The Role of Perceived Injustice in the Experience of Chronic Pain and Disability: Scale Development and Validation

Abstract

Introduction The primary objective of this research was to evaluate the psychometric properties of a questionnaire designed to assess perceive injustice associated with injury. Methods In Study 1, the 12-item Injustice Experience Questionnaire (IEQ) was administered to 226 individuals with musculoskeletal conditions. A subsample of 85 individuals were interviewed 1-year later about their ongoing symptoms and return to work status. In Study 2, the IEQ and other pain-related measures were administered on two separate occasions to 70 pain patients participating in a functional restoration rehabilitation program. ResultsStudy 1 Principal components analysis yielded a two-component solution with eigenvalues greater 1. Item content of the two components reflected elements of blame and irreparability of loss. In cross sectional analyses, the IEQ was significantly correlated with measures of catastrophic thinking, r = .75, P \ .01, fear of movement/re-injury, r = .58, P \ .01, depression, r = .66, P \ .01, and pain severity, r = .54, P \ .01. Cross-sectional regression analyses revealed that the IEQ, b = .44, P \ .01, and the PCS, b = .18, P \ .05, each contributed significant unique variance to the prediction of pain severity. The IEQ prospectively predicted return to work status, OR = .75, 95% CI = .58-.99, but not pain severity. Results-Study 2 Analyses supported the test re-test reliability of the IEQ, r = .90, P\.01. Treatment-related changes in the IEQ were significantly correlated with an objective index of improved physical function, r = .51, P \ .01. Conclusions The findings of these two studies support the construct validity of the IEQ and suggest that this measure might be a useful complement to psychosocial assessment of individuals with persistent pain conditions. Discussion addresses the processes through which perceived injustice might impact on disability and rehabilitation outcomes.

The Effect of Perceived Injustice on Appraisals of Physical Activity: An Examination of the Mediating Role of Attention Bias to Pain in a Chronic Low Back Pain Sample

“…Errors and outliers were evenly Of the participants, 38 identified as White, 9 identified as African American, 3 identified as Hispanic, and 3 indicated multiple ethnic backgrounds. Participants' reported levels of perceived injustice (M=21.91; SD=13.08) were comparable to mean levels obtained in other chronic pain samples (see, e.g., [32,38]). Male and female participants did not differ significantly on any study variables listed in Table 1.…”

“…A growing body of research suggests that perceptions of injustice contribute to detrimental physical and psychological outcomes both among individuals with recent injury [43] and chronic pain conditions [13,26,31,38]. Pain-related injustice perception has been conceptualized as a cognitive appraisal reflecting the severity and irreparability of pain-or injury-related loss, externalized blame, and unfairness [37,38].…”

“…Pain-related injustice perception has been conceptualized as a cognitive appraisal reflecting the severity and irreparability of pain-or injury-related loss, externalized blame, and unfairness [37,38]. Outcomes associated with elevated injustice perception have included greater self-reported pain and disability [32,37], higher pain behavior [39], and poorer outcomes following rehabilitation treatment [38] and expression of pain; or (3) a high facial expression of pain. The selection of different pain expression levels allowed us to examine whether AB in relation to perceived injustice is moderated by varying levels of pain expressiveness.…”

Preserving workers' dignity in workers' compensation systems: An international perspective

“…This said, there is a wealth of literature showing the importance of fairness in the prevention of long-term disability in the employment context [Sullivan et al, 2008;Hepburn et al, 2010], so it should not be presumed that a human rights approach is antithetical to an approach based on economic considerations. International Labor Organization (ILO) conventions adopted in the early 20th century (ILO Convention C017) have had an influence in the development of social security/workers' compensation legislation throughout the world, as have ILO conventions on Medical care and sickness benefits (ILO Convention C130).…”

“…They promote emphasis on workers' residual abilities, yet policies are conducive to ignoring the impact of pain on the ability to work, a problem not only for workers but for the rehabilitation providers who are called upon to provide them with support . Perceived injustice of the process can itself impede return to work [Sullivan et al, 2008;Franche et al, 2009].…”