PREDICTORS OF SELF-MANAGEMENT IN PATIENTS WITH CHRONIC LOW BACK PAIN: A LONGITUDINAL STUDY

A. Banerjee^1,2,3, P. Hendrick², H. Blake^2,4

Background: Self-management (SM) defines how individuals manage their disease, symptoms, treatment and roles and is a key strategy for managing chronic low back pain (CLBP). Further, SM programmes have only small to moderate benefits for reducing pain and disability in patients with CLBP. The benefits of SM programmes can potentially be optimised by identifying specific subgroups of patients who are best responders. However, no longitudinal study has examined predictors of self-management and its change in patients with CLBP.

Purpose: The objectives of this study were to determine whether biopsychosocial factors predict SM constructs at baseline and whether a change in the biopsychosocial factors over time (six-month) predicts change in SM constructs.

Methods: A multi-site longitudinal cohort study was conducted collecting self-reported validated measures for SM, pain intensity, disability, physical activity level, kinesiophobia, catastrophising, and depression at baseline and at six-months, including working-age individuals (18-65 years) who attended physiotherapy for their CLBP. The Health Education Impact Questionnaire (heiQ) was used to measure eight different SM constructs Health-Directed Activities (HDA), Positive and Active Engagement in Life (PAEL), Emotional Distress (ED), Self-Monitoring and Insight (SMI), Constructive Attitudes and Approaches (CAA), Skill and Technique Acquisition (STA), Social Integration and Support (SIS) and Health Service Navigation (HSN). A multivariate regression analysis using the General Linear Model (GLM) was performed for each of the SM constructs to identify baseline predictors and predictors of change in SM constructs. The study protocol was approved by a UK National Health Service Ethics Committee (14/ES/0167). 

Results: 270 patients with CLBP [mean age 43.74 (standard deviation 11.89) and 61% female] were recruited into the study and 153 participants completed the six-month follow-up survey. Physical activity levels and healthcare use (positively); and levels of disability, depression, kinesiophobia, catastrophising (negatively) predicted (p<0.05, adjusted R² ranged from .07 to .55) SM constructs at baseline in patients with CLBP. Baseline depression, kinesiophobia, catastrophising and physical disability negatively predicted five (PAEL, ED, SMI, CAA and STA), two (CAA and HSN), one (ED) and three (PAEL, CAA and SIS) SM constructs respectively. Changes in SM constructs (from baseline to six months) were predicted (p<0.05, adjusted R² ranged from .13 to .32) by changes in levels of depression, kinesiophobia, catastrophising, physical activity, use of analgesics; and presence of leg pain; and being employed and married. Change in catastrophising, depression and kinesiophobia respectively predicted change in five (HDA, PAEL, CAA, SIS and HSN), two (PAEL and CAA) and one SM constructs (CAA).

Conclusion(s): The results indicate levels of disability, physical activity, depression, catastrophising and kinesiophobia predicted multiple constructs of SM measured using the heiQ in working-age adults with CLBP. This study is the first longitudinal study exploring a range of biopsychosocial predictors of SM in patients with CLBP. Further studies are needed to validate these results in other cohorts and clinical contexts including patients of a wider age range and with acute and sub-acute of low back pain.

Implications: These biopsychosocial predictors of SM and its change may potentially help to screen and triage patients with CLBP into targeted SM programmes.

Funding, acknowledgements: The University of Nottingham, UK funded this doctoral research study.

Keywords: chronic low back pain, self-management, regression analysis

Topic: Musculoskeletal: spine

Did this work require ethics approval? Yes

Institution: National Health Service/ Health Research Authority Ethics Committee (UK)

Committee: East of Scotland Research Ethics Service

Ethics number: 15/ES/1067