Musculoskeletal disorders such as knee osteoarthritis (OA) are the primary cause of chronic pain in older adults. Recommended self-management strategies for knee OA include staying physically active in the face of pain, but many patients avoid activities they are capable of doing. The overall purpose of this study was to examine the extent to which daily pain catastrophizing, a maladaptive coping strategy, could influence OA patients' physical activity and sedentary behavior. The current study used data from 143 older knee OA patients who completed electronic daily diaries for 22 days and wore an accelerometer to capture physical activity and sedentary behavior. At the beginning of each day, patients reported their pain catastrophizing regarding the day ahead. Results from multilevel models demonstrated that on mornings when patients catastrophized more than usual about their pain in the day ahead, they spent more time in sedentary behavior and engaged in fewer minutes of moderate to vigorous physical activity that day. Cross-day lagged analyses further showed that the effect of morning pain catastrophizing on subsequent sedentary behavior extended to the next day. More time spent in sedentary behavior, in turn, contributed to greater pain catastrophizing the next morning. These findings support the mechanistic role of daily pain catastrophizing in the avoidance of physical activity for older OA patients, and suggest that effective interventions for pain catastrophizing may also reduce sedentary behavior and enhance physical activity, with longer-term benefits for pain management, physical function, and overall health.

译文

:肌肉骨骼疾病,例如膝骨关节炎(OA)是老年人慢性疼痛的主要原因。推荐的膝盖OA自我管理策略包括在面对疼痛时保持身体活动,但许多患者会避免进行自己能做的活动。这项研究的总体目的是研究灾难性的每日疼痛(一种适应不良的应对策略)在多大程度上影响OA患者的身体活动和久坐行为。当前的研究使用了143名年龄较大的膝盖OA患者的数据,这些患者完成了22天的每日电子日记,并佩戴了加速度计来捕捉身体活动和久坐的行为。在每天的开始,患者报告前一天的疼痛是灾难性的。多级模型的结果表明,早晨患者在前一天遭受的痛苦比平常多得多,他们在久坐行为上花费的时间更多,并且当天参加中度到剧烈运动的时间更少。跨日滞后分析进一步表明,早晨疼痛的灾难性后果对随后的久坐行为的影响延续到第二天。反过来,花在久坐行为上的时间更多,则导致第二天早上更大的痛苦成为灾难。这些发现支持了每日疼痛剧烈化在避免老年OA患者身体活动中的机械作用,并表明有效的疼痛剧烈化干预措施还可以减少久坐的行为并增强身体活动,对疼痛管理,身体机能具有长期益处,以及整体健康状况。

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