Illness Perceptions; Mediators and/or Moderators in Disabling Persistent Low Back Pain? A Multiple Baseline Single-Case Experimental Design

Abstract

IntroductionIllness Perceptions (IPs) may be important in the management of persistent low back pain. The mediation and/or moderation effect of IPs on primary outcomes in physiotherapy treatment is unknown. MethodsA multiple single-case experimental design, using a matched care physiothetapy intervention, with 3 phases (phases A-B-A’) was used including a 3-month follow up (phase A’). Primary outcomes: pain intensity, physical functioning and pain interference in daily life. Analyzes: linear mixed models, adjusted for fear of movement, catastrophizing, avoidance, sombreness and sleep. ResultsNine patients were included by six different primary care physiotherapists. Repeated measures on 196 data points showed that IPs Consequences, Personal control, Identity, Concern and Emotional response had a mediation effect on all three primary outcomes. The IP Personal control acted as a moderator for all primary outcomes, with clinically relevant improvements at 3-month follow up.ConclusionThis is the first study to shed some light in the mediating effects of IPs on the outcome of a matched care physiotherapy treatment. At baseline, assessing Personal control is relevant to determine the outcome prognosis of successful physiotherapy management of persistent low back pain.