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Psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture

Psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture
Psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture


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.
0749-8047
254-264
Bishop, Felicity L.
1f5429c5-325f-4ac4-aae3-6ba85d079928
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Prescott, P.
cf0adfdd-989b-4f15-9e60-ef85eed817b2
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Lewith, George T.
0fc483fa-f17b-47c5-94d9-5c15e65a7625
Bishop, Felicity L.
1f5429c5-325f-4ac4-aae3-6ba85d079928
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Prescott, P.
cf0adfdd-989b-4f15-9e60-ef85eed817b2
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Lewith, George T.
0fc483fa-f17b-47c5-94d9-5c15e65a7625

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)

Record type: Article

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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More information

Accepted/In Press date: 30 March 2014
Published date: March 2015
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 364162
URI: https://eprints.soton.ac.uk/id/eprint/364162
ISSN: 0749-8047
PURE UUID: 153f929f-5546-4bea-bdb0-2ae701735081
ORCID for Felicity L. Bishop: ORCID iD orcid.org/0000-0002-8737-6662
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 07 Apr 2014 13:48
Last modified: 19 Jun 2019 00:37

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Contributors

Author: Lucy Yardley ORCID iD
Author: P. Prescott
Author: C. Cooper ORCID iD
Author: Paul Little
Author: George T. Lewith

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