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Assessing perceived disability: Development, validation, and clinical utility of the Perceived Disability Scale
P14
Abstracts
The Journal of Pain
(152) Depressive symptoms mediate associations among pain and fatigue in adolescents
(154) Clinical and demographic predictors of three dimensions of sleep in patients with acute and chronic pain
A Lewandowski, L Murphy, and T Palermo; Seattle Children’s Hospital, Seattle, WA
D Bruns and A Bruns; Health Psychology Associates, Greeley, CO
Fatigue is common in children and adolescents with pain complaints, and it has been associated with negative consequences including poor quality of life, depression, and problems with neurocognitive functioning. There is limited data, however, on the mechanisms that underlie the relationship between pain and fatigue particularly the role of depressive symptoms. This study aimed to: 1) identify predictors of fatigue, and 2) determine if depressive symptoms mediated the relationship between pain and fatigue in youth with weekly pain. Participants were 113 youth (aged 12-18 years; M = 15.18; 72.6% female) who reported experiencing pain at least once/week . Youth were recruited from a pain clinic (n = 61), an outpatient depression treatment program (n = 29), and from the community (n = 23). Participants underwent 10 days of actigraphic sleep monitoring and completed measures of pain intensity (NRS 0-10), pubertal status, depression (CES-D), and the PedsQL Multidimensional Fatigue Scale (General, Sleep-Rest, and Cognitive Fatigue subscales). Adolescents reported moderate pain intensity (M=5.64, SD=1.97). Regression analyses controlling for actigraphic sleep duration and pubertal status revealed that pain and depression predicted General (p < .001), Sleep-Rest (p < .05), and Total (p < .001) fatigue scores. Depression (p < .001) was the only significant predictor of Cognitive fatigue. As hypothesized, tests of mediation revealed depressive symptoms mediated the relationships between pain intensity and Total fatigue score, as well as the General and Sleep-Rest subscales (p < .05). The mediation model predicting Cognitive fatigue was not significant. Findings of this study highlight depression as an important mechanism in the relationship between pain and fatigue. Results underscore the importance of assessing and targeting depressive symptoms in youth with comorbid pain and fatigue.
Sleep quality is known to be influenced by a number of variables. However, less is known about the clinical and demographic predictors of poor sleep quality for specific dimensions of sleep in patients with pain. In this study, 414 patients in multidisciplinary treatment for pain or injury were asked to rate their sleep quality using three dimensions: delayed onset (minutes to fall asleep), difficulty staying asleep (number of times waking during the sleep cycle), and insufficient sleep (number of hours of sleep). Following this, stepwise logistic regression was used to predict each of these sleep dimensions using BHI-2 and demographic predictor variables: Gender, age, race, education, acute vs. chronic status, pain, somatization, muscular bracing, depression, anxiety, anger, borderline personality traits, dependent personality traits, caffeine use, alcohol use, tobacco use, opioid prescription, sleep medication prescription, height, weight and body mass index. Predictor variables were entered using a forward stepwise method, using p<.01 to enter a variable to the regression equation, and p<.05 to retain, to reduce the risk of Type I errors. These analyses determined that delayed sleep onset was predicted by (in order of entry) muscular bracing (p=.004) and pain level (p=.01), R2=.102. Difficulty staying asleep was predicted by pain level (p=.005) and dependent traits (p=.01), R2=.102. Finally, insufficient sleep was predicted by pain level (p=.000) and height (p=.001), R2=.154. While these regression equations produced low R2s, these results suggest that in patients with pain or injury, specific dimensions of sleep may have different predictors. Additionally, the absence of race, gender, education and other demographic predictors was noted, suggesting that the differences in sleep may be more attributable to clinical variables.
(153) EEG-assessed bandwidth activity differences between individuals with SCI with and without chronic pain
(155) Assessing perceived disability: Development, validation, and clinical utility of the Perceived Disability Scale
A Braden, J Howe, M Jensen, L Sherlin, S Hakimian, M Reyes, and A Gianas; University of Washington, Seattle, WA
K Salyer, K Lofland, E Janke, and D Corsica; Argosy University, Chicago Campus, Chicago, IL
Chronic pain is a significant problem for many individuals living with a spinal cord injury (SCI). However, not all people with SCIs experience chronic pain as a direct result of the injury. Electroencephalograph (EEG) technology may be useful to understand possible differences in brain activity in individuals with SCI with and without chronic pain. The purpose of the current study is to measure and compare baseline brain activity between participants who experience daily SCI-related pain to those who do not. Fifteen participants with (N=8) and without (N=7) chronic pain underwent an EEG assessment. Participants with SCI and chronic daily pain produced significantly more relative fast wave activity (b-wave) and significantly less slow wave (a-wave) activity, suggesting differences in brain activity between these groups, and the potential utility of EEG for identifying these differences. The findings also suggest the possibility that interventions that alter brain wave activity in persons with a SCI and pain, such as neurofeedback training, could influence the experience of pain.
Evaluating self-perception is important in determining the degree to which cognitive and emotional factors may be influencing physical disability. Current measures are inadequate, assessing objective functionality or applicable to a limited population. The Perceived Disability Scale (PDS) is a brief, self-report instrument developed to assess self-perception of disability. The ten items of the PDS are designed to provide inter-item consistency with single items measuring congruous content, thus allowing for discriminating responses. Scoring of the PDS may be compared within the same patient population by diagnosis or across other disabled or rehabilitation populations. This study intends to report preliminary norms for the PDS among a variety of clinical populations and explore the clinical utility of the PDS in practice. Outpatients receiving treatment for obesity (n=491), spinal cord injury (n=34), erectile dysfunction (n=96), or chronic pain (n=651) completed the PDS upon intake at their respective specialty clinics. All four means were significantly different from each other, F(3,1268)=147.827, p<.001, with spinal cord injured patients reporting the highest level of perceived disability, followed by chronic pain, erectile dysfunction, and obesity respectively. Patients with chronic pain in head, face, and/ or mouth reported significantly lower levels of perceived disability than all other regions of pain, F(6,629)=9.162, p<.001, with the exception of the thoracic region. Subjects reporting an on-the-job injury, F(1,705)=28.757, p<.001, or worker’s compensation, F(1,637)=52.431, p<.001, also indicated significantly higher levels of perceived disability than non-reporters. Thus, the PDS is an effective tool in differentiating levels of perceived disability between medical populations. Further research is necessary to explore the relationship between PDS scores and treatment outcomes, identifying high-risk patients due to cognitive and emotional interference as it relates to perceived disability.
Abstracts
The Journal of Pain
(152) Depressive symptoms mediate associations among pain and fatigue in adolescents
(154) Clinical and demographic predictors of three dimensions of sleep in patients with acute and chronic pain
A Lewandowski, L Murphy, and T Palermo; Seattle Children’s Hospital, Seattle, WA
D Bruns and A Bruns; Health Psychology Associates, Greeley, CO
Fatigue is common in children and adolescents with pain complaints, and it has been associated with negative consequences including poor quality of life, depression, and problems with neurocognitive functioning. There is limited data, however, on the mechanisms that underlie the relationship between pain and fatigue particularly the role of depressive symptoms. This study aimed to: 1) identify predictors of fatigue, and 2) determine if depressive symptoms mediated the relationship between pain and fatigue in youth with weekly pain. Participants were 113 youth (aged 12-18 years; M = 15.18; 72.6% female) who reported experiencing pain at least once/week . Youth were recruited from a pain clinic (n = 61), an outpatient depression treatment program (n = 29), and from the community (n = 23). Participants underwent 10 days of actigraphic sleep monitoring and completed measures of pain intensity (NRS 0-10), pubertal status, depression (CES-D), and the PedsQL Multidimensional Fatigue Scale (General, Sleep-Rest, and Cognitive Fatigue subscales). Adolescents reported moderate pain intensity (M=5.64, SD=1.97). Regression analyses controlling for actigraphic sleep duration and pubertal status revealed that pain and depression predicted General (p < .001), Sleep-Rest (p < .05), and Total (p < .001) fatigue scores. Depression (p < .001) was the only significant predictor of Cognitive fatigue. As hypothesized, tests of mediation revealed depressive symptoms mediated the relationships between pain intensity and Total fatigue score, as well as the General and Sleep-Rest subscales (p < .05). The mediation model predicting Cognitive fatigue was not significant. Findings of this study highlight depression as an important mechanism in the relationship between pain and fatigue. Results underscore the importance of assessing and targeting depressive symptoms in youth with comorbid pain and fatigue.
Sleep quality is known to be influenced by a number of variables. However, less is known about the clinical and demographic predictors of poor sleep quality for specific dimensions of sleep in patients with pain. In this study, 414 patients in multidisciplinary treatment for pain or injury were asked to rate their sleep quality using three dimensions: delayed onset (minutes to fall asleep), difficulty staying asleep (number of times waking during the sleep cycle), and insufficient sleep (number of hours of sleep). Following this, stepwise logistic regression was used to predict each of these sleep dimensions using BHI-2 and demographic predictor variables: Gender, age, race, education, acute vs. chronic status, pain, somatization, muscular bracing, depression, anxiety, anger, borderline personality traits, dependent personality traits, caffeine use, alcohol use, tobacco use, opioid prescription, sleep medication prescription, height, weight and body mass index. Predictor variables were entered using a forward stepwise method, using p<.01 to enter a variable to the regression equation, and p<.05 to retain, to reduce the risk of Type I errors. These analyses determined that delayed sleep onset was predicted by (in order of entry) muscular bracing (p=.004) and pain level (p=.01), R2=.102. Difficulty staying asleep was predicted by pain level (p=.005) and dependent traits (p=.01), R2=.102. Finally, insufficient sleep was predicted by pain level (p=.000) and height (p=.001), R2=.154. While these regression equations produced low R2s, these results suggest that in patients with pain or injury, specific dimensions of sleep may have different predictors. Additionally, the absence of race, gender, education and other demographic predictors was noted, suggesting that the differences in sleep may be more attributable to clinical variables.
(153) EEG-assessed bandwidth activity differences between individuals with SCI with and without chronic pain
(155) Assessing perceived disability: Development, validation, and clinical utility of the Perceived Disability Scale
A Braden, J Howe, M Jensen, L Sherlin, S Hakimian, M Reyes, and A Gianas; University of Washington, Seattle, WA
K Salyer, K Lofland, E Janke, and D Corsica; Argosy University, Chicago Campus, Chicago, IL
Chronic pain is a significant problem for many individuals living with a spinal cord injury (SCI). However, not all people with SCIs experience chronic pain as a direct result of the injury. Electroencephalograph (EEG) technology may be useful to understand possible differences in brain activity in individuals with SCI with and without chronic pain. The purpose of the current study is to measure and compare baseline brain activity between participants who experience daily SCI-related pain to those who do not. Fifteen participants with (N=8) and without (N=7) chronic pain underwent an EEG assessment. Participants with SCI and chronic daily pain produced significantly more relative fast wave activity (b-wave) and significantly less slow wave (a-wave) activity, suggesting differences in brain activity between these groups, and the potential utility of EEG for identifying these differences. The findings also suggest the possibility that interventions that alter brain wave activity in persons with a SCI and pain, such as neurofeedback training, could influence the experience of pain.
Evaluating self-perception is important in determining the degree to which cognitive and emotional factors may be influencing physical disability. Current measures are inadequate, assessing objective functionality or applicable to a limited population. The Perceived Disability Scale (PDS) is a brief, self-report instrument developed to assess self-perception of disability. The ten items of the PDS are designed to provide inter-item consistency with single items measuring congruous content, thus allowing for discriminating responses. Scoring of the PDS may be compared within the same patient population by diagnosis or across other disabled or rehabilitation populations. This study intends to report preliminary norms for the PDS among a variety of clinical populations and explore the clinical utility of the PDS in practice. Outpatients receiving treatment for obesity (n=491), spinal cord injury (n=34), erectile dysfunction (n=96), or chronic pain (n=651) completed the PDS upon intake at their respective specialty clinics. All four means were significantly different from each other, F(3,1268)=147.827, p<.001, with spinal cord injured patients reporting the highest level of perceived disability, followed by chronic pain, erectile dysfunction, and obesity respectively. Patients with chronic pain in head, face, and/ or mouth reported significantly lower levels of perceived disability than all other regions of pain, F(6,629)=9.162, p<.001, with the exception of the thoracic region. Subjects reporting an on-the-job injury, F(1,705)=28.757, p<.001, or worker’s compensation, F(1,637)=52.431, p<.001, also indicated significantly higher levels of perceived disability than non-reporters. Thus, the PDS is an effective tool in differentiating levels of perceived disability between medical populations. Further research is necessary to explore the relationship between PDS scores and treatment outcomes, identifying high-risk patients due to cognitive and emotional interference as it relates to perceived disability.