Body Perception Disturbances in Chronic Limb Pain: Exploring Different Assessment Tools and Their Associations with...

Background: Body perception disturbances (BPDs) are highly prevalent in chronic limb pain, manifesting as hostile feelings towards the limb, reduced sensory-motor function, and altered limb ownership. Various questionnaires and tests assess BPD, but their interrelation and associations with limb disability remain underexplored. This study aimed to evaluate BPD assessments, examine whether they capture overlapping or distinct aspects of BPD, and determine their associations with upper- and lower-limb disability. Methods: This observational cross-sectional study included 92 participants with chronic limb pain. Participants completed BPD questionnaires (Bath-BPD, Neurobehavioral) and tests (Laterality Recognition, Fingers/Toe Perception, Human Figure Drawing), along with clinical pain measures and the symptom severity index. Dependent outcomes were upper- and lower-limb disability. Results: Cluster analysis grouped all measures into 'High' and 'Low' BPD severity clusters, with overall cluster quality rated as fair (silhouette = 0.40). The Neurobehavioral questionnaire emerged as the primary contributor to the cluster structure (silhouette = 1). The 'High' BPD cluster showed significantly greater symptom severity (t(63) = -4.13, p < 0.001). Pain severity, Bath-BPD questionnaire, and symptom severity were significantly associated with upper-limb disability (p < 0.001), whereas pain intensity alone accounted for 24% of lower-limb disability variance. Conclusions: Despite the diversity of BPD assessments, the clustering pattern suggests a partial convergence between measures, though a weak cohesiveness of BPD tests indicates that they capture partially distinct aspects of body perception. BPD questionnaires were associated with upper-limb disability, whereas lower-limb disability was associated with pain intensity. These findings emphasize the importance of assessing BPDs in musculoskeletal care and suggest their potential role as indicators of symptom severity.