 1987;236:269–75.

    Article  CAS  Google Scholar 

  49. Bialosky JE, Bishop MD, Cleland JA. Individual expectation: an overlooked, but pertinent, factor in the treatment of individuals experiencing musculoskeletal pain. Phys Ther. 2010;90:1345–55.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Flood AB, Lorence DP, Ding J, McPherson K, Black NA. The role of expectations in patients’ reports of post-operative outcomes and improvement following therapy. Med Care. 1993;31:1043–56.

    Article  CAS  PubMed  Google Scholar 

  51. Wager TD, Scott DJ, Zubieta JK. Placebo effects on human μ-opioid activity during pain. Proc Natl Acad Sci U S A. 2007;104:11056–61.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  52. Petrie KJ, Cameron LD, Ellis CJ, Buick D, Weinman J. Changing illness perceptions after myocardial infarction: an early intervention randomized controlled trial. Psychosom Med. 2002;64:580–6.

    PubMed  Google Scholar 

  53. Broadbent E, Ellis CH, Thomas J, Gamble G, Petrie KJ. Further development of an illness perception intervention for myocardial infarction patients: a randomized controlled trial. J Psychosom Res. 2009;67:17–23.

    Article  PubMed  Google Scholar 

  54. Von Korff M, Deyo RA, Cherkin D, Barlow W. Back pain in primary care: outcomes at 1 year. Spine. 1993;18:855–62.

    Article  Google Scholar 

  55. McGeary DD, Mayer TG, Gatchel RJ. High pain ratings predict treatment failure in chronic occupational musculoskeletal disorders. J Bone Joint Surg Am. 2006;88:317–25.

    Article  PubMed  Google Scholar 

  56. Banks SM, Kern RD. Explaining high rates of depression in chronic pain: a diathesis-stress framework. Psychol Bull. 1996;119:95–110.

    Article  Google Scholar 

  57. Brown G. A causal analysis of chronic pain and depression. J Abnorm Psychol. 1990;99:127–37.

    Article  CAS  PubMed  Google Scholar 

  58. Hayden JA, Chou R, Hogg-Johnson S, Bombardier C. Systematic reviews of low back pain prognosis had variable methods and results—guidance for future prognosis reviews. J Clin Epidemiol. 2009;62:781–96.

    Article  CAS  PubMed  Google Scholar 

  59. Macfarlane GJ, Thomas E, Croft PR, Papageorgiou AC, Jayson MI, Silman AJ. Predictors of early improvement in low back pain amongst consulters to general practice: the influence of pre-morbid and episode-related factors. Pain. 1999;80:113–9.

    Article  CAS  PubMed  Google Scholar 

  60. Cherkin DC, Keyo RA, Street JH, Barlow W. Predicting poor outcomes for back pain seen in primary care using patients’ own criteria. Spine. 1996;21:2900–7.

    Article  CAS  PubMed  Google Scholar 

  61. Hansson T, Jensen I. Sickness absence due to back and neck disorders. Scan J Public Health. 2004;32:109–51.

    Article  Google Scholar 

  62. Lincoln AE, Smith GS, Amoroso PJ, Bell NS. The natural history and risk factors of musculoskeletal conditions resulting in disability among US Army personnel. Work. 2002;18:99–113.

    PubMed Central  PubMed  Google Scholar 

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Acknowledgments

This research was supported by the U.S. Army Military Operational Medicine Research Program, under Work Unit No. 61005. The views and opinions expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government. Approved for public release; distribution is unlimited. This research has been conducted in compliance with all applicable federal regulations governing the protection of human subjects in research (protocol NHRC.2010.0002).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Behavioral Science and Epidemiology Department, Naval Health Research Center, 140 Sylvester Rd., San Diego, CA, 92106-3521, USA

    Stephanie Booth-Kewley, Emily A. Schmied, Robyn M. Highfill-McRoy & Cedric F. Garland

  2. U.S. Army-Baylor Doctoral Program in Physical Therapy, Navy Medicine Training Support Center, Fort Sam Houston, TX, 78234, USA

    Todd C. Sander

  3. II Marine Expeditionary Force, Health Service Support, Camp Lejeune, NC, 28542-0080, USA

    Steve J. Blivin

  4. Department of Family and Preventive Medicine and Moores UCSD Cancer Center, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0631, USA

    Cedric F. Garland

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  1. Stephanie Booth-Kewley
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Correspondence to Stephanie Booth-Kewley.

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Booth-Kewley, S., Schmied, E.A., Highfill-McRoy, R.M. et al. A Prospective Study of Factors Affecting Recovery from Musculoskeletal Injuries. J Occup Rehabil 24, 287–296 (2014). https://doi.org/10.1007/s10926-013-9456-7

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