Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2022 | Back Pain | Research

Illness perceptions; exploring mediators and/or moderators in disabling persistent low back pain. Multiple baseline single-case experimental design

Authors: E. J. Edwin de Raaij, H. Harriet Wittink, J. F. Francois Maissan, J. Jos Twisk, R. W. J. G. Raymond Ostelo

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Abstract

Introduction

Illness Perceptions (IPs) may play a role in the management of persistent low back pain. The mediation and/or moderation effect of IPs on primary outcomes in physiotherapy treatment is unknown.

Methods

A multiple single-case experimental design, using a matched care physiotherapy intervention, with three 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.

Results

Nine 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.

Conclusion

Our study might indicate that some IPs have a mediating or a moderating effect on the outcome of a matched care physiotherapy treatment. Assessing Personal control at baseline, as a relevant moderator for the outcome prognosis of successful physiotherapy management of persistent low back pain, should be further eplored.

Available only for authorised users

Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013;380(9859):2163–2196. https://doi.org/10.1016/S0140-6736(12)61729 − 2.

Buchbinder R, van Tulder M, Öberg B, et al. Low back pain: a call for action. Lancet. 2018. https://doi.org/10.1016/S0140-6736(18)30488-4.

Clark S, Horton R. Low back pain: a major global challenge. Lancet March 2018. https://doi.org/10.1016/S0140-6736(18)30725-6.

Hartvigsen J, Hancock MJ, Kongsted A, Lancet QLT. What low back pain is and why we need to pay attention. Elsevier. 2018;391(10137):2356–67. https://doi.org/10.1016/S0140-6736(18)30480-X.CrossRef

Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet March 2018. https://doi.org/10.1016/S0140-6736(18)30489-6.

OSullivan P. It’s time for change with the management of non-specific chronic low back pain. Br J Sports Med. 2012;46(4):224–7. https://doi.org/10.1136/bjsm.2010.081638.CrossRef

Caneiro JP, Roos EM, Barton CJ, et al. It is time to move beyond “body region silos” to manage musculoskeletal pain: five actions to change clinical practice. Br J Sports Med. 2019. https://doi.org/10.1136/bjsports-2018-100,488 bjsports–2018–100,488–2.

O’Sullivan P, Caneiro JP, O’Keeffe M, O’Sullivan K. Unraveling the Complexity of Low Back Pain. J Orthop Sports Phys Ther. 2016;46(11):932–7. https://doi.org/10.2519/jospt.2016.0609.CrossRefPubMed

Henschke N, Ostelo RW, van Tulder MW, et al. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2010;7:CD002014. https://doi.org/10.1002/14651858.CD002014.pub3.CrossRef

10.

Medicine OCFE-B. OCEBM Levels of Evidence Working Group. the Oxford 2011 Levels of Evidence. 2011.

11.

Shamseer L, Bukutu C, Schmid CH, et al. CONSORT extension for reporting N-of-1 trials (CENT) 2015: explanation and elaboration. J Clin Epidemiol. 2016;76:18–46. https://doi.org/10.1016/j.jclinepi.2015.05.018.CrossRefPubMed

12.

Kent DM, Steyerberg E, van Klaveren D. Personalized evidence based medicine: predictive approaches to heterogeneous treatment effects. BMJ. 2018;45:k4245–18. https://doi.org/10.1136/bmj.k4245.CrossRef

13.

Linton SJ, Nicholas M, Shaw W. Why wait to address high-risk cases of acute low back pain? A comparison of stepped, stratified, and matched care. Pain. 2018;159(12):2437–41. https://doi.org/10.1097/j.pain.0000000000001308.CrossRefPubMed

14.

Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H. Fear of movement/(re) injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62(3):363–72.CrossRef

15.

Picavet HSJ. Pain Catastrophizing and Kinesiophobia: Predictors of Chronic Low Back Pain. Am J Epidemiol. 2002;156(11):1028–34. https://doi.org/10.1093/aje/kwf136.CrossRefPubMed

16.

Vlaeyen JW, de Jong J, Geilen M, Heuts PH, van Breukelen G. Graded exposure in vivo in the treatment of pain-related fear: a replicated single-case experimental design in four patients with chronic low back pain. Behav Res Ther. 2001;39(2):151–66. https://doi.org/10.1016/s0005-7967(99)00174-6.CrossRefPubMed

17.

Lee H, Mansell G, McAuley JH, et al. Causal mechanisms in the clinical course and treatment of back pain. Best Pract Res Clin Rheumatol. 2016;30(6):1074–83. https://doi.org/10.1016/j.berh.2017.04.001.CrossRefPubMed

18.

Sivertsen B, Lallukka T, Petrie KJ, Steingrímsdóttir ÓA, Stubhaug A, Nielsen CS. Sleep and pain sensitivity in adults. Pain. 2015;156(8):1433–9. https://doi.org/10.1097/j.pain.0000000000000131.CrossRefPubMed

19.

Nicholas MK, Linton SJ, Watson PJ, Physical CM. Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: a reappraisal. Academicoupcom. 2011.

20.

Leventhal H, Meyer D, Nerenz D. The Common Sense Representation of Illness Danger. In: Rachman S, editor. Medical Psychology. Vol II. Pergamon Press; 1980. p. 7–29.

21.

de Raaij EJ, Ostelo RW, Maissan F, Mollema J, Wittink H. The Association of Illness Perception and Prognosis for Pain and Physical Function in Patients With Noncancer Musculoskeletal Pain: A Systematic Literature Review. J Orthop Sports Phys Ther. 2018;48(10):789–800. https://doi.org/10.2519/jospt.2018.8072.CrossRefPubMed

22.

de Raaij EJ, Ostelo RWJG, Maissan JF, Pool J, Westers P, Wittink H. Illness perceptions associated with patient burden with musculoskeletal pain in outpatient physical therapy practice, a cross-sectional study. Musculoskelet Sci Pract. 2020;45:102072. https://doi.org/10.1016/j.msksp.2019.102072.CrossRefPubMed

23.

Hagger M, Orbell S. A Meta-Analytic Review of the Common-Sense Model of Illness Representations. Psychol Health. 2003;18(2):141–84.CrossRef

24.

Kraemer HC, Wilson GT, Fairburn CG, Agras WS. Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry. 2002;59(10):877–83. https://doi.org/10.1001/archpsyc.59.10.877.CrossRefPubMed

25.

Tate RL, Perdices M, Rosenkoetter U, et al. The Single-Case Reporting Guideline In BEhavioural Interventions (SCRIBE) 2016: Explanation and elaboration. Arch Sci Psychol. 2016;4(1):10–31. https://doi.org/10.1037/arc0000027.CrossRef

26.

Siemonsma PC, Stuive I, Roorda LD, et al. Cognitive treatment of illness perceptions in patients with chronic low back pain: a randomized controlled trial. Phys Ther. 2013;93(4):435–48. https://doi.org/10.2522/ptj.20110150.CrossRefPubMed

27.

Beurskens AJ, de Vet HC, Köke AJ, et al. A patient-specific approach for measuring functional status in low back pain. J Manipulative Physiol Ther. 1999;22(3):144–8.CrossRef

28.

Dionne CE, Dunn KM, Croft PR, et al. A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine. 2008;33(1):95–103. https://doi.org/10.1097/BRS.0b013e31815e7f94.CrossRefPubMed

29.

de Raaij EJ, Schröder C, Maissan FJ, Pool JJ, Wittink H. Cross-cultural adaptation and measurement properties of the Brief Illness Perception Questionnaire-Dutch Language Version. Man Ther. 2012;17(4):330–5. https://doi.org/10.1016/j.math.2012.03.001.CrossRefPubMed

30.

Hallegraeff JM, Van Der Schans CP, Krijnen WP, de Greef MH. Measurement of acute nonspecific low back pain perception in primary care physical therapy: reliability and validity of the brief illness perception questionnaire. BMC Musculoskelet Disord. 2013;14(1):1–1. https://doi.org/10.1186/1471-2474-14-53.CrossRef

31.

Caneiro JP, Smith A, Linton SJ, Moseley GL, OSullivan P. “How does change unfold?” an evaluation of the process of change in four people with chronic low back pain and high pain-related fear managed with Cognitive Functional Therapy_ A replicated single-case experimental design study. Behav Res Ther. 2019:1–12. https://doi.org/10.1016/j.brat.2019.02.007.

32.

Ostelo RWJG, Deyo RA, Stratford P, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change, vol. 33; 2008. p. 90–4. https://doi.org/10.1097/BRS.0b013e31815e3a10.CrossRef

33.

Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736–47. https://doi.org/10.1016/S0140-6736(16)30970-9.CrossRefPubMed

34.

Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24(6):769–81. https://doi.org/10.1016/j.berh.2010.10.002.CrossRefPubMed

35.

Delitto A. Research in low back pain: time to stop seeking the elusive “magic bullet”. Phys Ther. 2005;85(3):206–8.CrossRef

36.

Caneiro JP, Bunzli S, OSullivan P. Beliefs about the body and pain: the critical role in musculoskeletal pain management. Braz J Phys Ther. 2020:1–13. https://doi.org/10.1016/j.bjpt.2020.06.003.

37.

Costa L, Maher CG, Hancock MJ, Jmcma J. Prognosis in People with Back Pain, vol. 184; 2012. p. 1229–30. https://doi.org/10.1503/cmaj.120627.CrossRef

38.

Hayden JA, Tougas ME, Riley R, Iles R. Individual recovery expectations and prognosis of outcomes in non-specific low back pain: prognostic factor exemplar review; 2014. https://doi.org/10.1002/14651858.CD011284.CrossRef

39.

McCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: New concepts are needed to study research participation effects. J Clin Epidemiol. 2014;67(3):267–77. https://doi.org/10.1016/j.jclinepi.2013.08.015.CrossRefPubMedPubMedCentral

40.

Doody C, McAteer M. Clinical Reasoning of Expert and Novice Physiotherapists in an Outpatient Orthopaedic Setting. Physiotherapy. 2002;88(5):258–68. https://doi.org/10.1016/S0031-9406(05)61417-4.CrossRef

41.

Hoffman LJ, Chu BC. When Is Seeking Safety Functional? Taking a Pragmatic Approach to Distinguishing Coping From Safety. Cogn Behav Pract. 2019;26(1):176–85. https://doi.org/10.1016/j.cbpra.2018.11.002.CrossRef

Title: Illness perceptions; exploring mediators and/or moderators in disabling persistent low back pain. Multiple baseline single-case experimental design
Authors: E. J. Edwin de Raaij
H. Harriet Wittink
J. F. Francois Maissan
J. Jos Twisk
R. W. J. G. Raymond Ostelo
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Back Pain
Back Pain
Back Pain
Published in: BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-022-05031-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Illness perceptions; exploring mediators and/or moderators in disabling persistent low back pain. Multiple baseline single-case experimental design

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2022

The impact of sarcopenia on low back pain and quality of life in patients with osteoporosis

Concurrent validity of DorsaVi wireless motion sensor system Version 6 and the Vicon motion analysis system during lifting

Construct validity and reliability of the 2-Minute Step Test (2MST) in individuals with low back pain

Risk factors for postoperative pneumonia in patients undergoing hip fracture surgery: a systematic review and meta-analysis

Risk factors of transport gap bending deformity in the treatment of critical-size bone defect after bone transport

Characteristics of the patellofemoral joint of patients with DDH and the effects of Bernese periacetabular osteotomy on the patellofemoral joint