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Resilience, Pain Interference, and Upper Limb Loss: Testing the Mediating Effects of Positive Emotion and Activity Restriction on Distress

Published:February 05, 2016DOI:https://doi.org/10.1016/j.apmr.2016.01.016

      Abstract

      Objective

      To test mediating effects of positive emotion and activity restriction on the associations of resilience and pain interference with distress reported by individuals with traumatic upper limb loss evaluated for prosthetics.

      Design

      Cross-sectional correlational study of several demographic and self-report measures of resilience, pain interference, activity restriction, positive emotions, and symptoms of depression and posttraumatic stress.

      Setting

      Six regional centers throughout the United States.

      Participants

      A total of 263 prospective participants consented to be evaluated for eligibility and need for upper extremity prosthetics; participants (N=202; 57 women [28.2%] and 145 men [71.8%]; mean age, 41.81±14.83y; range, 18.01–72.95y) who sustained traumatic injuries were retained in this study. Most of them were identified as white (70.8%; n=143), followed by black (10.4%; n=21), Hispanic (9.9%; n=20), Asian (3.0%; n=6), other (1.5%; n=3), and missing (4.5%; n=9).

      Interventions

      Not applicable.

      Main Outcome Measures

      Primary Care Posttraumatic Stress Disorder Screen and depression screen.

      Results

      Resilience and pain interference were significantly correlated in predicted directions with positive emotions, activity restriction, and the 2 distress variables. A path model revealed that the associations of resilience and pain interference with both distress variables were completely mediated by positive emotions and activity restriction. There were no significant direct effects of resilience or pain interference on either distress variable.

      Conclusions

      Resilience may facilitate adjustment via beneficial and predicted associations with positive emotions and active engagement with the environment. These relations are independent of the significant and inverse associations of pain interference with these same variables. Longitudinal research is needed to understand interactions between positive emotions and activity over time in promoting adjustment after traumatic limb loss. Individuals reporting depression and/or posttraumatic stress disorder symptoms may require interventions that reduce avoidance and promote activities that may increase the likelihood of experiencing positive emotions.

      Keywords

      List of abbreviations:

      CFI (comparative fit index), PTSD (posttraumatic stress disorder), RMSEA (root mean square error of approximation), SRMR (standardized root mean square residual), TLI (Tucker-Lewis index)
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      References

        • Dunn D.
        • Uswatte G.
        • Elliott T.
        Happiness, resilience, and positive growth following physical disability: issues for understanding, research, and therapeutic intervention.
        in: Lopez S. The Oxford handbook of positive psychology. 2nd ed. Oxford Univ Pr, New York2009: 651-664
        • Mancini A.
        • Bonanno G.
        Resilience to potential trauma: toward a life span approach.
        in: Reich J. Zautra A. Hall J. Handbook of adult resilience: concepts, methods, and applications. 1st ed. Guilford Pr, New York2010: 258-282
        • Windle G.
        • Bennett K.
        Caring relationships: how to promote resilience in challenging times.
        in: Unger M. The social ecology of resilience: a handbook of theory and practice. 1st ed. Springer, New York2012: 219-231
        • Davydov D.
        • Stewart R.
        • Ritchie K.
        • Chaudieu I.
        Resilience and mental health.
        Clin Psychol Rev. 2010; 30: 479-495
        • Fletcher D.
        • Sarkar M.
        Psychological resilience: a review and critique of definitions, concepts, and theory.
        Eur Psychol. 2013; 18: 12-23
        • Meredith L.
        Promoting psychological resilience in the U.S. military.
        RAND Corporation, Santa Monica2011
        • Steenkamp M.
        • Nash W.
        • Litz B.
        Post-traumatic stress disorder.
        Am J Prev Med. 2013; 44: 507-512
        • Fredrickson B.
        Positive emotions broaden and build.
        Adv Exp Soc Psychol. 2013; 47: 1-53
        • Cohn M.
        • Fredrickson B.
        • Brown S.
        • Mikels J.
        • Conway A.
        Happiness unpacked: positive emotions increase life satisfaction by building resilience.
        Emotion. 2009; 9: 361-368
        • Kok B.
        • Coffey K.
        • Cohn M.
        • et al.
        How positive emotions build physical health: perceived positive social connections account for the upward spiral between positive emotions and vagal tone.
        Psychol Sci. 2013; 24: 1123-1132
        • Ong A.
        • Bergeman C.
        • Boker S.
        Resilience comes of age: defining features in later adulthood.
        J Pers. 2009; 77: 1777-1804
        • Silverman A.
        • Molton I.
        • Alschuler K.
        • Ehde D.
        • Jensen M.
        Resilience predicts functional outcomes in people aging with disability: a longitudinal investigation.
        Arch Phys Med Rehabil. 2015; 96: 1262-1268
        • Seale G.
        • Berges I.
        • Ottenbacher K.
        • Ostir G.
        Change in positive emotion and recovery of functional status following stroke.
        Rehabil Psychol. 2010; 55: 33-39
        • Berges I.
        • Seale G.
        • Ostir G.
        The role of positive affect on social participation following stroke.
        Disabil Rehabil. 2012; 34: 2119-2123
        • White B.
        • Driver S.
        • Warren A.
        Resilience and indicators of adjustment during rehabilitation from a spinal cord injury.
        Rehabil Psychol. 2010; 55: 23-32
        • Rainey E.
        • Petrey L.
        • Reynolds M.
        • Agtarap S.
        • Warren A.
        Psychological factors predicting outcome after traumatic injury: the role of resilience.
        Am J Surg. 2014; 208: 517-523
        • Quale A.
        • Schanke A.
        Resilience in the face of coping with a severe physical injury: a study of trajectories of adjustment in a rehabilitation setting.
        Rehabil Psychol. 2010; 55: 12-22
        • Elliott T.
        • Berry J.
        • Richards J.
        • Shewchuk R.
        Resilience in the initial year of caregiving for a family member with a traumatic spinal cord injury.
        J Consult Clin Psychol. 2014; 82: 1072-1086
        • Ong A.
        • Zautra A.
        • Reid M.
        Psychological resilience predicts decreases in pain catastrophizing through positive emotions.
        Psychol Aging. 2010; 25: 516-523
        • Caspi A.
        • Silva P.
        Temperamental qualities at age three predict personality traits in young adulthood: longitudinal evidence from a birth cohort.
        Child Dev. 1995; 66: 486
        • Chapman B.
        • Goldberg L.
        Replicability and 40-year predictive power of childhood ARC types.
        J Pers Soc Psychol. 2011; 101: 593-606
        • Block J.
        • Block J.
        The role of ego control and ego resiliency in the organization of behavior.
        in: Collins W. The Minnesota symposium on child psychology, Vol 13: development of cognition, affect, and social relations. 1st ed. Erlbaum, Hillsdale1980: 39-101
        • Block J.
        • Kremen A.
        IQ and ego-resiliency: conceptual and empirical connections and separateness.
        J Pers Soc Psychol. 1996; 70: 349-361
        • Farkas D.
        • Orosz G.
        Ego-resiliency reloaded: a three-component model of general resiliency.
        PLos One. 2015; 10: e0120883
        • Darnall B.
        • Ephraim P.
        • Wegener S.
        • et al.
        Depressive symptoms and mental health service utilization among persons with limb loss: results of a national survey.
        Arch Phys Med Rehabil. 2005; 86: 650-658
        • Ephraim P.
        • Wegener S.
        • MacKenzie E.
        • Dillingham T.
        • Pezzin L.
        Phantom pain, residual limb pain, and back pain in amputees: results of a national survey.
        Arch Phys Med Rehabil. 2005; 86: 1910-1919
        • Hanley M.
        • Ehde D.
        • Jensen M.
        • Czerniecki J.
        • Smith D.
        • Robinson L.
        Chronic pain associated with upper-limb loss.
        Am J Phys Med Rehabil. 2009; 88: 742-751
        • Erosa N.
        • Berry J.
        • Elliott T.
        • Underhill A.
        • Fine P.
        Predicting quality of life five years after medical discharge for traumatic spinal cord injury.
        Br J Health Psychol. 2013; 19: 688-700
        • Molton I.
        • Hirsh A.
        • Smith A.
        • Jensen M.
        Age and the role of restricted activities in adjustment to disability-related pain.
        J Health Psychol. 2013; 19: 1025-1034
        • Fredrickson B.
        • Tugade M.
        • Waugh C.
        • Larkin G.
        What good are positive emotions in crisis? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001.
        J Pers Soc Psychol. 2003; 84: 365-376
        • Ware J.
        • Kosinski M.
        • Keller S.A.
        12-item short-form health survey.
        Med Care. 1996; 34: 220-233
        • Jarl G.
        • Heinemann A.
        • Hermansson L.
        Validity evidence for a modified version of the Orthotics and Prosthetics Users’ Survey.
        Disabil Rehabil Assist Technol. 2012; 7: 469-478
        • Prins A.
        • Ouimette P.
        • Kimerling R.
        • et al.
        The Primary Care PTSD Screen (PC-PTSD): development and operating characteristics.
        Prim Care Psychiatry. 2004; 9: 9-14
        • Kirkcaldy R.
        • Tynes L.
        Best practices: depression screening in a VA primary care clinic.
        Psychiatr Serv. 2006; 57: 1694-1696
        • Muthén L.
        • Muthén B.
        Mplus users’ guide.
        7th ed. Muthén & Muthén, Los Angeles2012
        • Mueller R.
        Basic principles of structural equation modeling.
        Springer, New York1996
        • Weston R.
        • Gore P.
        • Chan F.
        • Catalano D.
        An introduction to using structural equation models in rehabilitation psychology.
        Rehabil Psychol. 2008; 53: 340-356
        • Hayes A.
        Beyond Baron and Kenny: statistical mediation analysis in the new millennium.
        Commun Monogr. 2009; 76: 408-420
        • Tanaka J.
        “How big is big enough?”: sample size and goodness of fit in structural equation models with latent variables.
        Child Dev. 1987; 58: 134-146
        • Kline R.
        Principles and practice of structural equation modeling.
        Guilford Pr, New York2005
        • Hoyt W.
        • Imel Z.
        • Chan F.
        Multiple regression and correlation techniques: recent controversies and best practices.
        Rehabil Psychol. 2008; 53: 321-339
        • Losoi H.
        • Silverberg N.
        • Wäljas M.
        • et al.
        Resilience is associated with outcome from mild traumatic brain injury.
        J Neurotrauma. 2015; 32: 942-949
        • Mausbach B.
        • Chattillion E.
        • Moore R.
        • Roepke S.
        • Depp C.
        • Roesch S.
        Activity restriction and depression in medical patients and their caregivers: a meta-analysis.
        Clin Psychol Rev. 2011; 31: 900-908
        • Elliott T.
        • Hsiao Y.
        • Kimbrel N.
        • et al.
        Resilience, traumatic brain injury, depression, and posttraumatic stress among Iraq/Afghanistan war veterans.
        Rehabil Psychol. 2015; 60: 263-276
        • Desmond D.
        • Coffey L.
        • Gallagher P.
        • MacLachlan M.
        • Wegener S.
        • O’Keeffe F.
        Limb amputation.
        in: Kennedy P. The Oxford handbook of rehabilitation psychology. 1st ed. Oxford Univ Pr, New York2012: 351-367
        • Mazzucchelli T.
        • Kane R.
        • Rees C.
        Behavioral activation treatments for depression in adults: a meta-analysis and review.
        Clin Psychol Sci Pract. 2009; 16: 383-411