Sleep Quality, Pain Catastrophization, and Orthopedic Health Literacy

Abstract

Category: Ankle Introduction/Purpose: Evidence increasingly indicates the importance of orthopedic health literacy, sleep quality, and a propensity for pain catastrophization in orthopedic patient outcomes. Using previously validated questionnaires including the Literacy in Musculoskeletal Problems (LiMP), Pain Catastrophization Scale (PCS), and the Pittsburgh Sleep Quality Index (PSQI), this study investigated the relationship between these factors and common functional outcome instruments including the Disability of Arm, Shoulder, and Hand (DASH) and the Foot and Ankle Outcome Score (FAOS). Methods: 245 patients in outpatient clinics of one foot and ankle surgeon and three hand surgeons were approached. Inclusion criteria required age greater than 18, English proficiency, and a newly presenting chief complaint. Enrolled patients completed a demographics form, LiMP, PCS, PSQI, and the DASH or FAOS based on extremity. Clinical history was reviewed retrospectively. DASH and FAOS scores were normalized to the same scale (0 – 100, best to worst) and termed “functional survey” (FS). Correlations were calculated between FS scores, subjective questionnaires, and demographic/clinical information. For the variables of race and education level, one-way ANOVA analysis was conducted to determine if FS scores differed based on these variables. Variables that were significantly correlated with FS score were entered into a multivariate linear regression analysis to assess their effect on FS score. Results: 231 patients (131 hand/wrist, 100 foot/ankle) were enrolled and completed all questionnaires. ANOVA analysis found that there were no significant differences in FS scores based on education or race (p > 0.05). Multivariate regression analysis was conducted with FS score as the dependent variable, and factors that were significantly correlated with FS score, including PCS, PSQI Global Score, visit type (trauma vs. non-trauma), and insurance type (private vs. public) as the independent variables. Health literacy was not significantly correlated with OS score. Results from this analysis can be found in Table 1. The model significantly (p < 0.05) accounted for 19.2% of variation in OS score. Conclusion: There is a strong correlation between tendency to catastrophize pain, sleep quality, and FS score. Every 1 unit increase in the PSQI/PCS corresponds with a 1.8/0.38 point increase in FS score; indicating higher functional disability. Given the strong correlation at baseline, such factors as poorly controlled tendency to catastrophize pain may confound functional outcomes. No significant correlation was noted between health literacy and FS scores. This suggests that an increased level of orthopedic knowledge does not affect perception of functional disability. However, our results show that sleep quality and catastrophic thinking may confound functional outcome scores.