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Clinical Journal of Pain:
doi: 10.1097/AJP.0000000000000108
Original Article: PDF Only

Psychological Covariates of Longitudinal Changes in Back-related Disability in Patients Undergoing Acupuncture.

Bishop, Felicity L. PhD; Yardley, Lucy PhD; Prescott, Philip PhD; Cooper, Cyrus MA, DM, FRCP, FMedSci; Little, Paul MD, PhD, FRCGP; Lewith, George T. MA, MD, FRCP, MRCGP

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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.

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

(C) 2014 Wolters Kluwer Health, Inc. All rights reserved.

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