The Correlation of Cognitive Flexibility with Pain Intensity and Magnitude of Disability in Upper Extremity Illness

Abstract

Cognitive flexibility – the ability to restructure one’s knowledge, incorporate new facts, widen perspective, and adapt to the demands of new and unexpected conditions – can help one adapt to illness. The aim of this study was to assess the relationship between cognitive flexibility and hand and upper extremity specific disability in patients presenting to a hand surgeon. Secondarily, we determined predictors of cognitive flexibility and pain. Eighty-nine consecutive outpatients completed the Cognitive flexibility questionnaire (CFS), Short Health Anxiety Inventory-5 (SHAI-5), Pain Self-Efficacy Questionnaire (PSEQ), Disabilities of Arm, Shoulder and Hand, short form (QuickDASH), and Patient Health Questionnaire for Depression-2 (PHQ-2) in a cross-sectional study. CFS did not correlate with disability or pain intensity. Disability correlated with PSEQ (r=–0.66, p<0.01), PHQ-2 (r=0.38, p=<0.01), and SHAI-5 (r=0.33, p<0.01). Pain intensity correlated with PSEQ (r=–0.51 p<0.01) and PHQ-2 (r=0.41 p<0.01). There was a small correlation between the CFS and PSEQ (r=0.25, p=0.02). The best multivariable models for QuickDASH and pain intensity included PSEQ and PHQ and explained 35 % and 28 % of the variability respectively. Upper extremity specific disability and pain intensity are limited more by self-efficacy than cognitive flexibility. Interventions to improve self-efficacy might help patients with upper extremity illness.

Keywords

Cognitive flexibility scale - Pain intensity - Disability - Upper extremity - Self-efficacy

• References

• 1 Ring D, Kadzielski J, Malhotra L, Lee SG, Jupiter JB. Psychological factors associated with idiopathic arm pain. J Bone Joint Surg Am 2005; 87 (2) 374-380 doi:10.2106/JBJS.D.01907
• 2 Salkovskis PM, Rimes KA, Warwick HM, Clark DM. The health anxiety inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol Med 2002; 32 (5) 843-853
• 3 Souer JS, Buijze G, Ring D. A prospective randomized controlled trial comparing occupational therapy with independent exercises after volar plate fixation of a fracture of the distal part of the radius. J Bone Joint Surg Am 2011; 93 (19) 1761-1766 doi:10.2106/JBJS.J.01452
• 4 Turner JA, Jensen MP, Warms CA, Cardenas DD. Catastrophizing is associated with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain after spinal cord injury. Pain 2002; 98 (1–2) 127-134
• 5 Vranceanu AM, Barsky A, Ring D. Psychosocial aspects of disabling musculoskeletal pain. J Bone Joint Surg Am 2009; 91 (8) 2014-2018. doi:10.2106/JBJS.H.01512
• 6 Doornberg JN, Ring D, Fabian LM, Malhotra L, Zurakowski D, Jupiter JB. Pain dominates measurements of elbow function and health status. J Bone Joint Surg Am 2005; 87 (8) 1725-1731 doi:10.2106/JBJS.D.02745
• 7 Niekel MC, Lindenhovius AL, Watson JB, Vranceanu AM, Ring D. Correlation of DASH and QuickDASH with measures of psychological distress. J Hand Surg 2009; 34 (8) 1499-1505 doi:10.1016/j.jhsa.2009.05.016
• 8 Vranceanu AM, Jupiter JB, Mudgal CS, Ring D. Predictors of pain intensity and disability after minor hand surgery. J Hand Surg 2010; 35 (6) 956-960 doi:10.1016/j.jhsa.2010.02.001
• 9 Vranceanu AM, Safren S, Zhao M, Cowan J, Ring D. Disability and psychologic distress in patients with nonspecific and specific arm pain. Clin Orthop RelatRes 2008; 466 (11) 2820-2826 doi:10.1007/s11999-008-0378-1
• 10 Canas J, Quesada JF, Antoli A, Fajardo I. Cognitive flexibility and adaptability to environmental changes in dynamic complex problem-solving tasks. Ergonomics 2003; 46 (5) 482-501 doi:10.1080/0014013031000061640
• 11 Spiro RJ, Jehng J. Cognitive flexibility and hypertext: theory and technology for the non-linear and multidimensional traversal of complex subject matter. Cognition, education, and multimedia. 1990. Erlbaum, Hillsdale, NJ:
• 12 Martin M, Anderson C. Cognitive flexibility scale: three validity studies. Commun Rep 1998; 11 (1) 1-9
• 13 Martin M, Rubin R. Development of a communication flexibility scale. South Commun J 1994; 1994 (59) 171-178
• 14 Martin M, Rubin R. A new measure of cognitive flexibility; Matthew M. Martin and Rebecca B. Psychol Rep 1995; 76: 623-626
• 15 Tchanturia K, Davies H, Roberts M, Harrison A, Nakazato M, Schmidt U, Treasure J, Morris R. Poor cognitive flexibility in eating disorders: examining the evidence using the Wisconsin Card Sorting Task. PloS one 2012; 7 (1) doi:10.1371/journal.pone.0028331
• 16 McAnarney E, Zarcone J, Singh P, Michels J, Welsh S, Litteer T, Wang H, Klein J. Restrictive anorexia nervosa and set-shifting in adolescents: a biobehavioral interface. J Adolesc Health: Off Publ Soc Adolesc Med 2011; 49 (1) 99-101 doi:10.1016/j.jadohealth.2010.11.259
• 17 Schmidt U, Treasure J. Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. The British J Clin Psychol/The British Psychol Soc 2006; 45 (Pt 3) 343-366 doi:10.1348/014466505X53902
• 18 Greve K, Stickle T, Love J, Bianchini K, Stanford M. Latent structure of the Wisconsin card sorting test: a confirmatory factor analytic study. Arch Clin Neuropsychol: Off J Natl Acad Neuropsychologists 2005; 20 (3) 355-364 doi:10.1016/j.acn.2004.09.004
• 19 Chelune GJ, Baer RA. Developmental norms for the Wisconsin card sorting test. J Clin Exp Neuropsychol 1986; 8 (3) 219-228 doi:10.1080/01688638608401314
• 20 Diamond A, Barnett WS, Thomas J, Munro S. Preschool program improves cognitive control. Science 2007; 318 (5855) 1387-1388 doi: 10.1126/science. 1151148
• 21 DeGood DE, Tait RC. Assessment of pain beliefs and pain coping. 2nd edn Handbook of pain assessment. Guilford Press; New York: 2001
• 22 Dolce JJ, Crocker MF, Moletteire C, Doleys DM. Exercise quotas, anticipatory concern and self-efficacy expectancies in chronic pain: a preliminary report. Pain 1986; 24 (3) 365-372
• 23 Jensen MP, Turner JA, Romano JM, Karoly P. Coping with chronic pain: a critical review of the literature. Pain 1991; 47 (3) 249-283
• 24 Lorig K, Chastain RL, Ung E, Shoor S, Holman HR. Development and evaluation of a scale to measure perceived selfefficacy in people with arthritis. Arthritis Rheum 1989; 32 (1) 37-44
• 25 Kahneman D (25 October 2011) Thinking, Fast and Slow. Macmillan ISBN 978-1-4299-6935-2 (Retrieved 8 April 2012)
• 26 Bilgin M. Developing a cognitive flexibility scale: validity and reliability studies. Soc Behav Personal Int J 2009; 37 (3) 343
• 27 Martin MM, Anderson CM. The cognitive flexibility scale: three validity studies. Commun Rep 1998; 11 (1) 9 doi:10.1080/08934219809367680
• 28 Martin MM, Rubin RB. A new measure ofcognitive flexibility. Psychol Rep 1995; 76 (2) 623
• 29 Alberts NM, Hadjistavropoulos HD, Jones SL, Sharpe D. The short health anxiety inventory: a systematic review and metaanalysis. J Anxiety Disord 2013; 27 (1) 68-78 doi:10.1016/j.janxdis.2012.10.009
• 30 Asghari A, Nicholas MK. Pain self-efficacy beliefs and pain behaviour. A prospective study. Pain 2001; 94 (1) 85-100
• 31 Nicholas MK. The pain self-efficacy questionnaire: taking pain into account. Eur J Pain 2007; 11 (2) 153-163 doi:10.1016/j.ejpain.2005.12.008
• 32 Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? validity, reliability, and responsiveness of the disabilities of the Arm, shoulder and hand outcome measure in different regions of the upper extremity. J Hand Ther 2001; 14 (2) 128-146
• 33 Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. the upper extremity collaborative group (UECG). Am J Ind Med 1996; 29 (6) 602-608 doi:10.1002/(SICI) 1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L
• 34 Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord 2006; 7: 44 doi:10.1186/1471-2474-7-44
• 35 Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16 (9) 606-613
• 36 Kroenke K, Spitzer RL, Williams JB. The patient health questionnaire-2: validity of a two-item depression screener. Med Care 2003; 41 (11) 1284-1292 doi:10.1097/01.MLR.0000093487.78664.3C