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Characterizing injury-related perceived threat trajectories after acute, isolated extremity injuries: A prospective
Prudence Butler1, Nigel Armfield2, Shaun O'Leary3
1Sunshine Coast Hospital and Health Service Persistent Pain Management Service, Nambour, Queensland, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia; RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia.
Abstract:
'Perceived threat', or the anticipation of harm/loss associated with injury may influence persistent pain. Changes in perceived threat over time, and its association with pain interference and distress over time are unknown. This study recruited 138 patients (mean (SD) age 41.1(14.8), 65% female) with isolated extremity injuries within three weeks of injury and re-assessed them at 6 weeks, 3 and 6 months. Group-based trajectory modelling was used to identify trajectories of perceived threat, pain interference, anxiety, depression and post-traumatic stress symptoms, and to examine their interrelationships. Logistic regression explored baseline predictors of perceived threat trajectory group membership. Identified trajectory groups were: 1) perceived threat (improving low (37%), improving medium (42.2%) and stable high (20.8%)); 2) pain interference (improving moderate to mild (59.4%) and improving severe to moderate (40.6%)); 3) anxiety symptoms (none (79.2%) and stable moderate to severe (20.8%)); 4) depressive symptoms (none (22.7%), improving mild to none (57.1%) and stable moderate to severe (20.2%); and 5) PTSD (stable low (65.2%), stable moderate (21.2%) and improving (13.7%)). Strong linkages were identified between the low perceived threat and mild pain interference and distress symptom trajectories, and between the stable high perceived threat and the severe to moderate pain interference trajectories. Higher baseline pain intensity (OR[95%CI]= 1.46[1.13-1.90]) and anxiety (OR[95%CI]= 1.08[1.01-1.16]) predicted membership to the stable high perceived threat trajectory group. Findings suggest perceived threat reflects both trait-like and dynamic features. Patients with high, stable perceived threat are likely to have worse pain interference, but not necessarily worse psychological distress. PERSPECTIVE: Following an extremity injury, most adults show low or improving perceived threat, pain interference, and distress over six months. About one in five experience persistently high perceived threat, associated with greater pain interference but not consistently with psychological distress. High perceived threat may mark patients with more complex recovery patterns.
