Mansell, G, Hill, JC, Main, C, Von Korff, M and van der Windt, DA (2017) Mediators of Treatment Effect in the Back In Action Trial: Using Latent Growth Modelling to Take Change Over Time into Account. The Clinical Journal of Pain, 33 (9). pp. 811-819. ISSN 1536-5409

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OBJECTIVES: To test whether change in fear-avoidance beliefs was a mediator of the effect of treatment on disability outcome; To test an analytical approach, latent growth modelling, not often applied to mediation analysis.

METHODS: Secondary analysis was carried out on a randomised controlled trial designed to compare an intervention addressing fear-avoidance beliefs (n=119) with treatment as usual (n=121) for patients with low back pain, which found the intervention to be effective. Latent growth modelling was used to perform a mediation analysis on the trial data to assess the role of change in fear-avoidance beliefs on disability outcomes. The product of coefficients with bias-corrected bootstrapped confidence intervals was used to calculate the mediating effect.

RESULTS: A statistically significant mediating effect of fear-avoidance beliefs on the effect of treatment on disability outcome was found (standardised indirect effect -0.35 (bias-corrected 95% CI -0.47 to -0.24)). Poor fit of the latent growth model to the data suggested that other factors not accounted for in this model are likely to be part of the same mediating pathway.

DISCUSSION: Fear-avoidance beliefs were found to mediate the effect of treatment on disability outcome. Measurement of all potential mediator variables in future studies would help to more strongly identify which factors explain observed treatment effects. Latent growth modelling was found to be a useful technique to apply to studies of treatment mediation, suggesting that future studies could employ this approach.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Lippincott, Williams & Wilkins at - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: mediation analysis, latent growth modeling, low back pain
Subjects: R Medicine > RA Public aspects of medicine
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Related URLs:
Depositing User: Symplectic
Date Deposited: 13 Feb 2017 12:11
Last Modified: 09 Apr 2021 13:50

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