Daily and Weekly Associations Among Pain Intensity, Self-Reported Activity Limitations, and Objectively Assessed Physical Activity in Youth With Acute Musculoskeletal Pain

Abstract

Monitoring recovery during acute pain episodes is useful for identifying youth at risk for pain persisting. Subjective and objective measures can assess function postinjury, but associations among these different measures and pain patterns in the acute period are unknown. To fill this gap, we examined associations among self-reported activity limitations, objectively measured physical activity, and pain intensity in 176 youth (age 11–17, 46% male) seeking health care for acute musculoskeletal pain. Participants completed 7-day electronic diaries rating daily pain intensity and activity limitations (Child Activity Limitations Interview [CALI]) while concurrently wearing an Actiwatch to record physical activity. The results revealed youth reported pain on 47.8% of days with an average intensity of 33.4 (0–100). Averaged across the week, between-participant analyses showed greater activity limitations were associated with lower mean (rActive = −.204, rRoutine = −.159, P < .05) and peak activity (rActive = −.291, rRoutine = −.184, P < .05). Same-day correlations between CALI scores and physical activity measures within participants were not significant. Linear mixed-effects models revealed higher daily pain intensity was associated with greater self-reported activity limitations on Routine (β = .23, P < .001) and Active CALI-9 subscales (β = .07, P < .001). Conversely, higher daily pain was associated with higher activity on actigraphy, specifically higher mean activity (β = .46, P < .01), more activity bouts (β = .013, P < .01), more time in light activity (β = .04, P < .01), and less sedentary time (β = −.04, P < .01). Taken together, self-reported activity limitations and objective physical activity represent 2 distinct, yet related, aspects of physical functioning associated with pain. Future work should examine how physical activity and activity limitations change longitudinally and predict pain persistence. PerspectiveThis study examined daily associations between pain intensity, self-reported activity limitations, and objectively assessed physical activity in youth during the acute recovery period following a musculoskeletal injury. Self-reported activity limitations and objective physical activity represent 2 distinct, yet related, aspects of physical functioning that are associated with pain.