Psychosocial factors that can influence the self-assessment of function

What has plagued the evaluation process in this area has been the level of agreement in the wide variation in the measures used to document a construct such as pain, as well as changes in that construct as reflected in the measurement of function. The present article reviews the major psychosocial barriers to assessment/recovery that have been implicated as influencing the self-assessment of function. The following are discussed: secondary gain; secondary loss; emotional distress (such as anger, anxiety and depression); psychopathology; somatization and symptom magnification; compliance and resistance; patient comprehension/mental status; and iatrogenic effects.