Activity patterns among patients with chronic pain after orthopaedic trauma

Abstract

Activity patterns influence the development and perpetuation of musculoskeletal pain. To date, three major patterns have been observed in particular on chronic low back pain patients: avoidance, pacing and persistence. Relationships between these behaviours and clinical outcomes remain inconclusive. Moreover, there is only few data on other chronic pain syndromes. Our aim was to identify activity patterns in patients with chronic pain after orthopaedic trauma and to describe relationships with pain, depressive symptomatology and disability. Participants were rehab orthopaedic trauma inpatients with chronic pain (mean duration: 9 months). Activity patterns classification was made at entry with the “Patterns of Activity Measure-Pain” (POAM-P) and the Tampa scale for Kinesiophobia (TSK). Outcomes were assessed with the Brief Pain Inventory (BPI), the Hospital Anxiety and Depression scale (HADS), the Spinal Function Sort (SFS: spinal and lower limb trauma) and the Hand Function Sort (HFS: upper limb trauma). Descriptive statistics and ANOVA were used. 497 inpatients were included (mean age: 43 years; female: 22%). Patterns distribution was: 46% avoidance; 30% pacing and 24% persistence. Kinesiophobia (TSK ≥ 45points) is much more marked in avoidance (71%). Nevertheless, 37% in pacing, 22% in persistence also have kinesiophobia which may suggest the existence of more than three patterns. Outcomes were always poor in avoidance, intermediate in pacing and better in persistence behaviour. The 3 main activity patterns were identified in rehab orthopaedic trauma inpatients. In this cross-sectional study, persistence behaviour was associated with better self-perceptions.