Abstract
BackgroundSubstantial variation exists in physical functioning (PF) among patients with comparable pain severity, which may be partly explained by underlying psychological processes, like cognitive appraisal of pain and coping with pain. It remains unclear to what extent such determinants contribute to changes in PF over time, especially in older populations. Therefore, we examined longitudinal associations of cognitive appraisals and coping strategies with PF, in older adults with joint pain and comorbidity.MethodsA prospective cohort study among 407 older adults with joint pain and comorbidity provided data over 18 months, with 6 month time-intervals. We measured PF (RAND-36), five cognitive appraisals (consequences, concerns, emotional representations, self-efficacy, catastrophizing), four coping strategies (ignoring pain, positive self-statement, increasing activity levels, activity avoidance) and three time-dependent covariates; pain intensity, anxiety and depressive symptoms. Longitudinal associations were analyzed with Generalized Estimated Equations (GEE), by testing auto-regressive models, adjusted for covariates.ResultsMore negative thoughts about consequences of pain (β = -0.54, 95 % CI = -1.02; -0.06), more catastrophizing (β = -0.67, 95 % CI = -1.26; -0.07) and more activity avoidance (β = -0.32, 95 % CI = -0.57; -0.08) were significantly associated with subsequent deterioration in PF, whereas higher perceived self-efficacy (β = 0.22, 95 % CI = 0.12; 0.31) was associated with subsequent improvement in PF. Neither concerns, emotional representations, ignoring pain, positive self-statement nor increasing activity levels were longitudinally related to PF.ConclusionsMore negative thoughts about consequences of pain, more catastrophizing and more activity avoidance contributed to deteriorated PF, whereas higher perceived self-efficacy contributed to improved PF. This knowledge may contribute to future management of functional limitations in older adults with joint pain and comorbidity.
Highlights
Substantial variation exists in physical functioning (PF) among patients with comparable pain severity, which may be partly explained by underlying psychological processes, like cognitive appraisal of pain and coping with pain
More negative thoughts about consequences of joint pain, more catastrophizing and more activity avoidance were significantly associated with subsequent deterioration in PF, whereas higher perceived self-efficacy was associated with subsequent improvement in PF
Previous studies reported associations between negative illness beliefs and poorer PF in populations with low back pain, osteoarthritis and chronic widespread pain [7,8,9], these results were only partly supported in our study, as we only found a relation between more negative thoughts about the consequences of pain and deterioration in PF
Summary
Substantial variation exists in physical functioning (PF) among patients with comparable pain severity, which may be partly explained by underlying psychological processes, like cognitive appraisal of pain and coping with pain. In patients over 65 of age, self-reported pain of hip and knee show prevalence rates of 25–30 % [2] It is not self-evident that all individuals with severe pain experience poor physical functioning (PF); in groups of people with comparable pain severity, some improve, some remain stable and others (gradually) deteriorate in PF [3, 4]. This variation may be partly explained by underlying psychological processes [5, 6]. This can refer to cognitive coping strategies; i.e., changing the way one thinks/feels about the stressful situation (e.g., ignoring pain) or to behavioural coping strategies; i.e., changing the way one handles/deals with the situation (e.g., increasing activities)
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