The Effect of Questionnaire Content on Measures of Pain Intensity, Magnitude of Disability, and Symptoms of Depression in Patients With Arm Illness

Patient mood, pain intensity, and magnitude of disability can be measured using
questionnaires. The Pain Catastrophizing Scale (PCS) was developed to measure the extent to
which the ineffective coping strategy of catastrophic thinking impacts pain experience. It is
currently one of the most widely used measures of catastrophic thinking related to pain. The
PCS instructions ask participants to reflect on past painful experiences, and to indicate the
degree to which they experienced 13 thoughts or feelings when experiencing pain. The
questions in the PCS are negatively phrased, e.g. "it's terrible and I think it's never going
to get any better."

The effect by which exposure to a stimulus influences a response to a later response is
called "priming." Priming is the process of activating particular representations or
associations in memory just before carrying out an action or task. Priming affects all
aspects of human behavior. For example, syntactic priming is the tendency to use syntactic
structures that parallel the structures of sentences we have heard recently: a speaker who
has just heard a sentence in passive voice is subsequently more likely to use a passive
construction himself.

Priming apparently also has affective dimensions. Zajonc performed an experiment where he
showed a list of Chinese characters to his test subjects. He subsequently showed the subjects
a list of Chinese words and asked them which words they "liked the best." The words
containing characters presented in the first list were evaluated more positively. The
negative questions in the PCS may prime patients to be more negative in subsequent
questionnaires.

Our group has performed multiple studies on the use of certain words, phrases, and concepts
in hand and upper extremity surgery. Bossen et al showed that positive or negative wording of
MRI reports influences patients' emotional response, satisfaction, and understanding. We are
interested in looking at the possibility that certain questionnaires can affect other
questionnaires via a priming effect.

We propose a three-arm single blind, randomized (1:1:1) controlled trial to assess whether
negative questions of the PCS affect measures of mood, pain, or disability.

Aim:

The aim of this study is to assess whether the negative questions in the PCS affect measures
of mood, pain, or disability.

Primary null hypothesis:

There is no difference in Patient Reported Outcomes Measurement Information System (PROMIS)
Upper Extremity Function between patients who complete the standard PCS, patients who
complete the positively adjusted PCS, and patients who do not complete the PCS.

Secondary null hypothesis:

There is no difference in pain intensity, PROMIS depression, and (Positive Affect Negative
Affect Scale) PANAS scores between patients who complete the standard PCS, patients who
complete the positively adjusted PCS, and patient who do not complete the PCS.

Inclusion Criteria:

- All new and follow-up patients presenting to the Orthopaedic Hand and Upper Extremity
Service

- English fluency and literacy

Exclusion Criteria:

- pregnant women

- Inability to complete enrollment forms due to any mental status or language problems
(e.g. dementia, head injury, overall illness).