Foster, NE and Thomas, E and Bishop, A and Dunn, KM and Main, CJ (2009) Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care. Pain, 148 (3). 398 -406. ISSN 0304-3959

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Abstract

Many psychological factors have been suggested to be important obstacles to recovery from low back pain, yet most studies focus on a limited number of factors. We compared a more comprehensive range of 20 factors in predicting outcome in primary care. Consecutive patients consulting 8 general practices were eligible to take part in a prospective cohort study; 1591 provided data at baseline and 810 at 6 months. Clinical outcome was defined using the Roland and Morris Disability Questionnaire (RMDQ). The relative strength of the baseline psychological measures to predict outcome was investigated using adjusted multiple linear regression techniques. The sample was similar to other primary care cohorts (mean age 44 years, 59% women, mean baseline RMDQ 8.6). The 20 factors each accounted for between 0.04% and 33.3% of the variance in baseline RMDQ score. A multivariate model including all 11 scales that were associated with outcome in the univariate analysis accounted for 47.7% of the variance in 6 months RMDQ score; rising to 55.8% following adjustment. Four scales remained significantly associated with outcome in the multivariate model explaining 56.6% of the variance: perceptions of personal control, acute/chronic timeline, illness identify and pain self-efficacy. When all independent factors were included, depression, catastrophising and fear avoidance were no longer significant. Thus, a small number of psychological factors are strongly predictive of outcome in primary care low back pain patients. There is clear redundancy in the measurement of psychological factors. These findings should help to focus targeted interventions for back pain in the future.

Item Type: Article
Additional Information: This is the final published version of the article (version of record). It first appeared online via Elsevier at http://dx.doi.org/10.1016/j.pain.2009.11.002 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Adaptation, Psychological, Adolescent, Adult, Anxiety, Culture, Depression, Disability Evaluation, Female, Humans, Illness Behavior, Linear Models, Low Back Pain, Male, Middle Aged, Pain Measurement, Primary Health Care, Retrospective Studies, Self Concept, Severity of Illness Index, Surveys and Questionnaires, Young Adult
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Related URLs:
Depositing User: Symplectic
Date Deposited: 19 Dec 2016 15:04
Last Modified: 19 Dec 2016 15:18
URI: http://eprints.keele.ac.uk/id/eprint/2689

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