Assessment of avoidance behavior in patients with proximal humerus fracture

Abstract

Moderate to strong evidence demonstrates a relationship between fear of movement-related pain (kinesiophobia) and pain and disability in musculoskeletal pain. However, evidence is weak for this relationship in proximal humerus fractures, and the isolated study of avoidance behavior is little explored. In addition, the scales that measure fear of pain related to movement (Tampa Scale of Kinesiophobia, TSK) and avoidance behavior (Avoidance Daily Activities Photo Scale, ADAP Shoulder Scale) still do not have a score capable of identifying the patient with high level of such negative psychological factors. The objectives of the study are to characterize fear and avoidance behavior in proximal humeral fractures and to investigate the association with psychological (self-efficacy, resilience, symptoms of depression and catastrophizing), behavioral (kinesiophobia) and biological (age, sex, time since symptoms and level of shoulder pain and disability). In addition, a score on the ADAP Shoulder Scale capable of distinguishing individuals with high avoidance behavior will be identified. To this end, the study will collect data from patients with proximal humerus fractures at the Rehabilitation Center of HCFMRP-USP, at the Cuiabá School-Health Center (CSE-Cuiabá) and at a private clinic. The study will evaluate 105 individuals with fracture of the proximal humerus and will use the ADAP Shoulder Scale, Tampa Scale of Kinesiophobia (TSK), The Shoulder Pain and Disability Index (SPADI), Pain-related Self-Efficacy Beliefs (PSEQ) self-efficacy scales, Connor-Davidson Resilience Scale (CD -RISC), Patient Health Questionnaire (PHQ-9) and Pain Catastrophic Thoughts Scale (PCS). The characterization data of the sample and scores from questionnaires will be presented in means, standard deviation and frequencies. Simple correlations will be performed to analyze the association between ADAP Shoulder Scale scores and TSK and SPADI scale scores. Univariate and multiple linear regression will be performed to analyze the influence of psychological factors on avoidance behavior in individuals with proximal humerus fracture. The scores capable of identifying the "High avoidance behavior" will be generated by the ROC curve and analysis of the area under the ROC curve.