Beliefs about back pain and associations with clinical outcomes: a primary care cohort study

Abstract

ObjectiveTo investigate associations between beliefs about low back pain (LBP) at baseline and pain intensity and disability at 2-week, 13-week and 52-week follow-up.DesignObservational cohort study.SettingPrimary care private chiropractic clinics in Denmark.ParticipantsA total of 2734 adults consulting a chiropractor for a new episode of LBP, with follow-up data available from 71%, 61% and 52% of the participants at 2, 13 and 52 weeks, respectively.Outcome measuresBeliefs about LBP were measured by the Back Belief Questionnaire (BBQ) before consulting the chiropractor. Pain (Numerical Rating Scale 0–10) and disability (the Roland-Morris Disability Questionnaire) were measured at baseline and after 2, 13 and 52 weeks. Associations were explored using longitudinal linear mixed models estimating interactions between BBQ and time, and by estimating associations between single items of BBQ and 13-week outcomes.ResultsMore positive beliefs about LBP were weakly associated with a reduction in pain at 2 weeks (β interaction BBQ#Time=−0.02 (95% CI −0.04 to −0.001)), at 13 weeks (−0.03 (95% CI −0.05 to −0.01)) and at 52 weeks of follow-up (−0.03 (95% CI −0.05 to −0.01); p=0.003). For disability, the association was uncertain (p=0.7). The item ‘Back trouble means periods of pain for the rest of one’s life’ had the strongest association with both reduction in pain (−0.29, 95% CI −0.4 to −0.19, p<0.001) and disability (−2.42, 95% CI −3.52 to −1.33, p<0.001) at 13-week follow-up.ConclusionPositive beliefs regarding LBP, measured by the BBQ, were associated with a reduction in pain intensity at both short-term and long-term follow-up. However, the association was weak, and the clinical relevance is therefore questionable. No clear association was demonstrated between beliefs and disability. This study did not show promise that back beliefs as measured by the BBQ were helpful for predicting or explaining the course of LBP in this setting.

Development and initial testing of a brief, generic self-reported disability questionnaire: The Universal Disability Index

“…This becomes problematic when considering the known complexity of pain and what the respondent should considered to be ‘pain-related’, which may be very different from the opinion of the clinician or the researcher. Indeed, the past three decades has seen growing evidence to support the notion that a person’s psychosocial status such as learned beliefs [ 66 ], fears [ 67 ], and perceptions [ 68 ] can influence the magnitude of their disability. Importantly, respondents are often likely unaware of the relationships between these constructs and their own perceived activity limitations and participation restrictions, and certainly may not attribute them directly to their pain.…”

Low back pain management attitudes and pharmacy practice: the impact of community pharmacists’ characteristics.

“…Based on an analysis of the extant literature, [28][29][30] a structured questionnaire was first created to ensure the study points were relevant to the UAE context. Osteopathic specialists were consulted to ascertain whether the questionnaire's format and applicability to the study were adequate.…”