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Wong M1, Gonzalez J1, Glynn T1, Widerstrom-Noga E1, Cahalin L1
1University of Miami Miller School of Medicine, Physical Therapy, Miami, United States
Background: Pain catastrophizing is one of the strongest psychosocial predictors of pain related disability. Moreover, racial and ethnic minority groups are purported to have greater pain catastrophizing and greater pain related disability than non-Hispanic Whites (NHW). However, it is not well understood if the relationship between pain catastrophizing and pain related disability differs between racial and ethnic groups.
Purpose: The purpose of this study was to assess differences between NHW, non-Hispanic Blacks (NHB), and Hispanic individuals in pain catastrophizing, self-reported disability, and the relationship between pain catastrophizing and disability.
Methods: We prospectively collected data on 1080 individuals (NHW n=510, NHB n=94, and Hispanics n=476) seeking outpatient physical therapy services (PT) for musculoskeletal pain. Ethnicity, Pain Catastrophizing Scale scores, and anatomic region-based disability questionnaires (i.e. Oswestry Disability Index, Neck Disability Index, QuickDASH, and Lower Extremity Functional Scale) were administered at evaluation and discharge.
Results: There were no significant differences between groups for age, chronicity, and diagnoses. Baseline PCS scores were significantly higher (p .01) for the Hispanic and NHB groups than for the NHW group with mean score of 41%±28, 41%±25, and 29%±23, respectively. Similarly, mean baseline disability scores were also higher for the Hispanic and NHB groups than for NHW with mean disability scores of 52%±24, 47%±21, and 45%±22, respectively. Hispanics and NHB also demonstrated greater decreases in PCS after PT scores than NHW with change scores of 16%±25, 18%±23, and 12%±19, respectively. The change in disability after PT was not significantly different between groups with mean change scores of 19%±23 for Hispanics, 17%±21 for NHB, and 19%±22 for NHW. There was a weak but significant relationship between baseline PCS score and baseline disability scores in NHW (r=.23, p .01) and Hispanics (r=.26, p .01) but not in NHB (r=.08, p=.47). None of the groups demonstrated a relationship between baseline PCS scores and change in disability. The differences between groups in the correlation of baseline PCS with baseline disability was near to significant between NHW and NHB (Z=1.35, p=.09) and between NHB and Hispanics (Z=-1.62, p=.053), but there was no difference between NHW and Hispanics (Z=-.05, p=.31).
Conclusion(s): Racial and ethnic minorities demonstrated higher baseline pain catastrophizing and disability than NHW. However, minority groups demonstrated significantly greater decreases in pain catastrophizing after PT than NHW, and all groups demonstrated equivalent changes in disability. Thus, although higher baseline pain catastrophizing and disability is a known risk factor for poor outcomes, minority groups were not more resistant to PT management despite having higher baseline values. It is plausible that minority groups, Hispanics in particular, interpret and answer these questionnaires differently. Thus, the higher pain catastrophizing and disability frequently observed in minorities when compared to NHW may be influenced by response tendency bias, and this difference may not be an accurate estimate of worse prognosis.
Implications: These findings improve our understanding of racial and ethnic differences in patient responses to pain catastrophizing and disability questionnaires, which may in turn improve the prognostic utility of these measures and help to combat disparities in healthcare management.
Keywords: Race, Ethnicity, Pain catastrophizing
Funding acknowledgements: Internal Funding from the UM Department of Physical Therapy
Purpose: The purpose of this study was to assess differences between NHW, non-Hispanic Blacks (NHB), and Hispanic individuals in pain catastrophizing, self-reported disability, and the relationship between pain catastrophizing and disability.
Methods: We prospectively collected data on 1080 individuals (NHW n=510, NHB n=94, and Hispanics n=476) seeking outpatient physical therapy services (PT) for musculoskeletal pain. Ethnicity, Pain Catastrophizing Scale scores, and anatomic region-based disability questionnaires (i.e. Oswestry Disability Index, Neck Disability Index, QuickDASH, and Lower Extremity Functional Scale) were administered at evaluation and discharge.
Results: There were no significant differences between groups for age, chronicity, and diagnoses. Baseline PCS scores were significantly higher (p .01) for the Hispanic and NHB groups than for the NHW group with mean score of 41%±28, 41%±25, and 29%±23, respectively. Similarly, mean baseline disability scores were also higher for the Hispanic and NHB groups than for NHW with mean disability scores of 52%±24, 47%±21, and 45%±22, respectively. Hispanics and NHB also demonstrated greater decreases in PCS after PT scores than NHW with change scores of 16%±25, 18%±23, and 12%±19, respectively. The change in disability after PT was not significantly different between groups with mean change scores of 19%±23 for Hispanics, 17%±21 for NHB, and 19%±22 for NHW. There was a weak but significant relationship between baseline PCS score and baseline disability scores in NHW (r=.23, p .01) and Hispanics (r=.26, p .01) but not in NHB (r=.08, p=.47). None of the groups demonstrated a relationship between baseline PCS scores and change in disability. The differences between groups in the correlation of baseline PCS with baseline disability was near to significant between NHW and NHB (Z=1.35, p=.09) and between NHB and Hispanics (Z=-1.62, p=.053), but there was no difference between NHW and Hispanics (Z=-.05, p=.31).
Conclusion(s): Racial and ethnic minorities demonstrated higher baseline pain catastrophizing and disability than NHW. However, minority groups demonstrated significantly greater decreases in pain catastrophizing after PT than NHW, and all groups demonstrated equivalent changes in disability. Thus, although higher baseline pain catastrophizing and disability is a known risk factor for poor outcomes, minority groups were not more resistant to PT management despite having higher baseline values. It is plausible that minority groups, Hispanics in particular, interpret and answer these questionnaires differently. Thus, the higher pain catastrophizing and disability frequently observed in minorities when compared to NHW may be influenced by response tendency bias, and this difference may not be an accurate estimate of worse prognosis.
Implications: These findings improve our understanding of racial and ethnic differences in patient responses to pain catastrophizing and disability questionnaires, which may in turn improve the prognostic utility of these measures and help to combat disparities in healthcare management.
Keywords: Race, Ethnicity, Pain catastrophizing
Funding acknowledgements: Internal Funding from the UM Department of Physical Therapy
Topic: Pain & pain management; Disability & rehabilitation; Outcome measurement
Ethics approval required: Yes
Institution: University of Miami
Ethics committee: IRB
Ethics number: 20120497
All authors, affiliations and abstracts have been published as submitted.
