Cognitive set, secondary gain, and progress in physical rehabilitation.

摘要

The present study investigated the relationship between secondary gain incentives, therapeutic progress, and cognitive response sets related to degree of cooperation in a sample of 69 patients enrolled in an outpatient physical therapy program. Participants were referred to one of two major medical centers in a large metropolitan area. They included 54 low back pain patients, and 15 patients with disorders of the neck (n = 6), shoulder (n = 6), knee (n = 2) and ankle (n = 1). Three different cognitive response sets (angry negativity, disability exaggeration, and excessive virtue) were assessed with a structured 35-item sentence-completion test. Secondary gain incentives were assessed by interview at the time of enrollment into the study. They included receiving or having applied for Workers' Compensation, and receiving or having applied for Social Security Disability or some sort of personal injury award. Progress in outpatient therapy was assessed by physical therapists using standardized joint range-of-motion measurements according to the standards of the American Academy of Orthopedic Surgeons, taken at the beginning and at the end of therapy. Progress in therapy (Time 2 minus Time 1 range-of-motion measurements) were available for 43 patients: 28 of the low back pain patients and all 15 patients with other joint problems.;Zero order correlations revealed significant associations among demographic variables (age, years of education, number of children, number of siblings, and gender) and the three cognitive response sets as well as secondary gain incentive and progress in therapy. Results of multiple linear regression showed that Angry Negativity contributed to the prediction of progress in physical therapy. Three demographic variables (years of education, age, and number of siblings) accounted for most of the variance in the regression models predicting both secondary gain incentive and progress in therapy.;Post hoc comparison of patients with secondary gain incentive versus those without secondary gain incentive showed no differences between groups on any of the cognitive response sets or progress in therapy. The two groups differed only on years of education. Due to multicollinearity concerns two additional regressions were conducted, entering all three cognitive response sets in one block for each of the criterion variables. The first regression, predicting secondary gain incentive, showed that the disability exaggeration cognitive response set was related to secondary gain incentive. The second regression, predicting progress in therapy, once again identified Angry Negativity as a significant predictor of suboptimal progress in therapy for this sample of outpatient physical therapy patients.;This study showed that two of the three cognitive response sets measured by the SCT-35 were associated with the two outcome variables after accounting for the degree of association among predictor variables, demographic variables, and mood. Patients who scored highly on the Angry Negativity cognitive response set showed suboptimal progress over the course of their outpatient physical therapy program. Patients who scored highly on the Disability Exaggeration cognitive response set were more likely to have a secondary gain incentive. For the samples studied, patients appeared to use a specific cognitive response set to achieve a specific goal.