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

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

Authors

A. Banerjee

P. Hendrick

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HOLLY BLAKE holly.blake@nottingham.ac.uk
Professor of Behavioural Medicine



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).

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 Science and Business Media LLC
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.