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§

doi: 10.1097/AJP.0000000000000108
Original Articles

Objectives: To identify psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture.

Materials and Methods: A longitudinal postal questionnaire study was conducted with data collection at baseline (pretreatment), 2 weeks, 3, and 6 months later. A total of 485 patients were recruited from 83 acupuncturists before commencing acupuncture for back pain. Questionnaires measured variables from 4 theories (fear-avoidance model, common-sense model, expectancy theory, social-cognitive theory), clinical and sociodemographic characteristics, and disability. Longitudinal multilevel models were constructed with disability over time as the outcome.

Results: Within individuals, reductions in disability (compared with the person’s individual mean) were associated with reductions in: fear-avoidance beliefs about physical activity (β=0.11, P<0.01) and work (β=0.03, P<0.05), catastrophizing (β=0.28, P<0.05), consequences (β=0.28, P<0.01), concerns (β=0.17, P<0.05), emotions (β=0.16, P<0.05), and pain identity (β=0.43, P<0.01). Within-person reductions in disability were associated with increases in: personal control (β=−0.17, P<0.01), comprehension (β=−0.11, P<0.05) and self-efficacy for coping (β=−0.04, P<0.01). Between individuals, people who were less disabled had weaker fear-avoidance beliefs about physical activity (β=0.12, P<0.01), had more self-efficacy for coping (β=−0.07, P<0.01), perceived less severe consequences of back pain (β=0.87, P<0.01), had more positive outcome expectancies (β=−0.30, P<0.05), and appraised acupuncture appointments as less convenient (β=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 theorizing pain-related disability. Positive changes in patients’ beliefs about back pain might underpin the large nonspecific effects of acupuncture seen in trials and could be targeted clinically.

*Department of Psychology

School of Mathematics

MRC Lifecourse Epidemiology Unit

§School of Medicine, University of Southampton, Southampton, UK

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Supported by Arthritis Research UK (Career Development Fellowship 18099), Chesterfield, UK. G.T.L.’s post is supported by a grant from the Rufford Maurice Laing Foundation. The remaining authors declare no conflict of interest.

Reprints: Felicity L. Bishop, PhD, Centre for Applications of Health Psychology, Faculty of Social and Human Sciences, Building 44 Highfield Campus, University of Southampton, Southampton SO17 1BJ, UK (e-mail:

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Received October 28, 2013

Received in revised form April 25, 2014

Accepted March 30, 2014

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