Background & Aims
Patients beliefs about low back pain can affect perceived harms and benefits of various treatment options. This can subsequently influence the patient’s level of engagement with interventions and the treatment effectiveness. When receiving care, a greater emphasis on the biomedical model could lead to surgery being seen as one of the only acceptable interventions. Similarly, from a biomedical perspective, exercise could be seen as potentially exacerbating rather than helping low back pain. In contrast, patients who don’t perceive surgery to be an effective solution or understand that exercise can help improve their symptoms, may engage at a higher level with evidence-based treatments. Therefore, the aim of this study was to assess the influence of healthy versus maladaptive beliefs about surgery and exercise as interventions for low back pain. Specifically, we aimed to assess the relationship between these beliefs and self-reported pain interference and physical function outcomes.
Methods
A cohort was derived from 629 clinical trial participants receiving non-pharmacological pain management for low back pain in primary care. Participants were asked which treatments they perceived as most beneficial. Specifically, they were asked to consider if they perceived surgery as being more or less likely to properly address their problem, and if they perceived exercise as more or less likely to make their symptoms better or worse. Each question was rated on a Likert scale (1=completely disagree; 5=completely agree). Participants who somewhat or completely agreed (scores 4 or 5) that surgery would be beneficial or that exercise would make their symptoms worse were categorized as having maladaptive beliefs using separate variables. We modeled the influence of maladaptive beliefs on 6-week and 6-month outcomes for PROMIS Physical Function and Pain Interference domains while adjusting for age, active-duty status, and military rank within generalized linear (Gaussian) models.
Results
The cohort was 28.8% female, mean (SD) age of 33.4 (8.3) years, 79.8% enlisted (versus officers) and 83.1% active-duty (versus dependents or retirees). After accounting for covariates, baseline beliefs that surgery would not be helpful predicted significantly lower pain interference (ß=-2.58, SD=0.70; P<0.001) and significantly higher physical function (ß=2.94, SD=0.67; P<0.001) at 6 weeks. Baseline beliefs that exercise (aerobic and resistance) would help improve their back pain predicted significantly lower pain interference (ß=-3.02, SD=0.74; P<0.001) and significantly higher physical function (ß=2.51, SD=0.72; P<0.001) at 6 weeks. The overall effect held for the same outcomes at 6 months.
Conclusions
Maladaptive beliefs about treatment have the potential to adversely influence pain and physical function outcomes in the short term out to six months. Patients receiving care for low back pain who believed that surgery would be beneficial or that exercise would be harmful improved significantly less than patients who felt otherwise. The ability to better understand and address patient beliefs about treatment effectiveness may present an opportunity to improve engagement with interventions and subsequently treatment outcomes.
References
1. Naye F, Cachinho C, Tremblay A-P, et al. How to objectively assess and observe maladaptive pain behaviors in clinical rehabilitation: a systematic search and review. Arch Physiother 2021;11(1):15.
2. Christe G, Pizzolato V, Meyer M, Nzamba J, Pichonnaz C. Unhelpful beliefs and attitudes about low back pain in the general population: A cross-sectional survey. Musculoskelet Sci Pract 2021;52:102342.
3. Rialet-Micoulau J, Lucas V, Demoulin C, Pitance L. Misconceptions of physical therapists and medical doctors regarding the impact of lifting a light load on low back pain. Braz J Phys Ther 2022;26(1):100385.
4. Hall A, Coombs D, Richmond H, et al. What do the general public believe about the causes, prognosis and best management strategies for low back pain? A cross-sectional study. BMC Public Health 2021;21(1):682.
Presenting Author
Daniel Rhon
Poster Authors
Topics
- Mechanisms: Psychosocial and Biopsychosocial