General and specific self-efficacy reports of patients with chronic low back pain: are they related to performances in a functional capacity evaluation?

Differences in pain, disability, and psychological function in low back pain patients with and without anxiety

Objectives: Non-specific low back pain affects people of all ages and is a leading contributor to disease burden worldwide. Chronic low back pain (LBP) reduces working hours, increases comorbidities, and increases rehabilitation needs. The aim of this study was to evaluate whether there were differences in pain, dysfunction, and psychological factors between two groups. The supplementary demonstrated the relationship between these influencing factors and anxiety.

Methods: A cross-sectional study was designed to analyze the differences in pain, disability, and psychological function in non-specific LBP patients with and without anxiety. In total, 60 subjects were divided into two groups based on self-rated anxiety scores: 30 patients with SAS score ≥50 were in the low back pain with anxiety group, and 30 for the LBP without anxiety group with SAS score <50. The pain intensity was assessed using the Visual Analog Scale; psychological function, using the Pain Anxiety Symptoms Scale, the Tampa Scale for Kinesiophobia, and the Fear Avoidance Beliefs Questionnaire; functional disability, using the Oswestry Disability Index and the Roland–Morris Disability Questionnaire; quality of life using 36-Item Short-Form Health Survey questionnaire; and the quality of sleep using Pittsburgh Sleep Quality Index, and the relationships between variables and anxiety scores were estimated using Spearman correlation analysis.

Results: A total of 60 participants were enrolled after self-rated anxiety was assessed and the full investigation was finished. The analyses showed significant differences of pain intensity (p = 0.034, disability (ODI, p = 0.007; RMDQ, p = 0.012) and psychological function (TSK, p = 0.000; PASS, p = 0.009; FABQ, p = 0.000; SF-36, p = 0.000; and PSQI, p = 0.000) between the two groups. Spearman correlation analysis showed that the anxiety score had significant positive correlations with functional disability (ODI, p = 0.004 and 95% CI = 0.112–0.573; RMDQ, p = 0.003, 95% CI = 0.135–0.586) and psychological function (TSK, p = 0.001, 95% CI = 0.174–0.612), excellent positive correlation with quality of sleep (PASS, p = 0.025, 95% CI = 0.031–0.512), and strongly negative correlations with the quality of life (SF-36, p = 0.000, 95% CI = 0.761–0.433).

Conclusion: We recognized that anxiety in low back pain patients was mainly due to interaction with the intensity of pain, disability level, and a mass of psychological function. The future research direction could be to alleviate the anxiety on the comprehensive efficacy of patients with low back pain.

Psychological and physical factors related to disability in chronic low back pain

BACKGROUND

Chronic low back pain (CLBP) is a public health problem that causes high levels of disability. Psychological and physical factors could play a critical role in the disability perception of patients.

OBJECTIVE

The objective was to identify the psychological and physical factors associated with CLBP disability in patients and assess differences between asymptomatic subjects and CLBP patients through physical tests and psychological self-reports.

METHODS

A cross-sectional study was performed. Total sample of 80 participants were classified into two groups: patients with CLBP (n= 49) and asymptomatic subjects (i.e. the control group) (n= 31). The physical tests included lower back range of motion (LBROM), postural stability, lower back strength (LBS), and lumbopelvic motor control tests. The psychological self-reports included low back disability (Roland Morris Disability Questionnaire), self-efficacy, pain catastrophizing, and pain-related fear.

RESULTS

Self-efficacy and LBS displayed moderate negative correlations with disability in patients with CLBP (R=-0.47 and -0.40, respectively). Disability was predicted by self-efficacy and LBROM (β=-0.45 and -033 respectively, p< 0.01), explaining 30% of the variance in these patients. The comparative analysis showed statistically significant differences between groups in the physical/psychological variables (p< 0.01); however, the effect-sizes were small for all these variables.

CONCLUSIONS

The results of this study highlight the relevance of psychological and physical factors in CLBP patient disability. Evaluation and treatment in CLBP patients should take these factors into account.

Functional Capacity Evaluation in Different Societal Contexts: Results of a Multicountry Study

Purpose To examine factors associated with Functional Capacity Evaluation (FCE) results in patients with painful musculoskeletal conditions, with focus on social factors across multiple countries. Methods International cross-sectional study was performed within care as usual. Simple and multiple multilevel linear regression analyses which considered measurement's dependency within clinicians and country were conducted: FCE characteristics and biopsychosocial variables from patients and clinicians as independent variables; and FCE results (floor-to-waist lift, six-minute walk, and handgrip strength) as dependent variables. Results Data were collected for 372 patients, 54 clinicians, 18 facilities and 8 countries. Patients' height and reported pain intensity were consistently associated with every FCE result. Patients' sex, height, reported pain intensity, effort during FCE, social isolation, and disability, clinician's observed physical effort, and whether FCE test was prematurely ended were associated with lift. Patient's height, Body Mass Index, post-test heart-rate, reported pain intensity and effort during FCE, days off work, and whether FCE test was prematurely ended were associated with walk. Patient's age, sex, height, affected body area, reported pain intensity and catastrophizing, and physical work demands were associated with handgrip. Final regression models explained 38‒65% of total variance. Clinician and country random effects composed 1-39% of total residual variance in these models. Conclusion Biopsychosocial factors were associated with every FCE result across multiple countries; specifically, patients' height, reported pain intensity, clinician, and measurement country. Social factors, which had been under-researched, were consistently associated with FCE performances. Patients' FCE results should be considered from a biopsychosocial perspective, including different social contexts.

Predictive Value of the Fear-Avoidance Model on Functional Capacity Evaluation

Purpose Measuring the predictive value of the Fear-Avoidance Model (FAM) on lifting tasks in Functional Capacity Evaluation (FCE), and on reasons for stopping the evaluation (safe maximal effort, versus self-limited). Methods A monocentric prospective study was conducted on 298 consecutive inpatients. Components of the FAM were analyzed using the Cumulative Psychosocial Factor Index (CPFI: kinesiophobia, catastrophizing, depressive mood) and perceived disability (Hand/Spinal Function Sort: HFS/SFS). Floor-to-waist, waist-to-overhead and dominant-hand lifting tests were measured according to the FCE guidelines. Maximal safe performance was judged by certified FCE assessors. Analyses were conducted with linear multiple regression models. Results The CPFI was significantly associated with the 3 FCE lifting tests: floor-to-waist (ß = - 1.12; p = 0.039), waist-to-overhead (ß = - 0.88; p = 0.011), and dominant-handed lifting (ß = - 1.21; p = 0.027). Higher perceived disability was also related to lower performances: floor-to-waist (ß = 0.09; p < 0.001), waist-to-overhead (ß = 0.04; p < 0.001), and dominant-handed lifting (ß = 0.06; p < 0.001). The CPFI was not related to performances of patients with self-limited effort despite higher psychological scores, while a relationship was found for patients who achieved a safe maximal performance. Higher perceived disability was related to performances in both situations. Conclusions FAM components should be taken into account when interpreting maximal physical performance in FCE. This study also suggests that factors other than pain-related fears may influence patients with self-limited effort.

Comparative efficacy of three active treatment modules on psychosocial variables in patients with long-term mechanical low-back pain: a randomized-controlled trial

BACKGROUND

Psychosocial factors precipitate and perpetuate the risk of developing long-term Low-Back Pain (LBP) with resultant disability. However, management of psychosocial aspects of LBP still remains a major challenge. This study investigated the effect of static or dynamic back extensors endurance exercise on psychosocial variables of Fear-Avoidance Behaviour (FAB), Pain Self-Efficacy Belief (PSEB) and Back Pain Consequences Belief (BPCB) in patients with LBP.

METHODS

A randomized-controlled trial of 67 patients assigned into McKenzie Protocol (MP) group (n = 25), MP and Static Endurance Exercise Group (MPSEEG; n = 22); and MP and Dynamic Endurance Exercise Group (MPDEEG; n = 20) was carried out. Treatment was applied thrice weekly for eight weeks.

RESULTS

The groups were comparable in general and baseline psychosocial parameters (p > 0.05). The different regimens had significant effects on all outcome parameters across baseline, 4th and 8th week (p < 0.05). The regimens were comparable in mean change scores on BPCB and FAB at the 4th and 8th week respectively (p > 0.05). MPDBEEG had higher mean change in PSEB at the 4th and 8th week respectively.

CONCLUSIONS

McKenzie Protocol alone, or in combination with static or dynamic back extensors endurance exercise has comparable effect on FAB, PSEB and BPCB in patients with LBP. The addition of dynamic endurance exercise to the MP led to significantly higher positive effects on PSEB.

Influence of Physical Therapists' Kinesiophobic Beliefs on Lifting Capacity in Healthy Adults

BACKGROUND

Physical therapists' recommendations to patients to avoid daily physical activity can be influenced by the therapists' kinesiophobic beliefs. Little is known about the amount of influence of a physical therapist's kinesiophobic beliefs on a patient's actual lifting capacity during a lifting test.

OBJECTIVE

The objective of this study was to determine the influence of physical therapists' kinesiophobic beliefs on lifting capacity in healthy people.

DESIGN

A blinded, cluster-randomized cross-sectional study was performed.

METHODS

The participants (n=256; 105 male, 151 female) were physical therapist students who performed a lifting capacity test. Examiners (n=24) were selected from second-year physical therapist students. Participants in group A (n=124) were tested in the presence of an examiner with high scores on the Tampa Scale of Kinesiophobia for health care providers (TSK-HC), and those in group B (n=132) were tested in the presence of an examiner with low scores on the TSK-HC. Mixed-model analyses were performed on lifting capacity to test for possible (interacting) effects.

RESULTS

Mean lifting capacity was 32.1 kg (SD=13.6) in group A and 39.6 kg (SD=16.4) in group B. Mixed-model analyses revealed that after controlling for sex, body weight, self-efficacy, and the interaction between the examiners' and participants' kinesiophobic beliefs, the influence of examiners' kinesiophobic beliefs significantly reduced lifting capacity by 14.4 kg in participants with kinesiophobic beliefs and 8.0 kg in those without kinesiophobic beliefs.

LIMITATIONS

Generalizability to physical therapists and patients with pain should be studied.

CONCLUSIONS

Physical therapists' kinesiophobic beliefs negatively influence lifting capacity of healthy adults. During everyday clinical practice, physical therapists should be aware of the influence of their kinesiophobic beliefs on patients' functional ability.

Construct validity of functional capacity tests in healthy workers

BACKGROUND

Functional Capacity (FC) is a multidimensional construct within the activity domain of the International Classification of Functioning, Disability and Health framework (ICF). Functional capacity evaluations (FCEs) are assessments of work-related FC. The extent to which these work-related FC tests are associated to bio-, psycho-, or social factors is unknown. The aims of this study were to test relationships between FC tests and other ICF factors in a sample of healthy workers, and to determine the amount of statistical variance in FC tests that can be explained by these factors.

METHODS

A cross sectional study. The sample was comprised of 403 healthy workers who completed material handling FC tests (lifting low, overhead lifting, and carrying) and static work FC tests (overhead working and standing forward bend). The explainable variables were; six muscle strength tests; aerobic capacity test; and questionnaires regarding personal factors (age, gender, body height, body weight, and education), psychological factors (mental health, vitality, and general health perceptions), and social factors (perception of work, physical workloads, sport-, leisure time-, and work-index). A priori construct validity hypotheses were formulated and analyzed by means of correlation coefficients and regression analyses.

RESULTS

Moderate correlations were detected between material handling FC tests and muscle strength, gender, body weight, and body height. As for static work FC tests; overhead working correlated fair with aerobic capacity and handgrip strength, and low with the sport-index and perception of work. For standing forward bend FC test, all hypotheses were rejected. The regression model revealed that 61% to 62% of material handling FC tests were explained by physical factors. Five to 15% of static work FC tests were explained by physical and social factors.

CONCLUSIONS

The current study revealed that, in a sample of healthy workers, material handling FC tests were related to physical factors but not to the psychosocial factors measured in this study. The construct of static work FC tests remained largely unexplained.

Lombalgia crônica: comparação entre duas intervenções na força inspiratória e capacidade funcional

INTRODUÇÃO: A dor lombar crônica apresenta alta incidência, grandes custos sociais e pessoais e esforços terapêuticos muitas vezes frustrantes. Faz-se necessário, então, avaliar os recursos fisioterapêuticos para entendê-los melhor e fundamentá-los cientificamente. OBJETIVOS: Comparar os efeitos entre duas intervenções fisioterapêuticas sobre a força muscular respiratória (FMR) e a capacidade funcional (CF) em pacientes com lombalgia crônica. MATERIAIS E MÉTODOS: Série de casos cuja amostra (n = 10), composta por portadores de dor lombar crônica, foi dividida aleatoriamente em grupo controle, que recebeu fisioterapia convencional (eletroanalgesia, massoterapia e flexibilização), e grupo experimental, que recebeu a cinesioterapia combinada (composta por técnicas de isostretching + treinamento sensório-motor aquático). A mensuração da CF, realizada pelo teste de caminhada de seis minutos (TC6), e da FMR, pelas pressões máximas inspiratória (Pimáx) e expiratórias (Pemáx) por meio de manuvacuometria, aconteceu antes (ΔINI) e após (ΔFIN) as intervenções, que duraram sete semanas, com três sessões semanais. As comparações foram feitas pelo Mann-Whitney e Wilcoxon (α = 0,05). RESULTADOS: No GE, observou-se melhora, intragrupo, na Pimáx (p = 0,0164), Pemáx (p = 0,0227) e TC6 (p = 0,0092), e, no GC, apenas no TC6 (p = 0,018). Nas comparações intergrupo, obteve-se Pimáx e Pemáx semelhantes na ΔINI, mas diferentes na ΔFIN (p = 0,0166; p = 0,0045); e no TC6, observou-se diferença significativa apenas na ΔINI (p = 0,0484). CONCLUSÃO: O isostretching e treinamento sensório-motor aquático foram eficazes na melhora da FMR e da CF, e o tratamento fisioterapêutico convencional foi efetivo apenas na melhora da CF.

Are performance-based measures predictive of work participation in patients with musculoskeletal disorders? A systematic review

OBJECTIVE

Assessments of whether patients with musculoskeletal disorders (MSDs) can participate in work mainly consist of case history, physical examinations, and self-reports. Performance-based measures might add value in these assessments. This study answers the question: how well do performance-based measures predict work participation in patients with MSDs?

METHODS

A systematic literature search was performed to obtain longitudinal studies that used reliable performance-based measures to predict work participation in patients with MSDs. The following five sources of information were used to retrieve relevant studies: PubMed, Embase, AMA Guide to the Evaluation of Functional Ability, references of the included papers, and the expertise and personal file of the authors. A quality assessment specific for prognostic studies and an evidence synthesis were performed.

RESULTS

Of the 1,230 retrieved studies, eighteen fulfilled the inclusion criteria. The studies included 4,113 patients, and the median follow-up period was 12 months. Twelve studies took possible confounders into account. Five studies were of good quality and thirteen of moderate quality. Two good-quality and all thirteen moderate-quality studies (83%) reported that performance-based measures were predictive of work participation. Two good-quality studies (11%) reported both an association and no association between performance-based measures and work participation. One good-quality study (6%) found no effect. A performance-based lifting test was used in fourteen studies and appeared to be predictive of work participation in thirteen studies.

CONCLUSIONS

Strong evidence exists that a number of performance-based measures are predictive of work participation in patients with MSDs, especially lifting tests. Overall, the explained variance was modest.

Motor performance in chronic low back pain: is there an influence of pain-related cognitions? A pilot study

Background

Methods

Results

Conclusion

Factors associated with functional capacity test results in patients with non-specific chronic low back pain: a systematic review

INTRODUCTION

Functional capacity tests are standardized instruments to evaluate patients' capacities to execute work-related activities. Functional capacity test results are associated with biopsychosocial factors, making it unclear what is being measured in capacity testing. An overview of these factors was missing. The objective of this review was to investigate the level of evidence for factors that are associated with functional capacity test results in patients with non-specific chronic low back pain.

METHODS

A systematic literature review was performed identifying relevant studies from an electronic journal databases search. Candidate studies employed a cross-sectional or RCT design and were published between 1980 and October 2010. The quality of these studies was determined and level of evidence was reported for factors that were associated with capacity results in at least 3 studies.

RESULTS

Twenty-two studies were included. The level of evidence was reported for lifting low, lifting high, carrying, and static lifting capacity. Lifting low test results were associated with self-reported disability and specific self-efficacy but not with pain duration. There was conflicting evidence for associations of lifting low with pain intensity, fear of movement/(re)injury, depression, gender and age. Lifting high was associated with gender and specific self-efficacy, but not with pain intensity or age. There is conflicting evidence for the association of lifting high with the factors self-reported disability, pain duration and depression. Carrying was associated with self-reported disability and not with pain intensity and there is conflicting evidence for associations with specific self-efficacy, gender and age. Static lifting was associated with fear of movement/(re)injury.

CONCLUSIONS

Much heterogeneity was observed in investigated capacity tests and candidate associated factors. There was some evidence for biological and psychological factors that are or are not associated with capacity results but there is also much conflicting evidence. High level evidence for social factors was absent.

[Lifting capacity with low back pain : Discrepancy between self-rated and real lifting capacity in patients with back pain and pain-free controls]

BACKGROUND

The fear-avoidance model implies that in situations with physical demands patients with back pain will overestimate the demand and underestimate their own capacities.

PATIENTS AND METHODS

A total of 71 patients with back pain and 48 pain-free control subjects carried out a standardized lifting test with a preceding estimation of their lifting capacity.

RESULTS

In both groups the self-estimation and real lifting capacity were in concordance for most group members with patients showing less disconcordance than controls. In the control group 35% of the subjects even underestimated their lifting capacity, which was the case in only 14% of the patients. Patients more frequently overestimated their capacity than pain-free controls (14% vs. 2%). Within the patients subgroups could be identified where patients in general either underestimated or overestimated their own capacity. A comparison between the groups demonstrated significant differences in pain intensity, fear avoidance beliefs and effort.

CONCLUSION

As an explanation for these unexpected results it can be hypothesized that in cases of back pain, patients' attention is focused on pain-relevant issues which enables a more realistic estimation of their lifting capacity.

Activity-related pain in patients with chronic musculoskeletal disorders

PURPOSE

Activity-related pain may be a barrier to rehabilitation in patients with chronic musculoskeletal disorders. This study investigated patients' reports of increased pain during activity, and the association between such pain and psychological factors and pain variables.

METHOD

Questionnaires from 232 adults with chronic musculoskeletal pain measured pain intensity, spread of pain and pain duration. Pain during activity was assessed both on a 11-point Numeric Rating Scale (NRS), and operationalised as a dichotomous measure, where responders defined if they experienced pain during general activity and exercise. Psychological factors were measured by the Hopkins symptom check list 25, the Tampa Scale for Kinesiophobia and a subscale of the Arthritis Self-efficacy Scale. Multiple and logistic regression were used to analyse associations between increased pain during activity and associated variables.

RESULTS

Increased pain during activity was reported by 69% of participants. Fear of movement was a significant factor for reporting increased pain during activity, both general activity and exercise also in a subsample with low psychological distress. Other significant factors were spread of pain and a low sense of self-efficacy.

CONCLUSION

Patients with high fear of movement, large spread of pain and low self-efficacy were more likely to report increased pain during activity even in the absence of psychological distress.

Self-reported assessment of disability and performance-based assessment of disability are influenced by different patient characteristics in acute low back pain

For an individual, the functional consequences of an episode of low back pain is a key measure of their clinical status. Self-reported disability measures are commonly used to capture this component of the back pain experience. In non-acute low back pain there is some uncertainty of the validity of this approach. It appears that self-reported assessment of disability and direct measurements of functional status are only moderately related. In this cross-sectional study, we investigated this relationship in a sample of 94 acute low back pain patients. Both self-reported disability and a performance-based assessment of disability were assessed, along with extensive profiling of patient characteristics. Scale consistency of the performance-based assessment was investigated using Cronbach's alpha, the relationship between self-reported and performance-based assessment of disability was investigated using Pearson's correlation. The relationship between clinical profile and each of the disability measures were examined using Pearson's correlations and multivariate linear regression. Our results demonstrate that the battery of tests used are internally reliable (Cronbach's alpha = 0.86). We found only moderate correlations between the two disability measures (r = 0.471, p < 0.001). Self-reported disability was significantly correlated with symptom distribution, medication use, physical well-being, pain intensity, depression, somatic distress and anxiety. The only significant correlations with the performance-based measure were symptom distribution, physical well-being and pain intensity. In the multivariate analyses no psychological measure made a significant unique contribution to the prediction of the performance-based measure, whereas depression made a unique contribution to the prediction of the self-reported measure. Our results suggest that self-reported and performance-based assessments of disability are influenced by different patient characteristics. In particular, it appears self-reported measures of disability are more influenced by the patient's psychological status than performance-based measures of disability.

Construct validity of functional capacity evaluation lifting tests in construction workers on sick leave as a result of musculoskeletal disorders

OBJECTIVES

To assess the construct (discriminative and convergent) validity of 5 Ergo-Kit (EK) functional capacity evaluation (FCE) lifting tests in construction workers on sick leave as a result of musculoskeletal disorders (MSDs).

DESIGN

Cross sectional within-subject design.

SETTING

Occupational health service for the construction industry.

PARTICIPANTS

Male construction workers (N=72) on 6-week sick leave as a result of MSDs.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

After being assessed on 5 EK FCE lifting tests, participants were asked to complete the Von Korff questionnaire on pain intensity and disability as a result of MSDs and the instrument for disability risk assessing the risk for work disability. Discriminative validity was evaluated by comparing the results of the EK FCE lifting test scores between the 2 groups of participants based on the instrument for disability risk scores (high risk for work disability compared with low risk for work disability). Convergent validity was evaluated by assessing the associations between the results of the EK FCE lifting tests and Von Korff questionnaire self-reported pain intensity and disability as a result of MSDs.

RESULTS

The hypothesized differences between both instrument for disability risk groups on the 5 EK FCE lifting tests were found in the expected direction but were not statistically significant (1 test exhibited a trend). Pearson correlation coefficients showed a poor convergent validity between the scores of the Von Korff questionnaire and the EK FCE lifting tests (-.29< or =r< or =.05).

CONCLUSIONS

Poor construct validity of the 5 EK lifting tests was found: discriminative validity was not statistically established, and convergent validity with self-reported pain intensity and disability was poor.