Objectives: To identify psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture.
Methods: A longitudinal postal questionnaire study was conducted with data collection at baseline (pre-treatment), 2 weeks, 3 and 6 months later. 485 patients were recruited from 83 acupuncturists before commencing acupuncture for back pain. Questionnaires measured variables from four theories (fear avoidance model, common-sense model, expectancy theory, social-cognitive theory), clinical and socio-demographic characteristics, and disability. Longitudinal multilevel models were constructed with disability over time as the outcome.
Results: Within individuals, reductions in disability (compared to the person's individual mean) were associated with reductions in: fear avoidance beliefs about physical activity ([beta]=0.11, P<0.01) and work ([beta]=0.03, P<0.05), catastrophising ([beta]=0.28, P<0.05), consequences ([beta]=0.28, P<0.01), concerns ([beta]=0.17, P<0.05), emotions ([beta]=0.16, P<0.05), and pain identity ([beta]=0.43, P<0.01). Within-person reductions in disability were associated with increases in: personal control ([beta]=-0.17, P<0.01), comprehension ([beta]=-0.11, P<0.05) and self-efficacy for coping ([beta]=-0.04, P<0.01). Between individuals, people who were less disabled had weaker fear avoidance beliefs about physical activity ([beta]=0.12, P<0.01), had more self-efficacy for coping ([beta]=-0.07, P<0.01), perceived less severe consequences of back pain ([beta]=0.87, P<0.01), had more positive outcome expectancies ([beta]=-0.30, P<0.05) and appraised acupuncture appointments as less convenient ([beta]=0.92, P<0.05).
Discussion: Illness perceptions and, to a lesser extent, self-efficacy and expectancies can usefully supplement variables from the fear avoidance model in theorising pain-related disability. Positive changes in patients' beliefs about back pain might underpin the large non-specific effects of acupuncture seen in trials and could be targeted clinically.
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