The impact on society of mild to moderate musculoskeletal disorders (MSDs) is huge and much of this cost is related to slower resolution and chronicity of symptoms. One significant factor that influences the speed of recovery from such MSDs is the way in which subjects cope following onset. Endler and Parker (1994) have defined three coping styles that individuals may use in life: task, emotion and avoidance oriented coping (TOC, EOC and AOC). Many researchers conclude that TOC represents a higher order coping mechanism and EOC and AOC a lower order. Studies have also shown that compared to higher order coping, lower order coping is associated with increased chronicity following MSDs, (Menzel, 2007; Carroll, Cassidy & Cote, 2006).
The cause of an event may be perceived in many ways and McAuley, Duncan, & Russell, (1992) identify four causal dimensions; locus of causation, stability (unadaptability), personal control (self efficacy) and external control that reflect the cause of the event. This study explores how these causal dimensions influence coping style selection following the onset of a mild to moderate MSD and also explores the influence of a number of other variables that have been shown to influence coping.
This research shows with bivariate analysis of 265 subjects between the ages of 18–65 that following the onset or exacerbation of an MSD individuals are more likely to use TOC if they are more internal in their locus of causation (p=.017). Such individuals also show higher personal control (p<.001) and lower external control scores (p <.001) and show a lower sense of stability (p=.004) over the primary cause of their condition. A lower sense of personal control is also significantly associated with both EOC (p<.001) and AOC dominant subjects (p=.042). Last, EOC dominant subjects show higher stability (p=.028) and higher external control scores (p<.001).
With the inclusion of other predictor and control variables and using multinomial and binary logistic regression, it is seen that high personal control scores (OR=.918, 95% C.I=.863, .978) and low stability scores (OR=1.088, 95% C.I=1.008, 1.174) remain significant in the larger model for TOC dominance. Low personal control scores are also significant for AOC dominant coping (OR=1.078, 95% C.I=1.010, 1.151). The significance of personal control in both cases would suggest that self efficacy is a major contributor to coping style selection following MSDs.
Furthermore, in the sample 28.4% of subjects report at least mild sexual abuse at some point in their life and this is seen as a significant variable in the full model with sexually abused subjects having three times greater odds of being not-TOC dominant (OR=3.205, 95% C.I=1.226, 8.383). Similarly, subjects showing at least minor depression (48% of the sample) are four times more likely to be not-TOC dominant (OR=4.096, 95% C.I=1.804, 9.298) and show 84% higher odds for being EOC dominant (OR=.158, 95% C.I=.066, .378). Subjects with at least mild general anxiety disorder (31% of the sample) are 3 times more likely to be EOC dominant (OR=2.913, 95% C.I=1.171, 7.247). It is also seen that depression and anxiety are significant mediating variables in the relationship between sexual abuse and EOC dominance and anxiety is a significant moderator of the relationship between sexual abuse and AOC dominance following the onset of mild to moderate MSDs.
From this research it is seen that lower order coping, which may have an influence on recovery from mild to moderate MSDs, is related to causal dimensions. This is most directly observed with respect to the sense of personal control (self efficacy) and stability (unadaptability) of the primary cause of the MSD. Depression, anxiety and a history of sexual abuse are also found to be associated with lower order coping choices following the onset of mild to moderate MSDs.
What is important in terms of this research is that it highlights the need for employers to promote a sense of self efficacy and adaptability in the workplace as a protective mechanism against developing chronicity of mild to moderate MSDs. This research also highlights the degree to which promotion of higher order coping is important even in mild to moderate conditions. In addition, this research clearly demonstrates the degree to which non-physiological issues such as depression, anxiety and a history of sexual abuse impact the process of recovery from such conditions. Last, this research displays the impact of these issues in an arena in which they have traditionally been given little or no consideration and clearly shows the importance of giving depression, anxiety and sexual abuse due regard in the clinical management process of mild to moderate MSDs.
|School Location:||United States -- California|
|Source:||DAI-B 71/07, Dissertation Abstracts International|
|Subjects:||Physical therapy, Clinical psychology|
|Keywords:||Coping, Depression, Musculoskeletal conditions, Sexual abuse|
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