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Biopsychosocial predictors of pain, disability, health care consumption, and sick leave in first-episode and long-term back pain: A longitudinal study in the general population
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. (Beteendemedicin och sjukgymnastik, Behavioural medicine and physiotherapy)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience. (Beteeendemedicin och sjukgymnastik, Behavioural medicine and physiotherapy)
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. (Beteendemedicin och sjukgymnastik, Behavioural medicine and physiotherapy)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. (Beteendemedicin och sjukgymnastik, Behavioural medicine and physiotherapy)
2010 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 17, no 2, 79-89 p.Article in journal (Refereed) Published
Abstract [en]

Background: Long-term outcome in back pain is related mainly to cognitive factors such as pain-related beliefs and expectations. Most research has been performed on patient samples.

Purpose: This study aimed at investigating changes over time in reported back pain, pain intensity, disability, health care consumption and sick leave as well as biopsychosocial factors over a 12 month-period. A second aim was to identify predictors of reported pain, pain intensity, disability, health care consumption and sick leave.

Method: As parts of a large back pain sample from a general population (n = 1024), two groups – one with first-episode pain (n = 77) and one with long-term pain (n = 302) – responded twice to a self-administered questionnaire. Among participants reporting pain at both assessments, changes over time were analysed and predictive models were tested.

Results: Generally, the results demonstrated overall stability in the self-reports over time. However, reported pain decreased in both groups, while pain catastrophizing and pain expectations increased in the first-episode group. Pain intensity and disability were predicted in regression models including four cognitive factors and initially reported levels of pain intensity and disability.

Conclusion: The significance of pain-related beliefs and expectations both in early and later stages of a back pain condition is pointed out. The results in this study based on a sample from the general population are in line with previous research on patient samples.

Place, publisher, year, edition, pages
2010. Vol. 17, no 2, 79-89 p.
Keyword [en]
Musculoskeletal pain, biopsychosocial, cognitive-behavioral, longitudinal, general population
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Caring Sciences in Social Sciences
Identifiers
URN: urn:nbn:se:uu:diva-116435DOI: 10.1007/s12529-009-9055-3ISI: 000277284300001OAI: oai:DiVA.org:uu-116435DiVA: diva2:296666
Available from: 2010-02-18 Created: 2010-02-18 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Behaviours, Beliefs and Back Pain: Prognostic Factors for Disability in the General Population and Implementation of Screening in Primary Care Physiotherapy
Open this publication in new window or tab >>Behaviours, Beliefs and Back Pain: Prognostic Factors for Disability in the General Population and Implementation of Screening in Primary Care Physiotherapy
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to study prognostic factors for prolonged disability in back pain in the general population and physiotherapists’ screening for prolonged disability, applying a social cognitive learning perspective.

Methods and results: Studies I and II were based on a survey in the general population in Sweden. Study I included 1024 individuals aged 20-50 years, reporting non-specific back pain. Four groups (n = 100, 215, 172 and 537) based on duration and recurrence of back pain were formed and compared. After controlling for pain intensity, catastrophising and expectations of future pain were positively correlated to pain duration. Perceived social support was negatively correlated to pain duration. Study II was longitudinal over 12 months and analysed one group reporting first-episode back pain (n = 77), and one group reporting long-term back pain (n = 302). Future pain intensity and disability were predicted by initial levels of pain and disability and pain-related cognitions in both groups. Study III examined the inter-rater reliability of a research protocol for assessment of physiotherapists’ telephone screening for prolonged disability. The results demonstrated sufficient inter-rater reliability. Study IV evaluated the effect of a tailored skills training intervention on physiotherapists’ screening for prolonged disability in back pain. Four physiotherapists in primary care participated in four quasi-experimental single-subject studies. Effects were seen in all participants, with increased screening of prognostic factors and less time spent on detailed discussions about back pain.

Conclusions: The identification of mainly cognitive explanatory variables indicates the relevance of a social cognitive perspective of back pain-related disability (studies I and II). Physiotherapists’ telephone screening for prolonged disability in back can be reliably assessed (study III). It is suggested that interventions based on social cognitive theory are effective in producing change in specified clinical behaviours in physiotherapists (study IV).

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 87 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 55
Keyword
Physical therapy, behavioural medicine, back pain, general population, caregiver, prognostic factors, implementation, screening
National Category
Social Sciences
Research subject
Caring Sciences in Social Sciences
Identifiers
urn:nbn:se:uu:diva-121424 (URN)978-91-554-7758-5 (ISBN)
Public defence
2010-05-07, Universitetshuset, sal IX, Övre Slottsgatan 2, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2010-04-16 Created: 2010-03-23 Last updated: 2012-05-21Bibliographically approved

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Demmelmaier, IngridÅsenlöf, PernillaLindberg, PerDenison, Eva

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