Are depression, anxiety, and fear-avoidance predictors of outcomes after digital care for chronic musculoskeletal pain?
Abstract. Background:. Despite compelling evidence identifying psychological predictive factors in in-person rehabilitation, their validity in remote digital care settings remains unknown. Objective:. To assess whether fear-avoidance beliefs, depression, and anxiety predict pain outcomes after a dig...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2025-10-01
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| Series: | PAIN Reports |
| Online Access: | http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001319 |
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| author | Dora Janela Xin Tong Anabela C. Areias Diogo Pires Fabíola Costa Hélder Fonseca |
| author_facet | Dora Janela Xin Tong Anabela C. Areias Diogo Pires Fabíola Costa Hélder Fonseca |
| author_sort | Dora Janela |
| collection | DOAJ |
| description | Abstract. Background:. Despite compelling evidence identifying psychological predictive factors in in-person rehabilitation, their validity in remote digital care settings remains unknown.
Objective:. To assess whether fear-avoidance beliefs, depression, and anxiety predict pain outcomes after a digital care program (DCP) for chronic musculoskeletal pain (CMP).
Methods:. This ad hoc analysis of a decentralized interventional investigation included patients with CMP who underwent a DCP integrating exercise, education, and behavioral change. Pain outcomes were assessed using 4 measures: last pain score, relative pain change, achievement of postintervention mild pain, and pain response (≥30% change or last pain score ≤3). Predictors included baseline scores of Fear-avoidance Beliefs Questionnaire related to Physical Activity, Patient Health 9-item Questionnaire, and Generalized Anxiety Disorder 7-item scale. Structural equation models evaluated their predictive value on pain outcomes, with or without including potential demographic and clinical confounders.
Results:. Fear-avoidance beliefs and depression symptoms were consistent predictors across all pain outcomes after confounders adjustment. Worse outcomes were associated with higher baseline fear-avoidance beliefs (eg, last pain score: β = 0.15, SE 0.04, P < 0.001; pain response: odds ratio [OR] 0.86, 95% confidence interval [CI] 0.78; 0.96, P = 0.001) and depression levels (eg, last pain score: β = 0.14, SE 0.05, P = 0.007; pain response: OR 0.85, 95% CI 0.74; 0.98, P = 0.008). Anxiety did not significantly affect any pain outcome. Sensitivity analyses showed stronger predictive performance when psychological factors were combined with clinical characteristics.
Conclusions:. Fear-avoidance beliefs and depression consistently predicted pain outcomes, reinforcing their critical role in digital rehabilitation for CMP. Multimodal, tailored approaches targeting these factors may optimize recovery in remote care. |
| format | Article |
| id | doaj-art-6fa4a990429d4bd79e677c51fefbe7e2 |
| institution | Kabale University |
| issn | 2471-2531 |
| language | English |
| publishDate | 2025-10-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | PAIN Reports |
| spelling | doaj-art-6fa4a990429d4bd79e677c51fefbe7e22025-08-26T03:25:52ZengWolters KluwerPAIN Reports2471-25312025-10-01105e131910.1097/PR9.0000000000001319PR90000000000001319Are depression, anxiety, and fear-avoidance predictors of outcomes after digital care for chronic musculoskeletal pain?Dora Janela0Xin Tong1Anabela C. Areias2Diogo Pires3Fabíola Costa4Hélder Fonseca5a Sword Health, Inc, Draper, UT, USAc Department of Psychology, University of Virginia, Charlottesville, VA, USAa Sword Health, Inc, Draper, UT, USAd Instituto Politécnico de Setúbal, Escola Superior de Saúde, Setúbal, Portugala Sword Health, Inc, Draper, UT, USAb Faculty of Sport, University of Porto, Porto, PortugalAbstract. Background:. Despite compelling evidence identifying psychological predictive factors in in-person rehabilitation, their validity in remote digital care settings remains unknown. Objective:. To assess whether fear-avoidance beliefs, depression, and anxiety predict pain outcomes after a digital care program (DCP) for chronic musculoskeletal pain (CMP). Methods:. This ad hoc analysis of a decentralized interventional investigation included patients with CMP who underwent a DCP integrating exercise, education, and behavioral change. Pain outcomes were assessed using 4 measures: last pain score, relative pain change, achievement of postintervention mild pain, and pain response (≥30% change or last pain score ≤3). Predictors included baseline scores of Fear-avoidance Beliefs Questionnaire related to Physical Activity, Patient Health 9-item Questionnaire, and Generalized Anxiety Disorder 7-item scale. Structural equation models evaluated their predictive value on pain outcomes, with or without including potential demographic and clinical confounders. Results:. Fear-avoidance beliefs and depression symptoms were consistent predictors across all pain outcomes after confounders adjustment. Worse outcomes were associated with higher baseline fear-avoidance beliefs (eg, last pain score: β = 0.15, SE 0.04, P < 0.001; pain response: odds ratio [OR] 0.86, 95% confidence interval [CI] 0.78; 0.96, P = 0.001) and depression levels (eg, last pain score: β = 0.14, SE 0.05, P = 0.007; pain response: OR 0.85, 95% CI 0.74; 0.98, P = 0.008). Anxiety did not significantly affect any pain outcome. Sensitivity analyses showed stronger predictive performance when psychological factors were combined with clinical characteristics. Conclusions:. Fear-avoidance beliefs and depression consistently predicted pain outcomes, reinforcing their critical role in digital rehabilitation for CMP. Multimodal, tailored approaches targeting these factors may optimize recovery in remote care.http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001319 |
| spellingShingle | Dora Janela Xin Tong Anabela C. Areias Diogo Pires Fabíola Costa Hélder Fonseca Are depression, anxiety, and fear-avoidance predictors of outcomes after digital care for chronic musculoskeletal pain? PAIN Reports |
| title | Are depression, anxiety, and fear-avoidance predictors of outcomes after digital care for chronic musculoskeletal pain? |
| title_full | Are depression, anxiety, and fear-avoidance predictors of outcomes after digital care for chronic musculoskeletal pain? |
| title_fullStr | Are depression, anxiety, and fear-avoidance predictors of outcomes after digital care for chronic musculoskeletal pain? |
| title_full_unstemmed | Are depression, anxiety, and fear-avoidance predictors of outcomes after digital care for chronic musculoskeletal pain? |
| title_short | Are depression, anxiety, and fear-avoidance predictors of outcomes after digital care for chronic musculoskeletal pain? |
| title_sort | are depression anxiety and fear avoidance predictors of outcomes after digital care for chronic musculoskeletal pain |
| url | http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001319 |
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