gms | German Medical Science

Objectives/Interrogation: Psychological distress and ineffective coping have shown to significantly contribute to higher pain and decreased physical function among patients with orthopedic illness. However, little is known about the relationship among positive psychology factors - constructs that enable individuals to thrive and adapt to challenges - and pain and physical function in this population. Purpose of this study was to assess which positive psychology factors are associated with upper extremity physical function and pain intensity.

Methods: In a cross-sectional study, we recruited patients presenting to their regularly scheduled appointment with an orthopaedic surgeon at a Hand and Upper Extremity Clinic of a major urban academic medical center. Of 125 approached patients, 119 (44% men; mean age = 50 ± 17) met screening criteria and agreed to participate. Patients completed a clinical and demographic questionnaire, the Numerical Rating Scale to assess pain, the PROMIS Upper Extremity Physical Function CAT to assess physical function, and 7 measures assessing positive psychology constructs.

Results and Conclusions: In bivariate correlations satisfaction with life (r = .272, p = .003), greater gratitude (r = .248, p = .007), humor (r = .197, p = .033), mindfulness (r = .394, p < .001), and optimism (r = .224, p = .017) were associated with higher physical function. Similarly, satisfaction with life (r = -.411, p < .001), greater gratitude (r = -.411, p < .001), resilience (r = -.262, p = .004), mindfulness (r = .330, p < .001) and optimism (r = -.364, p < .001) were associated with lower pain. In multivariable linear regressions that controlled for relevant clinical and demographic variables, we found that mindfulness remained as sole significant positive psychology correlate of physical function (b = .360, t = 2.293, p = .024, sr2 = .188) and satisfaction with life as the sole significant positive psychology correlate of pain intensity (b = -.11, t = -2.16, p = .033, sr2 = -.184).

While causal inferences cannot be drawn, clinical interventions for this population may benefit from focusing on positive psychology principles aimed at human strengths and flourishing, rather than restricting to the standard medical model of physical therapy and pharmacology/opiates. Targeting mindfulness and satisfaction with life may be of particular benefit for this population. Such interventions focused on developing strengths may bypass stigma associated with traditional psychosocial interventions in orthopedic patients.