Early Pain Catastrophizing Exacerbates Impaired Limb Loading and 6-Minute Walk Test Distance 12 Months After Lower Extremity Fracture

Abstract Objective Disability is common after lower extremity fracture (LEF). Although psychosocial factors have been associated with patient-reported outcomes after LEF, they have not been associated with objective measures of function. Aberrant gait patterns are important markers of function, but...

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Bibliographic Details
Published in:Physical therapy 2021-11, Vol.101 (11), p.1
Main Authors: Van Wyngaarden, Joshua J, Archer, Kristin R, Spencer, Alex, Matuszewski, Paul E, Brightwell, Benjamin, Jacobs, Cale, Noehren, Brian
Format: Article
Language:English
Subjects:
Adult
Catastrophization - psychology
Complications and side effects
Development and progression
Disability Evaluation
Female
Femur
Fractures
Fractures (Injuries)
Fractures, Bone - psychology
Fractures, Bone - surgery
Gait disorders
Humans
Injuries
Leg
Leg injuries
Lower Extremity - injuries
Lower Extremity - surgery
Male
Middle Aged
Pain
Pain, Postoperative - psychology
Patient outcomes
Patient Reported Outcome Measures
Prognosis
Psychological aspects
Risk factors
Surveys and Questionnaires
Tibia
Walk Test
Walking - psychology
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Summary:Abstract Objective Disability is common after lower extremity fracture (LEF). Although psychosocial factors have been associated with patient-reported outcomes after LEF, they have not been associated with objective measures of function. Aberrant gait patterns are important markers of function, but are poorly defined after LEF. The primary purpose of this study was to explore whether pain catastrophizing and fear of movement 6 weeks after surgery were associated with injured limb loading outcomes and 6-minute walk test (6MWT) distance 12 months after femur or tibia fracture. The secondary purpose was to determine if limb loading characteristics differed between injured and uninjured limbs. Methods At 6 weeks after LEF, patients completed validated measures of pain catastrophizing, fear of movement, and depression. At 12 months, patients completed a 6MWT while wearing instrumented insoles that recorded the limb loading outcomes of stance time, impulse, and loading rate. Bivariate correlations assessed how patient and psychosocial characteristics at 6 weeks were associated with injured limb loading outcomes and 6MWT distance. Multivariable regression analyses were performed to determine if psychosocial variables were associated with each outcome after controlling for depression and patient demographic and clinical characteristics. Finally, paired t tests compared limb loading outcomes between limbs. Results Forty-seven participants completed the 6MWT at 12 months (65%), and 38 completed the 6MWT with the instrumented insoles. Fear of movement carried a poor relationship (r = 0.11–0.32) and pain catastrophizing a moderate relationship (r = 0.46–0.54) with 12-month outcomes. The regression results indicated that pain catastrophizing continued to be associated with all outcomes. Finally, the injured limb had significantly lower limb loading outcomes than the uninjured limb at 12 months (Cohen d = 0.54–0.69). Conclusion Pain catastrophizing early after LEF was associated with impaired limb loading and 6MWT distance at 12 months. Impact Impaired limb loading persists 12 months after LEF. Further research is needed to determine whether rehabilitative efforts focused on pain catastrophizing can restore limb loading after LEF.
ISSN:0031-9023
1538-6724
1538-6724
DOI:10.1093/ptj/pzab194