Bishop, Felicity L., Yardley, Lucy, Prescott, P., Cooper, C., Little, Paul and Lewith, George T. (2015) Psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture. The Clinical Journal of Pain, 31, 254-264. (doi:10.1097/AJP.0000000000000108). (PMID:24901897)
Abstract
Objectives: To identify psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture.
Materials and Methods: A longitudinal postal questionnaire study was conducted with data collection at baseline (pretreatment), 2 weeks, 3, and 6 months later. A total of 485 patients were recruited from 83 acupuncturists before commencing acupuncture for back pain. Questionnaires measured variables from 4 theories (fear-avoidance model, common-sense model, expectancy theory, social-cognitive theory), clinical and sociodemographic characteristics, and disability. Longitudinal multilevel models were constructed with disability over time as the outcome.
Results: Within individuals, reductions in disability (compared with the person’s individual mean) were associated with reductions in: fear-avoidance beliefs about physical activity (?=0.11, P<0.01) and work (?=0.03, P<0.05), catastrophizing (?=0.28, P<0.05), consequences (?=0.28, P<0.01), concerns (?=0.17, P<0.05), emotions (?=0.16, P<0.05), and pain identity (?=0.43, P<0.01). Within-person reductions in disability were associated with increases in: personal control (?=?0.17, P<0.01), comprehension (?=?0.11, P<0.05) and self-efficacy for coping (?=?0.04, P<0.01). Between individuals, people who were less disabled had weaker fear-avoidance beliefs about physical activity (?=0.12, P<0.01), had more self-efficacy for coping (?=?0.07, P<0.01), perceived less severe consequences of back pain (?=0.87, P<0.01), had more positive outcome expectancies (?=?0.30, P<0.05), and appraised acupuncture appointments as less convenient (?=0.92, P<0.05).
Discussion: Illness perceptions and, to a lesser extent, self-efficacy and expectancies can usefully supplement variables from the fear-avoidance model in theorizing pain-related disability. Positive changes in patients’ beliefs about back pain might underpin the large nonspecific effects of acupuncture seen in trials and could be targeted clinically.
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