J. van der Heiden1,2, T. Koppenaal1,3,4, C.J.J. Kloek1,2, M.F. Pisters1,3,4
1Julius Health Care Centers, Center for Physical Therapy Research and Innovation in Primary Care, Utrecht, Netherlands, 2HU University of Applies Sciences, Research Group Innovation of Human Movement Care, Utrecht, Netherlands, 3Fontys University of Applies Sciences, Department of Health Innovations and Technology, Eindhoven, Netherlands, 4Utrecht University, Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center UMC Utrecht, Utrecht, Netherlands
Background: Low back pain (LBP) is the leading cause of disability, activity limitation, and work absence worldwide. Approximately 90% of all LBP patients have non-specific LBP. Even though most people with non-specific LBP recover within 4-6 weeks, many people will experience recurring complaints. Practice guidelines and experts emphasize the importance of self-management, as it has both the potential of improving patient health outcomes and lowering healthcare costs. Self-management is a person’s ability to manage their symptoms, treatment, physical and psychological consequences, and lifestyle changes inherent to their health status. It is important that physiotherapists and other clinicians know which biopsychosocial characteristics are associated with self-management in people with non-specific LBP. This will help them identify people who need additional self-management support to aid these people in self-managing their non-specific LBP and help them reduce the risk of recurring complaints.
Purpose: The objective of this study is to determine which variables are associated with better self-management abilities in people with non-specific LBP.
Methods: A cross-sectional study was performed among people with non-specific LBP in primary care physiotherapy in the Netherlands. Participants were eligible for inclusion if they: 1) had non-specific LBP; 2) were 18 years or older; 3) mastered the Dutch language; 4) provided written informed consent. Exclusion criteria included; 1) a specific cause of LBP; 2) serious comorbidities; 3) current pregnancy. Self-management was measured with the Patient Activation Measure. Self-efficacy, pain catastrophizing, fear-avoidance beliefs, pain intensity, physical function, physical activity, age, gender, and educational level were considered as explanatory variables for self-management in people with non-specific LBP. All parameters, except for physical activity, were self-administered by patients via an online questionnaire during an appointment with one of the researchers. Physical activity was measured with the Activ8 (2M Engineering, Valkenswaard, The Netherlands). Multiple linear regression with backward stepwise selection (P>0,05) was used to determine variables associated with better self-management abilities.
Results: The mean age of the participants (n=208) was 47,7 years (SD=14,3) and a total of 102 participants (49%) were female. The median score for self-management of the participants measured with the PAM was 63,1 points (IQR=19,3). The regression analysis revealed that higher self-efficacy scores (β=0,5), lower pain catastrophizing scores (β=-0,2), the female gender (β=3,7), and a high educational level in comparison to a middle educational level (β=-4,8) were significantly associated with better self-management abilities in people with non-specific LBP. These variables explained 15,62% of the variance of self-management of the participants with non-specific LBP.
Conclusion(s): Higher self-efficacy, less pain catastrophizing, the female gender, and a high educational level are associated with better self-management abilities in people with non-specific LBP. Pain intensity, physical function, and physical activity are not associated with self-management in people with non-specific LBP.
Implications: Physiotherapists can use psychosocial risk factors, such as low self-efficacy and more pain catastrophizing, to help them identify people with non-specific LBP in whom additional attention to support self-management might be useful. Future research should focus on investigating the causal relationship between these psychosocial risk factors and self-management to improve self-management support interventions for people with non-specific LBP.
Funding, acknowledgements: This study is co-funded by the Taskforce for Applied Research SIA (RAAK.-PRO02.063), part of the Dutch Research Council (NWO).
Keywords: Non-specific low back pain, Self-management, Biopsychosocial risk factors
Topic: Musculoskeletal: spine
Did this work require ethics approval? Yes
Institution: University Medical Centre Utrecht
Committee: Medical Research Ethics Committee (MERC) Utrecht
Ethics number: 18-085/D
All authors, affiliations and abstracts have been published as submitted.
