Sex differences in response to rehabilitation treatment for musculoskeletal pain: the mediating role of post-traumatic stress symptoms

Abstract

Aim: Numerous investigations have revealed sex differences in recovery outcomes in individuals who have sustained work-related musculoskeletal injuries (WRMIs). Previous research has also revealed significant sex differences in the prevalence and severity of post-traumatic stress symptoms (PTSS) following musculoskeletal injury. This study investigated whether PTSS mediated sex differences in recovery outcomes in individuals receiving treatment for a work-related musculoskeletal injury. The recovery outcomes of interest in the present study were pain severity and pain-related disability. Methods: The study sample included 137 individuals (68 men; 69 women) with WRMIs who were enrolled in a 7-week physical rehabilitation program. Participants completed measures of pain severity, pain disability and PTSS at admission and termination of the physical rehabilitation program. Results: Consistent with previous research, independent samples t-tests revealed that women obtained significantly higher baseline scores on measures of pain severity (P < 0.01), number of pain sites (P < 0.001), depression (P < 0.001) and PTSS (P < 0.001) compared to men. Also consistent with previous research, the measure of PTSS, assessed at baseline, was prospectively associated with treatment-related disability reduction (P < 0.01), and return to work (P < 0.01). Bootstrap regression analyses revealed that PTSS partially mediated the relation between sex and pain-related disability. Conclusions: The results of the present study suggest that the experience of PTSS might be one of the factors that explain sex differences in recovery outcomes following a WRMI. The results call for greater attention to the assessment and intervention of PTSS in individuals who have sustained WRMIs.