Factors Associated with Disability and Pain Intensity among Patients Presenting to a Sports Medicine Practice

Abstract

PURPOSE:Psychological factors play an important role in the difference between physical impairment and the magnitude of disability. This study addressed the primary null hypothesis that there is no independent association between magnitude of disability and symptoms of depression, controlling for other factors among patients presenting to a tertiary care sports medicine practice. METHODS: In this cross-sectional study, 116 patients participated that presented to one of two orthopaedic sports surgeons or a physiatrist. The mean age was 43 years. We used Patient Reported Outcome Measurement Information System Computer Adaptive Tests (PROMIS CAT) to measure: limitations of physical function, symptoms of depression and coping strategies in response to pain. We used an 11-point measure of pain intensity from 0 to 10 and reported patient’s physical activity status. Multivariable regression analysis was performed to identify which factors have the strongest independent influence on disability and pain intensity. RESULTS:In bivariate analysis, we found an association between symptoms of depression and disability. In multivariable analysis, we found that symptoms of depression was not independently associated with disability. However, we did find a strong independent association between coping strategies in response to pain and disability (p <0.001, partial R-squared = 0.35), that explains 50% of the variability of disability in the final model. Also in bivariate analysis, we found an association between symptoms of depression and pain intensity, although, there was no independent association in multivariable analysis. However, there was a strong independent association between coping strategies in response to pain and pain intensity (p < 0.001, partial R-squared = 0.22), that explains, along with age and female race, 50% of the variability of pain intensity in the final model. CONCLUSIONS:The variation in pain intensity and magnitude of disability in patients presenting to a sports specialist is not associated with symptoms of depression, however, we found a strong association with coping strategies in response to pain. Interventions to optimize coping strategies (self-efficacy) may decrease the magnitude of disability and pain intensity in patients presenting to a sports medicine practice.