Development and validation of an instrument to predict functional recovery in tibial fracture patients: The Somatic Pre-Occupation and Coping (SPOC) questionnaire

Jason W. Busse, Mohit Bhandari, Gordon H. Guyatt, Diane Heels-Ansdell, Abhaya V. Kulkarni, Scott Mandel, David Sanders, Emil Schemitsch, Mark Swiontkowski, Paul Tornetta, Eugene Wai, Stephen D. Walter

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


OBJECTIVE: To explore the role of patients' beliefs in their likelihood of recovery from severe physical trauma. METHODS: We developed and validated an instrument designed to capture the impact of patients' beliefs on functional recovery from injury: the Somatic Pre-Occupation and Coping (SPOC) questionnaire. At 6-weeks postsurgical fixation, we administered the SPOC questionnaire to 359 consecutive patients with operatively managed tibial shaft fractures. We constructed multivariable regression models to explore the association between SPOC scores and functional outcome at 1 year as measured by return to work and Short Form-36 (SF-36) physical component summary and mental component summary scores. RESULTS: In our adjusted multivariable regression models that included preinjury SF-36 scores, SPOC scores at 6 weeks postsurgery accounted for 18% of the variation in SF-36 physical component summary scores and 18% of SF-36 mental component summary scores at 1 year. In both models, 6-week SPOC scores were a far more powerful predictor of functional recovery than age, gender, fracture type, smoking status, or the presence of multitrauma. Our adjusted analysis found that for each 14-point increment in SPOC score at 6 weeks (14 chosen on the basis of half a standard deviation of the mean SPOC score), the odds of returning to work at 1 year decreased by 40% (odds ratio, 0.60; 95% confidence interval, 0.50-0.73). CONCLUSION: The SPOC questionnaire is a valid measurement of illness beliefs in patients with tibial fracture and is highly predictive of their long-term functional recovery. Future research should explore if these results extend to other trauma populations and if modification of unhelpful illness beliefs is feasible and would result in improved functional outcomes.

Original languageEnglish (US)
Pages (from-to)370-378
Number of pages9
JournalJournal of orthopaedic trauma
Issue number6
StatePublished - Jun 2012


  • coping skills
  • employment
  • predictive value of tests
  • quality of life
  • tibial fractures


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