Illness perceptions; exploring mediators and/or moderators in disabling persistent low back pain. Multiple baseline single-case experimental design

E J Edwin De Raaij,H Harriet Wittink,J F Francois Maissan,J Jos Twisk,R W J G Raymond Ostelo

doi:10.1186/s12891-022-05031-3

Abstract

IntroductionIllness Perceptions (IPs) may play a role in the management of persistent low back pain. The mediation and/or moderation effect of IPs on primary outcomes in physiotherapy treatment is unknown.MethodsA multiple single-case experimental design, using a matched care physiotherapy intervention, with three phases (phases A-B-A’) was used including a 3 month follow up (phase A’). Primary outcomes: pain intensity, physical functioning and pain interference in daily life. Analyzes: linear mixed models, adjusted for fear of movement, catastrophizing, avoidance, sombreness and sleep.ResultsNine patients were included by six different primary care physiotherapists. Repeated measures on 196 data points showed that IPs Consequences, Personal control, Identity, Concern and Emotional response had a mediation effect on all three primary outcomes. The IP Personal control acted as a moderator for all primary outcomes, with clinically relevant improvements at 3 month follow up.ConclusionOur study might indicate that some IPs have a mediating or a moderating effect on the outcome of a matched care physiotherapy treatment. Assessing Personal control at baseline, as a relevant moderator for the outcome prognosis of successful physiotherapy management of persistent low back pain, should be further eplored.

Highlights

Illness Perceptions (IPs) may play a role in the management of persistent low back pain
Six physiotherapists participated in the study, all working in different primary care physiotherapy practices across the Netherlands
We found five IP dimensions mediating the effect on all three primary outcomes; namely, Consequences (45.2–56.3) Personal control (8.1–15.7), Identity (46.7–52.9), Concern (15.6–34.3) and Emotional response (24.3–38.9)

Summary

Introduction

Illness Perceptions (IPs) may play a role in the management of persistent low back pain. Most of the extensive body of knowledge on the management of LBP derives from systematic reviews and randomized controlled trials (RCTs). The use of evidence from systematic reviews and RCTs is a form of “reference class forecasting” and can be challenging for clinicians when making clinical relevant decisions for individual patients [12]. The call for a more personalized approach for LBP was made [13] Such an approach could be a matched-care intervention, in which patients’ individual prognostic factors for recovery are assessed, and a response guided treatment package can be designed. In this study we investigate the impact of taking into account another psychological factor in the risk-profile, namely Illness Perceptions’ (IPs), which is the core element of Leventhal’s Common Sense Model of health and Illness Representations (CSM) [20, 21]

Results

Discussion

Conclusion