Access Type

Open Access Dissertation

Date of Award

January 2012

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Psychology

First Advisor

Mark A. Lumley

Abstract

Disability among patients with chronic pain can be assessed functionally (behaviorally) or subjectively (self-report). However, discrepancies--including low or zero correlations--between these methods are commonly reported. Research suggests that subjective disability may be more influenced by psychosocial factors than disability measured during functional tasks, leading to under/over reporting, but further investigation is needed. This study sought to identify correlates of discrepancies between subjective and functional disability in two samples of patients with chronic pain.

Retrospective data was compiled from clinical records of 389 patients evaluated at a university multidisciplinary chronic spinal pain treatment program (52.7% men; 88.9% White, 9.8% Black; spinal pain duration M = 53.54 months; 74.2% reported low back pain; 18.1% did not complete high school, 30.9% completed high school, 36.6% attended some college or vocational training, and 14.1% had a college degree or higher).

A sample of 174 adults with rheumatoid arthritis (RA) was recruited from rheumatology clinics (84% women; 55% White, 44% Black, 1% Hispanic; age M = 54.6 years; education M = 13.5 yrs; RA duration M = 11.2 yrs).

In each sample markers of psychosocial adjustment (e.g., depression, pain, coping, disability status), subjective disability, and functional disability were assessed. Subjective and functional disability measures were standardized, and a discrepancy score calculated (functional - subjective).

Results identified a salubrious pattern of disability discrepancy (subjective < functional), which was associated with less pain, better social functioning, more adaptive coping, and less dysfunctional coping in the chronic spinal pain sample (small to medium effect size, p < .05). The salubrious discrepancy pattern was inversely associated with disability compensation, depression, negative affect, pain, and dysfunctional coping in the RA sample (small effect size, p < .05). Kinesiophobia, religion, and positive affect were not associated with the discrepancy score. The discrepancy pattern where subjective > functional was not associated with any markers of healthy adjustment.

Overall, markers of better psychosocial adjustment were modestly associated with the salubrious pattern of functional > subjective disability, whereas poor adjustment was associated with the reverse discrepancy pattern. Theoretical and clinical implications of these findings are discussed.

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