The mediating effect of psychological factors on the relationship between pain intensity and wrist joint function: a longitudinal study with mediation analysis

Abstract

Purpose Psychological factors and pain intensity are associated with wrist function. However, the mediating role of psychological factors in the relationship between pain intensity and wrist function in distal radius fractures remains unclear. We performed mediation analysis to investigate how psychological factors mediate the relationship between pain intensity and wrist function. Methods Twenty-one patients with distal radius fractures were included in this longitudinal study. Patient-rated wrist evaluation, one pain intensity-related outcome measure (numerical rating scale), and three psychological outcome measures (pain catastrophizing scale, hospital anxiety and depression scale, and pain self-efficacy questionnaire) were assessed. The mediation analysis with a bootstrap sampling procedure was used to assess indirect effects. The level of significance was set at 5%. Results Mediation analysis showed that the pain intensity, as measured by patient-rated wrist evaluation, had significant indirect effects on the hospital anxiety and depression scale-anxiety (95% bootstrapped confidence interval: 0.96–9.62) and pain self-efficacy questionnaire (95% bootstrapped confidence interval: 0.43–8.11) scores. Conclusions The relationship between pain intensity and wrist function was mediated by anxiety and self-efficacy. Our findings suggest that interventions focused on psychological factors, particularly anxiety and self-efficacy, may be important in distal radius fractures rehabilitation. IMPLICATIONS FOR REHABILITATION In patients with distal radius fractures, early post-operative pain mediates psychological factors and affects wrist function. Anxiety and self-efficacy are psychological factors that should be noted, and rehabilitation, including self-management, should be considered. Rehabilitative interventions for distal radius fractures should focus on psychological factors and management of post-operative pain.