Predictors of self-management in patients with chronic low back pain: a longitudinal study

Banerjee, A.; Hendrick, P.; Blake, H.

Abstract

Background: Self-management (SM) is a key recommended strategy for managing chronic low back pain (CLBP). However, SM programmes generate small to moderate benefits for reducing pain and disability in patients with CLBP. The benefits of the SM programme can potentially be optimised by identifying specific subgroups of patients who are the best responders. To date, no longitudinal study has examined the predictive relationships between SM and biopsychosocial factors in patients with CLBP. The aim was to determine whether biopsychosocial factors predict SM and its change over time in patients with CLBP. Methods: In this multi-centre longitudinal cohort study, we recruited 270 working-age patients with CLBP (mean age 43.74, 61% female) who consulted outpatient physiotherapy for their CLBP. Participants completed self-reported validated measures of pain intensity, disability, physical activity, kinesiophobia, catastrophising, depression and SM at baseline and six months. SM constructs were measured using eight subscales of the Health Education Impact Questionnaire (heiQ), including Health Directed Activity (HDA), Positive and Active Engagement in Life (PAEL), Emotional Distress (ED), Self-Monitoring and Insight (SMI), Constructive Attitudes and Approaches (CAA), Skill and Technique Acquisition (STA), Social Integration and Support (SIS) and Health Service Navigation (HSN). Data were analysed using General Linear Model (GLM) regression. Results: Physical activity and healthcare use (positively) and disability, depression, kinesiophobia, catastrophising (negatively) predicted (p < 0.05, R2 0.07–0.55) SM constructs at baseline in patients with CLBP. Baseline depression (constructs: PAEL, ED, SMI, CAA and STA), kinesiophobia (constructs: CAA and HSN), catastrophising (construct: ED), and physical disability (constructs: PAEL, CAA and SIS) negatively predicted a range of SM constructs. Changes over six months in SM constructs were predicted by changes in depression, kinesiophobia, catastrophising, and physical activity (p < 0.05, R2 0.13–0.32). Conclusions: Self-reported disability, physical activity, depression, catastrophising and kinesiophobia predicted multiple constructs of SM measured using the heiQ subscales in working-age patients with CLBP. Knowledge of biopsychosocial predictors of SM may help triage patients with CLBP into targeted pain management programmes. Trial registration: The study protocol was registered at ClinicalTrials.gov on 22 December 2015 (ID: NCT02636777).

Citation

Banerjee, A., Hendrick, P., & Blake, H. (2022). Predictors of self-management in patients with chronic low back pain: a longitudinal study. BMC Musculoskeletal Disorders, 23(1), Article 1071. https://doi.org/10.1186/s12891-022-05933-2

• Journal Article Type: Article
• Acceptance Date: Oct 28, 2022
• Online Publication Date: Dec 7, 2022
• Publication Date: Dec 7, 2022
• Deposit Date: Dec 9, 2022
• Journal: BMC Musculoskeletal Disorders
• Electronic ISSN: 1471-2474
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 23
• Issue: 1
• Article Number: 1071
• DOI: https://doi.org/10.1186/s12891-022-05933-2
• Keywords: Research Article, Low back pain, Chronic low back pain, Self-management, Longitudinal study, Regression analysis, Predictors, Health education impact questionnaire
• Public URL: https://nottingham-repository.worktribe.com/output/14601315
• Publisher URL: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05933-2#citeas
• Additional Information: Received: 13 March 2022; Accepted: 28 October 2022; First Online: 7 December 2022; : ; : The study received a favourable ethical opinion and research governance approval from the Health Research Authority (HRA) in the United Kingdom [Reference: East of Scotland Research Ethics Service- 15/ES/1067]. All participants had provided informed consent (written or using an online link) before taking part in the study.; : Not Applicable.; : The authors declare that they have no competing interests.