Bishop Felicity L, Yardley Lucy, Prescott Philip, Cooper Cyrus, Little Paul, Lewith George T
*Department of Psychology †School of Mathematics ‡MRC Lifecourse Epidemiology Unit §School of Medicine, University of Southampton, Southampton, UK.
Clin J Pain. 2015 Mar;31(3):254-64. doi: 10.1097/AJP.0000000000000108.
To identify psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture.
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.
Within individuals, reductions in disability (compared with the person's individual mean) were associated with reductions in: fear-avoidance beliefs about physical activity (β=0.11, P<0.01) and work (β=0.03, P<0.05), catastrophizing (β=0.28, P<0.05), consequences (β=0.28, P<0.01), concerns (β=0.17, P<0.05), emotions (β=0.16, P<0.05), and pain identity (β=0.43, P<0.01). Within-person reductions in disability were associated with increases in: personal control (β=-0.17, P<0.01), comprehension (β=-0.11, P<0.05) and self-efficacy for coping (β=-0.04, P<0.01). Between individuals, people who were less disabled had weaker fear-avoidance beliefs about physical activity (β=0.12, P<0.01), had more self-efficacy for coping (β=-0.07, P<0.01), perceived less severe consequences of back pain (β=0.87, P<0.01), had more positive outcome expectancies (β=-0.30, P<0.05), and appraised acupuncture appointments as less convenient (β=0.92, P<0.05).
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.
确定接受针灸治疗患者背部相关残疾纵向变化的心理协变量。
采用纵向邮寄问卷调查研究，在基线（治疗前）、2周、3个月和6个月后收集数据。在83名针灸师开始为背痛患者进行针灸治疗前，共招募了485名患者。问卷测量了来自4种理论（恐惧回避模型、常识模型、期望理论、社会认知理论）的变量、临床和社会人口学特征以及残疾情况。构建纵向多水平模型，将随时间变化的残疾情况作为结果。
在个体内部，残疾程度降低（与个体均值相比）与以下因素的降低相关：对身体活动的恐惧回避信念（β = 0.11，P < 0.01）和工作相关的恐惧回避信念（β = 0.03，P < 0.05）、灾难化思维（β = 0.28，P < 0.05）、后果认知（β = 0.28，P < 0.01）、担忧（β = 0.17，P < 0.05）、情绪（β = 0.16，P < 0.05）以及疼痛认同（β = 0.43，P < 0.01）。个体内部残疾程度降低与以下因素的增加相关：个人控制感（β = -0.17，P < 0.01）、理解能力（β = -0.11，P < 0.05）以及应对自我效能感（β = -0.04，P < 0.01）。在个体之间，残疾程度较轻的人对身体活动的恐惧回避信念较弱（β = 0.12，P < 0.01）、应对自我效能感较强（β = -0.07，P < 0.01）、认为背痛后果不那么严重（β = 0.87，P < 0.01）、有更积极的结果期望（β = -0.30，P < 0.05），并且认为针灸预约不太方便（β = 0.92, P < 0.05）。
疾病认知，以及在较小程度上的自我效能感和期望，在解释与疼痛相关的残疾时可以有效地补充恐惧回避模型中的变量。患者对背痛信念的积极改变可能是试验中针灸所显示的巨大非特异性效应的基础，并且可以在临床上作为目标。
