The Traumatic Injuries
Distress Scale: A New Tool That Quantifies Distress and Has Predictive Validity
With Patient-Reported Outcomes

DM, Krebs D, Moulden D, Wade P, Levesque L, Elliott J, MacDermid JC. J Orthop Sports Phys Ther. 2016 Sep

Take Home Message: The
Traumatic Injuries Distress Scale (TIDS) may be a short (12-item) tool to
assess early risk for persistent symptoms following acute musculoskeletal

following an acute musculoskeletal injury is suboptimal for up to 50% of
patients. A succinct and focused patient-reported outcome tool geared toward
emotional lability, sense of uncontrollability, and intrusion or hyperarousal may
allow clinicians to identify a patient with an acute injury who is at risk for
persistent symptoms. The purpose of this study was to develop and evaluate the
utility of the Traumatic Injuries Distress Scale (TIDS) among individuals within
30 days of an acute musculoskeletal injury. The new instrument is intended to
help identify patients at risk for persistent problems following a variety of acute
injuries (e.g., ankle sprain, low back pain). After initial testing, a 100-item
prototype was reduced to a 17-item scale that was used among adult patients
from physical therapy clinics and emergency departments. The investigators
included 206 patients (~11 days post injury). A subset of 76 patients completed
the TIDS at 1 week and 12 weeks following the initial TIDS delivery. Injury
region specific questionnaires were also administered at the initial time
point, including the Roland Morris Disability Questionnaire for low back pain and the Lower Extremity Functional Scale
for knee and
ankle injuries. Participants also completed measures of pain catastrophizing (Pain Catastrophizing Scale),
health-related satisfaction (Satisfaction and Recovery Index),
and pain intensity (0 to 10 scale). The investigators removed 5 items from the
TIDS because they failed to contribute to overall scale. Next, they examined
the common themes within the TIDS. The investigators found 3 factors: negative
affect (6 items), uncontrolled pain (4 items), and intrusion or hyperarousal (2
items; see table below). The total TIDS score and the sub-scores for the common
themes related with the other patient-reported outcomes, which the participants
completed at the same visit. Furthermore, the baseline TIDS score was related
with health-related satisfaction and other health outcomes 12 weeks later
within the subgroup.

Table. Items within the 3
factors from the Traumatic Injuries Distress Scale
Negative Affect
Uncontrolled Pain
of interest in appearance
by pain
agitated/scared when in a place that reminds them of the accident
on pain
that feel real
of motivation

doing enjoyed activities
at inability to control pain



a better grasp on whether a patient will end up having persistent symptoms when
they report to clinicians for the first or second time would allow for a more
informed and comprehensive treatment strategy. The authors introduced the TIDS,
which they narrowed down to 12 items, as a possible strategy to identify
patients at risk for persistent symptoms after a variety of acute
musculoskeletal injuries. However, the TIDS is only in the initial stages of testing.
The authors acknowledged the need for a future study to test the more region
specific utility of the TIDS because this would assist clinicians and
researchers in making the decision to incorporate the TIDS into practice. Overall,
early identification of patients that are at risk for persistent symptoms is
very important to care providers. Based on the authors’ findings, clinicians
should incorporate patient-reported outcomes at initial visits to assess
factors related to feeling overwhelmed by pain, loss of interest in appearance,
or feeling agitated or scared in a place reminiscent of the accident. The
implications of understanding more about a patient’s anxiety and pain
perception after an acute musculoskeletal injury are pronounced and lend
themselves toward a prognosis-based assessment approach.

Questions for
Discussion: What role does kinesiophobia play in addition to the items covered
by the TIDS? Do you think that patients with concussions should have been
included as a subcategory of injuries in this initial analysis?

by: L. Colby Mangum, MEd, ATC
by: Jeffrey Driban


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