Tew, Victoria Jane
(2014)
Pain pressure thresholds and psychosocial correlates in people with knee osteoarthritis.
DClinPsy thesis, University of Nottingham.
Abstract
This thesis focusses on chronic pain, pain sensitivity, depression, and anxiety in people with knee osteoarthritis (OA). The thesis includes details of three interrelated sub-studies: Study 1: An investigation into the associations between pain pressure thresholds (PPTs) and self-reported pain, depression, anxiety, and gender in knee OA; Study 2: An investigation into the inter-rater reliability of pressure algometry Quantitative Sensory Testing (QST); and Study 3: Rasch analysis of the State-Trait Anxiety Inventory short form (STAI-SF).
Previous research into self-reported pain and pain sensitivity assessed via QST in knee OA suggests that there are significant associations between these factors and depression and anxiety. However, few studies have investigated the relationships between pain sensitivity and mood in people with knee OA, as the majority of these studies are very medical in their focus. Gender differences in some QST studies have also been found, with women often presenting with lower pain thresholds than men. However, this finding has not been consistent, and appears to vary across different samples.
For Study 1, 77 people with a diagnosis of knee OA completed self-report measures of current pain level, depression, and anxiety. PPTs at four body sites were then measured for each participant using QST. Correlations showed that female gender, higher pain rating, and higher levels of depression and anxiety, were associated with lower PPTs. Parallel multiple regression models found that self-reported pain rating, depression, anxiety, and gender explained between 13 and 18% of the variance in PPTs (for each individual body site).
For Study 2, 20 healthy participants underwent the QST procedure used in Study 1 to measure their PPTs at four body sites. The QST was administered by the two testers who administered the QST in Study 1, in order to investigate inter-rater reliability. Acceptable inter-class coefficients were found for each body site PPT, suggesting that lack of inter-rater reliability was not a weakness of Study 1.
For Study 3, 246 people with a diagnosis of knee OA completed the STAI-SF. In order to evaluate the measurement properties of the STAI-SF with this client group, Rasch analysis was undertaken. The study examined the fit between the data collected from the STAI-SF and the Rasch model, in order to investigate whether it meets the psychometric requirements of interval-level measurement. An acceptable fit to the Rasch model was found, although the measure showed evidence of mistargetting.
The main conclusions of this thesis research were that, for people with knee OA, depression, anxiety, gender, and pain rating are related to PPTs and explain some of the variance in PPTs. The utility of the STAI-SF with people with knee OA was also queried. The key implication of this research is that it is important for the appropriateness of assessment tools used in knee OA for mood and pain (in research and/or clinical practice) to be more critically considered than they are in most current literature. This would help ensure that the data collected is more meaningful and helpful in guiding interventions for this client group.
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