Dataset Information

Psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture.

ABSTRACT:

Objectives

To identify psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture.

Materials and methods

A longitudinal postal questionnaire study was conducted with data collection at baseline (pretreatment), 2 weeks, 3, and 6 months later. A total of 485 patients were recruited from 83 acupuncturists before commencing acupuncture for back pain. Questionnaires measured variables from 4 theories (fear-avoidance model, common-sense model, expectancy theory, social-cognitive theory), clinical and sociodemographic characteristics, and disability. Longitudinal multilevel models were constructed with disability over time as the outcome.

Results

Within individuals, reductions in disability (compared with the person's individual mean) were associated with reductions in: fear-avoidance beliefs about physical activity (?=0.11, P<0.01) and work (?=0.03, P<0.05), catastrophizing (?=0.28, P<0.05), consequences (?=0.28, P<0.01), concerns (?=0.17, P<0.05), emotions (?=0.16, P<0.05), and pain identity (?=0.43, P<0.01). Within-person reductions in disability were associated with increases in: personal control (?=-0.17, P<0.01), comprehension (?=-0.11, P<0.05) and self-efficacy for coping (?=-0.04, P<0.01). Between individuals, people who were less disabled had weaker fear-avoidance beliefs about physical activity (?=0.12, P<0.01), had more self-efficacy for coping (?=-0.07, P<0.01), perceived less severe consequences of back pain (?=0.87, P<0.01), had more positive outcome expectancies (?=-0.30, P<0.05), and appraised acupuncture appointments as less convenient (?=0.92, P<0.05).

Discussion

Illness perceptions and, to a lesser extent, self-efficacy and expectancies can usefully supplement variables from the fear-avoidance model in theorizing pain-related disability. Positive changes in patients' beliefs about back pain might underpin the large nonspecific effects of acupuncture seen in trials and could be targeted clinically.

SUBMITTER: Bishop FL

PROVIDER: S-EPMC4323559 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature

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Publications

Psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture.

Bishop Felicity L FL Yardley Lucy L Prescott Philip P Cooper Cyrus C Little Paul P Lewith George T GT

The Clinical journal of pain 20150301 3

<h4>Objectives</h4>To identify psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture.<h4>Materials and methods</h4>A longitudinal postal questionnaire study was conducted with data collection at baseline (pretreatment), 2 weeks, 3, and 6 months later. A total of 485 patients were recruited from 83 acupuncturists before commencing acupuncture for back pain. Questionnaires measured variables from 4 theories (fear-avoidance model, common-sens ...[more]

PMID: 24901897

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Project description:Despite an elusive pathophysiology, common characteristics are often observed in individuals with chronic low back pain (LBP). These include psychological symptoms, altered pain perception, altered pain modulation and altered muscle activation. These factors have been explored as possible determinants of disability, either separately or in cross-sectional studies, but were never assessed in a single longitudinal study. Therefore, the objective was to determine the relative contribution of psychological and neurophysiological factors to future disability in individuals with past LBP. The study included two experimental sessions (baseline and six months later) to assess cutaneous heat pain and pain tolerance thresholds, pain inhibition, as well as trunk muscle activation. Both sessions included the completion of validated questionnaires to determine clinical pain, disability, pain catastrophizing, fear-avoidance beliefs and pain vigilance. One hundred workers with a history of LBP and 19 healthy individuals took part in the first experimental session. The second experimental session was exclusively conducted on workers with a history of LBP (77/100). Correlation analyses between initial measures and disability at six months were conducted, and measures significantly associated with disability were used in multiple regression analyses. A first regression analysis showed that psychological symptoms contributed unique variance to future disability (R2 = 0.093, p = .009). To control for the fluctuating nature of LBP, a hierarchical regression was conducted while controlling for clinical pain at six months (R2 = 0.213, p < .001) where pain inhibition contributed unique variance in the second step of the regression (R2 change = 0.094, p = .005). These results indicate that pain inhibition processes may constitute potential targets for treatment to alleviate future disability in individuals with past or present LBP. Then again, the link between psychological symptoms and pain inhibition needs to be clarified as both of these factors are linked together and influence disability in their own way.

Project description:ImportancePrevious studies, using mostly cross-sectional data, provide conflicting evidence of an association between lumbar spine radiographic changes and the severity of back pain-related disability. Such conflicting evidence may be associated with widely unnecessary diagnostic imaging of the lumbar spine.ObjectiveTo examine both cross-sectional and longitudinal associations between lumbar spine radiographic changes and the severity of back pain-related disability among middle-aged, community-dwelling women.Design, setting, and participantsThis population-based prospective cohort study used data from the Chingford 1000 Women Study. Analyses included data collected from year 6 (1994-1996; physical activity was measured), year 9 (1997-1999; treated as baseline), and year 15 (2003-2005), with a total length of follow-up for longitudinal analyses of 6 years. Data were analyzed from April 17 to November 3, 2020.ExposuresPrimary exposure was lumbar spine radiographic changes, defined using the Kellgren-Lawrence (K-L) grade. Secondary exposures were defined using presence of osteophytes and disc space narrowing. The composite score combined the number of lumbar spine segments with definite changes detected on radiographic images (ie, radiographic changes) (K-L grade ≥2, which means at least definite osteophyte and possible narrowing of disc space are present; osteophyte and disc space narrowing grade ≥1, which means at least mild or definite changes are present).Main outcomes and measuresSelf-reported back pain-related disability measured in years 9 and 15 assessed by the St Thomas disability questionnaire.ResultsAmong 650 women (mean [SD] age, 61.3 [5.9] years) in cross-sectional analyses and 443 women (mean [SD] age, 60.6 [6.0] years) in longitudinal analyses, there was no evidence to support an association between higher number of lumbar segments with radiographic changes (K-L grade, osteophytes, and disc space narrowing) and more severe back pain-related disability (eg, cross-sectional analyses using the K-L grade; 1 segment vs 0 segment: adjusted odds ratio, 1.22 [95% CI, 0.76-1.96]). No interactions were found of an association between lumbar spine radiographic changes and the severity of back pain-specific disability with age, body mass index, or smoking status.Conclusions and relevanceIn this cohort of middle-aged, community-dwelling women, there was no evidence to support an association between a higher number of lumbar segments with radiographic changes (K-L grade, osteophytes, and disc space narrowing) and more severe back pain-related disability cross-sectionally or over time. These findings provide further evidence against routinely using diagnostic imaging of the lumbar spine.

Dataset Information

Psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture.

Objectives

Materials and methods

Results

Discussion

Publications

Psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture.

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