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Difficult life events affect lower extremity illness

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Given the relationship between psychological distress and activity tolerance (capability), a stressful life event might diminish accommodation, increase symptoms, and induce a person to seek specialty care. As a first step to investigate this possibility, this study addressed whether difficult life events are associated with greater activity intolerance and pain intensity.

Methods

A cohort of 127 patients seeking specialty care for lower extremity symptoms completed questionnaires that inquired about difficult life events within the last 12 months as derived from the Holmes Rahe Life Stress Inventory, and recorded pain intensity on an 11-point ordinal scale, activity tolerance [Patient Reported Outcomes Measurement Information System Physical Function Computer Adaptive Test (CAT)], symptoms of anxiety (GAD-2; 2 item version of the Generalized Anxiety Disorder questionnaire), symptoms of depression (PROMIS Depression CAT), self-efficacy when in pain (Pain Self-Efficacy Questionnaire, 2 question version), and demographics. The treating clinician indicated if the disease was established (e.g. arthritis) or relatively new (e.g. sprain/strain). Bivariate and multivariable analyses sought factors associated with activity intolerance and pain intensity.

Results

Greater activity intolerance was associated with difficult life events in bivariate analyses (t = 2.13, MD = 3.18, 95% C.I. = 0.22–6.13, p = 0.04) and in multivariable analyses that excluded symptoms of depression. Greater pain intensity was not associated with difficult life events, but was associated with surgeon rating of established disease (β = 1.20, 95% C.I. = 0.33–2.08, p < 0.01), greater symptoms of anxiety (MD = 3.35, s = 1.72; ρ = 0.30, p < 0.01), and less education (β =  − 1.06, 95% C.I. =  − 1.94– − 0.18, p = 0.02) (no college degree).

Conclusion

When a musculoskeletal specialist identifies less activity tolerance (less capability) than anticipated for a given injury or pathology, they can anticipate a potential difficult life event, and expect alleviation of symptoms and improved capability as the stress is ameliorated with time and support. Specialists can be prepared to direct people to community or professional support if requested.

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Author information

Authors and Affiliations

  1. Department of Surgery and Perioperative Care, Dell Medical School, 1601 Trinity St Bldg B, Austin, TX, 78712, US

    Aresh Al Salman, Michael Z. Khatiri, Teun Cremers, David Ring & Amirreza Fatehi

  2. Dept. of Kinesiology and Health Education, Health Behavior and Health Education Program, The University of Texas at Austin, Austin, US

    Jacob E. Thomas

Authors
  1. Aresh Al Salman
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  2. Michael Z. Khatiri
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  3. Teun Cremers
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  4. David Ring
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Corresponding author

Correspondence to David Ring.

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Conflict of interest

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical review committee statement

All authors certify that all procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Patients were invited to participate by researchers not involved in patient care. They were assured all participation was voluntary, anonymous and did not affect their care. Accepting the invitation to enroll and answering the questionnaires implied consent. No identifying information about participants is included in the article. This study has been approved by our institute review board (IRB).

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Appendices

Appendix 1

Diagnosis

N (%)

Knee pain

28 (22%)

Ankle fracture

15 (12%)

Foot/toe fracture

15 (12%)

Tibia fracture

12 (9%)

Fibula fracture

3 (2%)

Femur fracture

5 (4%)

Meniscus/ACL/RCL tear

10 (8%)

Ankle sprain

6 (5%)

Knee arthritis

15 (12%)

Other

20 (16%)

Other: Hip fracture, Hip pain, Nerve pain, Ganglion cysts

Appendix 2

Verbatim comments about the impact of difficult life events

Stress from a difficult life event

 It has caused me pain, depression, lack of confidence, which is decreased by my age and arthritis

 More complicated due to maintaining my heath and care of mother with dementia

 Made me more sensitive to stuff that could be wrong with my knee

 Breast cancer. Has altered the way I feel on a day to day basis

 Made life more challenging

 Unable to concentrate

 Contributed to my stress and prevented healing

 Big stress in my life. Emotional and physical

 Stressed me out more so I couldn't concentrate on healing

 Both were expensive and I don't want this added expense

Resiliency after a difficult life event

 No difference. Because all I do is win no matter what

 I’m fine

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Al Salman, A., Khatiri, M.Z., Cremers, T. et al. Difficult life events affect lower extremity illness. Arch Orthop Trauma Surg 142, 599–605 (2022). https://doi.org/10.1007/s00402-020-03686-y

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