Aging Clinical and Experimental Research
Are changes in pain, cognitive appraisals and coping strategies
associated with changes in physical functioning in older adults
with joint pain and chronic diseases?
Outi E. Ilves
· Lotte A. H. Hermsen
· Johannes C. van der Wouden
· Jasmijn F. M. Holla
· Marike van der Leeden
· Stephanie S. Leone
· Henriette E. van der Horst
· Joost Dekker
Received: 20 February 2018 / Accepted: 29 May 2018
© Springer International Publishing AG, part of Springer Nature 2018
Background As the population ages, the number of people with chronic diseases increases. Frequently, older people suﬀer
from joint pain together with other chronic diseases, which can lead to decreased physical functioning.
Aims To investigate the associations of the changes in cognitive appraisals, coping strategies and pain with the change in
physical functioning in older people, who have chronic pain and chronic diseases.
Methods Elderly persons (n = 407, mean age 77 years, and 62% female), with self-reported joint pain and at least two
chronic diseases, ﬁlled in questionnaires about cognitive appraisals, coping strategies, pain intensity and physical function-
ing at baseline, at 6- and 18-month follow-ups. The associations of change in physical functioning with changes in cognitive
appraisals, coping strategies and pain were modelled using generalized estimating equations (GEE).
Results Increase in pain, in negative thinking about the consequences of pain, and in activity avoidance and decrease in
self-eﬃcacy beliefs were associated with a decline in physical functioning.
Discussion Observed mean changes were small but large inter-individual variability was seen. This shows that cognitive
appraisals and coping strategies are malleable. Statistical model of change clariﬁes the direction of longitudinal associations.
Conclusions The longitudinal ﬁndings suggest that joint pain, cognitive appraisals and coping strategies may determine
physical functioning in older people who have chronic pain and comorbidity.
Keywords Physical functioning · Coping strategies · Cognitive appraisals · Pain · Older adults · Chronic diseases
As the population ages, the number of people with chronic
diseases increases. It is also common that older adults have
many chronic diseases at the same time [1, 2]. Frequently,
they suﬀer from musculoskeletal diseases, which together
with other chronic diseases can lead to mobility limitations
and disability [1, 3–5]. Even though some manage well in
their daily living regardless of their pain or medical condi-
tion, Australian study shows that chronic pain interferes with
physical functioning in a notable proportion (17%) of older
persons after aged care rehabilitation .
The adjustment process to a chronic disease or pain is a
dynamic process across multiple life domains and the course
of the disease . Cognitive appraisals and coping strategies
are considered as important determinants of the outcome of
the adjustment to a stress or illness . Cognitive apprais-
als can be understood as a chain of cognitive reactions and
feelings caused by a stress factor . Cognitive appraisals
represent the subjective meaning and signiﬁcance of the
stress (i.e. morbidity and pain), while coping is deﬁned as
the eﬀort-requiring attempt to adapt and deal with the stress
. Successful outcome of the adjustment process can be
* Outi E. Ilves
Faculty of Sport and Health Sciences, University
of Jyvaskyla, P.O. Box 35, 40014 Jyvaskyla, Finland
Department of Rehabilitation Medicine, VU University
Medical Center Amsterdam, Amsterdam, Netherlands
Department of Rehabilitation Research, Reade, Centre
of Rehabilitation and Rheumatology, Amsterdam,
Department of Psychiatry, VU University Medical Center
Amsterdam, Amsterdam, Netherlands