For a study, researchers used moderation analysis to examine the relationship between pain intensity and magnitude of incapacity (dependent variables) and fracture severity (independent variable), as well as the influence of depressive symptoms and catastrophic thinking (moderators) in the early and late stages of recovery. A group of 731 patients recovering from a shoulder, elbow, or wrist fracture completed self-reported measures of pain intensity, upper extremity capability, depressive symptoms, and catastrophic thinking between 2 and 4 weeks and again between 6 and 9 months after the injury. Clinicians rated fracture severity, and investigators used multivariable regression analysis to examine the interactions between fracture severity, depression, catastrophic thinking, pain intensity, and magnitude of incapacity at the early and late stages of recovery. At both the early and late stages of recovery, symptoms of depression and catastrophic thinking reduced the relationship between pain intensity and fracture severity. Depression symptoms and catastrophic thinking reduced the relationship between the magnitude of incapacity and fracture severity, but only in the early stages of recovery. Because of the moderating effects of unhelpful thinking and distress, the relative divergence of pain intensity and magnitude of incapacity from the level of fracture severity indicates a benefit to anticipating mental health opportunities during fracture recovery. Fracture management can incorporate measures of unhelpful thinking and distress symptoms to address these opportunities better and ensure comprehensive recovery optimization.
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