Changes in Pain Catastrophizing and Fear-Avoidance Beliefs as Mediators of Early Physical Therapy on Disability and Pain in Acute Low-Back Pain: A Secondary Analysis of a Clinical Trial
| Autor: | Molly McFadden, Julie M. Fritz, Tom Greene, John S. Magel, Brittany L Sisco-Taylor, Jincheng Shen |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Musculoskeletal Rehabilitation & Regenerative Medicine Section Disability Evaluation Secondary analysis Surveys and Questionnaires medicine Back pain Humans Acute pain Acute low back pain Physical Therapy Modalities business.industry Catastrophization Chronic pain General Medicine Fear medicine.disease Acute Pain Oswestry Disability Index Clinical trial Anesthesiology and Pain Medicine Physical therapy Pain catastrophizing Neurology (clinical) medicine.symptom business Low Back Pain |
| Zdroj: | Pain Med |
| ISSN: | 1526-4637 0172-6803 |
| Popis: | Objective The Fear-Avoidance Model (FAM) of chronic pain posits that pain catastrophizing and fear-avoidance beliefs are prognostic for disability and chronicity. In acute low-back pain, early physical therapy (PT) is effective in reducing disability in some patients. How early PT impacts short- and long-term changes in disability for patients with acute pain is unknown. Based on the FAM, we hypothesized that early reductions in pain catastrophizing and fear-avoidance beliefs would mediate early PT’s effect on changes in disability (primary outcome) and pain intensity (secondary outcome) over 3 months and 1 year. Subjects Participants were 204 patients with low-back pain of Methods Patients completed the Pain Catastrophizing Scale (PCS), Fear-Avoidance Beliefs Questionnaire (FABQ work and physical activity scales), and outcomes (Oswestry Disability Index and Numeric Pain Rating Scale) at baseline, 4 weeks, 3 months, and 1 year. We applied longitudinal mediation analysis with single and multiple mediators. Results Early PT led to improvements in disability and pain over 3 months but not 1 year. In the single mediator model, 4-week reductions in pain catastrophizing mediated early PT’s effects on 3-month disability and pain intensity improvements, explaining 16% and 22% of the association, respectively, but the effects were small. Pain catastrophizing and fear-avoidance beliefs did not jointly mediate these associations. Conclusions In acute low-back pain, early PT may improve disability and pain outcomes at least partly through reducing patients’ catastrophizing. |
| Databáze: | OpenAIRE |
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