Relationship of Psychological and Cognitive Factors to Pain During Hip Fracture Rehabilitation: A Retrospective Analysis

Research

Objectives: To determine if impairments in cognition, expressive language, or pre-existing anxiety and/or depression were associated with pain perception, opioid use, and progress during inpatient rehabilitation following hip fracture.

Design: Retrospective CohortSetting: Inpatient rehabilitation facilityParticipants: One hundred patients admitted for rehabilitation following petrochanteric hip fracture between January 1, 2018 and December 30, 2020. Patients with intact, mild, or moderate/severe cognitive impairments were randomly selected for inclusion at a 1:1:1 ratio. Patients with dementia were excluded.Interventions: N/AMain Outcome Measures: Prior diagnosis of depression of anxiety, self-reported pain levels (rated 1-10) and opioid use during first week of admission, rehabilitation efficiency (change in functional independence [GG] per day), length of stay.

Results: Expressive language was assessed using language domains on the Montreal Cognitive Assessment (MoCA) and therapist assessments of patients’ abilities to express their needs and wants (Section BB of CMS IRF-PAI 3.0). A positive correlation between the Expression of Ideas and Wants and the average maximum pain levels (ρ = 0.243, P= 0.015) was observed, using Spearman's correlation. Language assessments on the MoCA were not related to pain (ρ=-0.078, P=0.46).

Higher average pain scores were associated with a diagnosis of anxiety and/or depression (ρ = 0.252, P= 0.012), lower MoCA scores (ρ = -0.225, P=0.031) and younger age (-0.243, P=0.015). These three factors were all independently associated with pain in a multivariable model (P < 0.05). Anxiety and/or depression was also associated with higher opioid frequency (ρ = 0.308, P= 0.002). There was a significant relationship between maximal pain scores and level of functional independence on admission and rehabilitation efficiency (ρ = -0.259, P=0.009).

Conclusions: Higher self-reported pain is associated with less efficient progress in rehabilitation. Patient cognition and ability to express oneself may affect pain reporting. Patients with anxiety and/or depression reported higher pain and used opioids more frequently than those without a diagnosis. Additional pain-management strategies should be considered in these populations.Author(s) Disclosures: None.