Does resiliency mediate the association of psychological adaptability with disability and pain in patients with an upper extremity injury or illness?

J Psychosom Res. 2019 Feb;117:1-9. doi: 10.1016/j.jpsychores.2018.12.002. Epub 2018 Dec 7.


Objective: Symptom intensity and magnitude of limitations are highly variable for a given nociception and pathophysiology. As psychological determinants are of great influence to physical wellbeing, we assessed the influence of the protective factor measured and labelled as resilience in upper extremity illness.

Methods: One hundred and six patients completed a survey of demographics, the Brief Resilience Scale (BRS), the Psychological Adaptation Scale (PAS), an 11-point ordinal measure of pain intensity, and the PROMIS Physical Function (PROMIS PF) Computer Adaptive Test (CAT). Measures of pain intensity and PROMIS PF were repeated 3 months later. We created mediation models using structural equation modeling (SEM) to assess the mediation effect of BRS on the association of PAS and other confounding variables with disability and pain at initial assessment and 3 months later.

Results: Resiliency does not mediate the association of psychological adaptability with physical limitations and pain intensity at baseline (P = .89 and .82 respectively) or 3 months after enrollment (P = .65 and .72 respectively).

Conclusions: Positive and protective factors promote beneficial resilience mechanisms that strengthen coping responses to pain and disability. In future studies we should either include more patients to improve power and provide more information about the health benefits of resilience or focus more on mood and self-efficacy on symptoms and limitations in patients with musculoskeletal illness.

Level of evidence: Prospective, longitudinal cohort study; Level II.

Keywords: Mediation analysis; Pain; Physical limitations; Psychological adaptability; Resilience.

MeSH terms

  • Adaptation, Psychological / physiology*
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Disability Evaluation*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Pain Measurement / methods*
  • Prospective Studies
  • Surveys and Questionnaires
  • Upper Extremity / injuries*
  • Upper Extremity / physiopathology
  • Young Adult