Psychosocial Correlates of Objective, Performance-Based, and Patient-Reported Physical Function Among Patients with Heterogeneous Chronic Pain

Abstract

Jonathan Greenberg,1,2 Ryan A Mace,1,2 Paula J Popok,1 Ronald J Kulich,2,3 Kushang V Patel,4 John W Burns,5 Tamara J Somers,6 Francis J Keefe,7 Michael E Schatman,8,9 Ana-Maria Vrancenanu1,2 1Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USA; 3Center for Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; 4Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA; 5Division of Behavioral Sciences, Rush Medical College, Chicago, IL, USA; 6Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; 7Department of Medicine, Duke University School of Medicine, Durham, NC, US; 8Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 9Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USACorrespondence: Ana-Maria Vrancenanu Email [email protected]: Improving all aspects of physical function is an important goal of chronic pain management. Few studies follow recent guidelines to comprehensively assess physical function via patient-reported, performance-based, and objective/ambulatory measures.Purpose: To test 1) the interrelation between the 3 types of physical function measurement and 2) the association between psychosocial factors and each type of physical function measurement.Methods: Patients with chronic pain (N=79) completed measures of: 1) physical function (patient-reported disability; performance-based  6-minute walk-test; objective accelerometer step count); 2) pain and non-adaptive coping (pain during rest and activity, pain-catastrophizing, kinesiophobia); 3) adaptive coping (mindfulness, general coping, pain-resilience); and 4) social-emotional dysfunction (anxiety, depression, social isolation and emotional support). First, we tested the interrelation among the 3 aspects of physical function. Second, we used structural equation modeling to test associations between psychosocial factors (pain and non-adaptive coping, adaptive coping, and social-emotional dysfunction) and each measurement of physical function.Results: Performance-based and objective physical function were significantly interrelated (r=0.48, p< 0.001) but did not correlate with patient-reported disability. Pain and non-adaptive coping (β=0.68, p< 0.001), adaptive coping (β=− 0.65, p< 0.001) and social-emotional dysfunction (β=0.65, p< 0.001) were associated with patient-reported disability but not to performance-based or objective physical function (ps> 0.1).Conclusion: Results suggest that patient-reported physical function may provide limited information about patients’ physical capacity or ambulatory activity. While pain and non-adaptive reactions to it, adaptive coping, and social-emotional dysfunction may potentially improve patient-reported physical function, additional targets may be needed to improve functional capacity and ambulatory activity.Trial Registration: ClinicalTrials.gov NCT03412916.Keywords: physical function, chronic pain, six-minute walk test, accelerometer, psychosocial factors

Keywords

• physical function
• chronic pain
• six-minute walk test
• accelerometer
• psychosocial factors