Association Between Anxiety and Upper Limb Functional Disability in Cervical Spondylosis Patients
DOI:
https://doi.org/10.61919/gzhbb432Keywords:
Cervical spondylosis; anxiety; Quick DASH; HADS-A; upper-limb disability; cross-sectional study.Abstract
Background: Cervical spondylosis is a common degenerative cervical spine disorder that may impair upper limb function. Psychological distress such as anxiety is present in musculoskeletal disorders. Limited evidence exists regarding the association of anxiety with amplified disability through behavioral and neurophysiological pathways. Objective: To determine the association between anxiety severity and upper limb functional disability in acute and sub-acute stages of cervical spondylosis patients. Methodology: A cross-sectional observational study enrolled 123 adults (30–55 years) with clinically diagnosed cervical spondylosis from outpatient physiotherapy departments in Lahore, Pakistan. Anxiety severity was assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) and categorized as normal (0–7), mild (8–10), moderate (11–14), or severe (15–21). Upper limb functional disability was assessed using the Quick DASH and categorized as minimal/no (0–20), mild (21–40), moderate (41–60), or severe (61– 80). Association between anxiety severity and upper limb functional disability was evaluated using chi-square testing, effect size (Cramer’s V) and ordinal trend analysis. Results: Mean age was 43.11±5.66 years and 67.5% were female. Anxiety was most commonly moderate (52.0%) and severe (22.0%). Quick DASH disability was most commonly mild (41.5%) and minimal/no (35.0%). Anxiety severity was strongly associated with disability category (χ²(9)=155.08, p<0.001; Cramer’s V=0.648), with a significant ordinal trend (χ²(1)=78.43, p<0.001). Conclusion: Anxiety severity is strongly and monotonically associated with upper limb functional disability in acute to sub-acute cervical spondylosis, supporting integrated psychological screening and psychologically informed rehabilitation.
References
1. Shedid D, Benzel EC. Cervical spondylosis anatomy: pathophysiology and biomechanics. Neurosurgery. 2007;60(1 Suppl 1):S1-7.
2. Sang D, Xiao B, Rong T, Wu B, Cui W, Zhang J, et al. Depression and anxiety in cervical degenerative disc disease: who are susceptible? Front Public Health. 2023;10:1002837.
3. Egwu M, Ajao B, Mbada C, Adeoshun I. Isometric grip strength and endurance of patients with cervical spondylosis and healthy controls: a comparative study. Hong Kong Physiother J. 2009;27:2-6.
4. Crofford LJ. Psychological aspects of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol. 2015;29(1):147-155.
5. Burston JJ, Valdes AM, Woodhams SG, Mapp PI, Stocks J, Watson DJG, et al. The impact of anxiety on chronic musculoskeletal pain and the role of astrocyte activation. Pain. 2019;160(3):658-669.
6. Mansfield M, Thacker M, Taylor JL, Bannister K, Spahr N, Jong ST, et al. The association between psychosocial factors and mental health symptoms in cervical spine pain with or without radiculopathy on health outcomes: a systematic review. BMC Musculoskelet Disord. 2023;24(1):235.
7. Daliri BO M, Khorasani HM, Olia NDB, Azhari A, Shakeri M, Moradi A. Association of psychological factors with limb disability in patients with cervical radiculopathy: comparison with carpal tunnel syndrome. BMC Musculoskelet Disord. 2022;23(1):667.
8. Nyirö L, Peterson CK, Humphreys BK. Exploring the definition of “acute” neck pain: a prospective cohort observational study comparing the outcomes of chiropractic patients with 0–2 weeks, 2–4 weeks and 4–12 weeks of symptoms. Chiropr Man Therap. 2017;25:24.
9. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-370.
10. Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord. 2006;7:44.
11. Xiao S, Yan H, Bao B, Wu Y, Cheng X, Xu C, et al. The impact of early vs. delayed surgery on outcomes in cervical spinal cord injury without fracture or dislocation. Front Surg. 2025;12:1619141.
12. Trivedi RB, Humphreys K. Participant exclusion criteria in treatment research on neurological disorders: are unrepresentative study samples problematic? Contemp Clin Trials. 2015;44:20-25.
13. Pal A, Dhara PC. Work related musculoskeletal disorders and postural stress of the women cultivators engaged in uprooting job of rice cultivation. Indian J Occup Environ Med. 2018;22(3):163-169.
14. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res. 2002;52(2):69-77.
15. Aaron RV, Ravyts SG, Carnahan ND, Bhattiprolu K, Harte N, McCaulley CC, et al. Prevalence of depression and anxiety among adults with chronic pain: a systematic review and meta-analysis. JAMA Netw Open. 2025;8(3):e250268.
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Copyright (c) 2025 Hafiza Huda Javeed, Zirwa Afzal, Muhammad Laeeq (Author)
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