Pain and fatigue as mediators of the relationship between mobility aid usage and depressive symptomatology in ambulatory individuals with SCI

Abstract

Study design Cross-sectional cohort study. Objectives To investigate a mediational model where pain (intensity and interference) and fatigue mediate the relationship between the use of mobility aids and moderate-to-severe depressive symptomatology among ambulatory participants with spinal cord injury (SCI). Setting A medical university in the southeastern United States. Methods Ambulatory adults (N = 652) with chronic SCI responded to a mail-in survey. The Patient Health Questionnaire-9 was used to assess moderate-to-severe depressive symptomatology. The Brief Pain Inventory was used to assess pain intensity and interference, and the Modified Fatigue Impact Scale–5-item version was used to assess fatigue. Participants self-reported use of mobility aids. Results On examining mobility aids used for ambulation, 65% were found to have used at least one aid. Severe pain intensity was reported by 11%, and 14% reported severe pain interference. Disabling fatigue was reported by 10% of the participants. Twenty-one percent (n = 138) reported moderate-to-severe levels of depressive symptoms. On examining the relationships between mobility aids and depressive symptomatology, using people as a mobility aid was associated with increased odds of depressive symptomatology (2.6) and always using a wheelchair was associated with lower odds (0.3). However, these relationships were no longer significant after controlling for the mediating variables pain intensity, pain interference and fatigue. Conclusions Pain and fatigue mediate the relationship between usage of certain mobility aids and depressive symptomatology. The use of people to assist in ambulation is associated with greater odds of moderate-to-severe depressive symptomatology, while always using a wheelchair is associated with lower odds.

Are Comorbid Pain and Depressive Symptoms Associated with Rehabilitation of Individuals with Spinal Cord Injury?

“…The association of depressive symptoms with functional limitation was examined; however, it is possible that those with functional limitations may result in higher levels of depressive symptoms. DiPiro and colleagues 21 found that pain and fatigue may mediate the relationship between mobility and depressive symptoms. The study did not examine how individuals in the comorbid group may differ from those with only pain or depressive symptoms.…”

The relationship between fatigue and participation in spinal cord injury

“…It is unclear whether depression has a unidirectional effect on fatigue (that is, depression causes fatigue) or whether the relationship is more complex. For example, a recent study on the relationship between mobility device usage and depressive symptomology in SCI found pain and fatigue to mediate the relationship, 26 supporting the concept of a more complex relationship between these factors. Regardless of direction of the effect, the associations of both depression and fatigue with participation are notable and speak to the need for research focused on treatment for depression and fatigue and the resultant effect on participation.…”

Prevalence of depression, fatigue, and sleep disturbances in patients with myelopathy: Their relation with functional and neurological recovery

“…Authors observed that fatigue was negatively correlated with social integration and psychological functioning. DiPiro et al 33 observed disabling fatigue in 10.3%…”