School of Physical Therapy, Arkansas Colleges of Health Education, Fort Smith, USA.
Psychology Department, Capella University, Minneapolis, USA.
BMC Musculoskelet Disord. 2022 Jan 3;23(1):21. doi: 10.1186/s12891-021-04955-6.
Chronic pain and the accompanying level of disability is a healthcare crisis that reaches epidemic proportions and is now considered a world level crisis. Chronic non-specific low back pain (CNLBP) contributes a significant proportion to the chronic pain population. CNLBP occurs with overlapping psychosocial factors. This study was design to investigate specific psychosocial factors and their influence on reported disability in a population with CNLBP.
The specific psychosocial factors examined included fear, catastrophizing, depression, and pain self-efficacy. This cross-sectional correlational study investigated the mediating role between pain self-efficacy, the specific psychosocial factors, and reported disability. The study recruited 61 female and 29 male participants from physical therapy clinics. The participants were between 20-to-60 years of age and diagnosed with CNLBP. All participants completed the Fear Avoidance Belief Questionnaire, The Pain Catastrophizing Scale, The Patient Health Questionnaire-9, The Pain Self-Efficacy Questionnaire, and The Lumbar Oswestry Disability Index. The battery of questionnaires measured fear of physical activity, pain catastrophizing, depression, pain self-efficacy, and reported disability. Multivariate regression and mediation analyses was used to analyse the data.
The principal finding was a strong inverse relationship between pain self-efficacy and reported disability with a p-value < 0.001. Further, pain self-efficacy was considered a statistical mediator with consistent p-value < 0.001 for the specific psychosocial factors investigated within this data set. Pain self-efficacy was considered to have a mediating role between reported fear of physical activity and disability, reported pain catastrophizing and disability, and reported depression and disability. Additionally, age and reported pain levels proved to be statistically significant. Adjustments for age and pain level did not alter the role of pain self-efficacy.
The results identified a mediating role for pain self-efficacy between the specific psychosocial factors (fear, catastrophizing, and depression) and reported disability. Pain self-efficacy plays a more significant role in the relationships between these specific psychosocial factors and reported disability with CNLBP than previously considered.
慢性疼痛及其伴随的残疾程度是一场达到流行程度的医疗保健危机，现在被认为是全球范围内的危机。慢性非特异性下腰痛（CNLBP）在慢性疼痛人群中占很大比例。CNLBP 伴有重叠的心理社会因素。本研究旨在调查特定的心理社会因素及其对 CNLBP 人群报告残疾的影响。
检查的特定心理社会因素包括恐惧、灾难化、抑郁和疼痛自我效能。这项横断面相关性研究调查了疼痛自我效能、特定心理社会因素和报告残疾之间的中介作用。该研究从物理治疗诊所招募了 61 名女性和 29 名男性参与者。参与者年龄在 20 至 60 岁之间，被诊断为 CNLBP。所有参与者都完成了恐惧回避信念问卷、疼痛灾难化量表、患者健康问卷-9、疼痛自我效能问卷和腰椎 Oswestry 残疾指数。这一系列问卷衡量了对身体活动的恐惧、疼痛灾难化、抑郁、疼痛自我效能和报告残疾。使用多元回归和中介分析来分析数据。
主要发现是疼痛自我效能与报告残疾之间存在强烈的负相关关系，p 值<0.001。此外，疼痛自我效能被认为是一个统计学上的中介变量，在所研究的数据集内的特定心理社会因素中，其 p 值<0.001 一致。疼痛自我效能被认为在报告的对身体活动的恐惧与残疾、报告的疼痛灾难化与残疾以及报告的抑郁与残疾之间具有中介作用。此外，年龄和报告的疼痛水平被证明具有统计学意义。调整年龄和疼痛水平并没有改变疼痛自我效能的作用。
研究结果确定了疼痛自我效能在特定心理社会因素（恐惧、灾难化和抑郁）与报告残疾之间的中介作用。疼痛自我效能在 CNLBP 中特定心理社会因素与报告残疾之间的关系中起着比以前认为的更为重要的作用。
