Computational protocol: Attachment, Symptom Severity, and Depression in Medically Unexplained Musculoskeletal Pain and Osteoarthritis: A Cross-Sectional Study

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Protocol publication

[…] Two clinical samples were investigated prior to treatment in a cross-sectional design. Patients of both samples suffered from chronic musculoskeletal pain for a continuous period of at least six months. They presented themselves to the Department of Orthopedic Surgery of the University of Heidelberg between September 2008 and January 2010. At the time of admission, comprehensive medical and psychological diagnostic procedures were administered. To check whether pain intensity, pain location, or pain spreading was fully explained by specific somatic pathology, the results of a clinical examination were compared to diagnostic imaging by an orthopedic specialist. Furthermore, the Structured Diagnostic Interview for DSM-IV Axis I Disorders (SCID-I) was administered by a trained psychologist to detect mental disorders. Patients were included in the UMP group, if 1) they suffered from CWP [], back pain, and/or limb pain in at least two pain sites; 2) pain intensity and/or spreading were not explained by diagnostic findings; 3) prior standard treatment consisting of at least one rehabilitation program or two inpatient treatments were ineffective; and 4) a somatoform disorder was diagnosed. Patients suffering from monolocular pain that was clearly explainable by severe osteoarthritis were included in the OA group. Patients with pain in other locations or with other somatic conditions were excluded from OA. Exclusion criteria for both samples included insufficient ability to communicate in German, age below 18 or over 80 years, and a diagnosis of psychosis, bipolar disorder, or neurological disorder.We calculated the necessary sample size for the entire sample (UMP and OA) with the G*Power Analysis software program for logistic regression analysis, and by reference to our primary hypothesis with regard to the secure-insecure RQ-2 attachment style categories. We expected a moderate effect of OR 3.0 for the association between insecure attachment with UMP (alpha = 0.05, two tailed). The results indicated that 172 participants were required. Of the 243 patients eligible (UMP: 117, OA: 126), 191 met the inclusion criteria (UMP: 97, OA: 94). Of these, 174 (91%) consented to participate in the study and completed the baseline questionnaires (UMP: 85, OA: 89) (). Data were acquired by means of standardized self-reported questionnaires that were personally administered and collected by the researchers on the first day of the patients’ outpatient or inpatient treatment (). A structured interview for assessment of any psychiatric disorders was conducted within the first three days of treatment. [...] Descriptive statistics, such as measures of central tendency and of dispersion, were used for basic statistical analysis. Depending on data type, parametric t-tests, ANOVA, Pearson’s chi-square and Fisher’s exact test, respectively, were used for basic group comparisons between UMP and OA. Correlations between the RQ and ECR-R dimensions were assessed by means of Pearson’s r. To test the first hypothesis, odds ratios and confidence intervals from logistic regression models were used to quantify attachment styles in both groups. Separate linear regression models were constructed to examine the associations of global or romantic attachment with pain intensity, disability, and depression. In the logistic and linear regression models, independent variables were included in a forced-entry fashion. Before applying the regression analysis, the variables were tested for normal distribution via the Kolmogorov-Smirnov test, and graphical interpretation. All tests for significance were two-sided; p values below. 05 were considered statistically significant. Statistical analysis was performed using IBM SPSS Statistics 21.Missing data resulted in decreased N values for regression analyses. Post hoc power calculation for logistic regression analysis with the given sample size of 148 patients with complete data for the examination of our first research question indicated a power of 80% with regard to the logistic regression analysis based on the secure-insecure categories, and of a power > 80 with regard to the analysis based on the four attachment style categories. […]

Pipeline specifications

Software tools G*Power, SPSS
Application Miscellaneous
Organisms Homo sapiens