Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P57. NASS Think Tank workshop reveals psychological factors are central to understanding chronic low back pain

Abstract

BACKGROUND CONTEXT Low back pain (LBP) is a bio-psycho-social condition and LBP patients are treated by various health professionals with different training and presumed beliefs. Considering that theoretical foundations and emphases vary among health disciplines, it is possible that these professionals (eg, researchers and clinicians from different disciplines) possess different “mental models” of what and how various factors relate to LBP. A novel way to investigate individual thinking about particular processes is through the development and analysis of fuzzy-logic cognitive maps (FCM). FCMs are particularly useful for modeling interactions between variables in complex systems, such as LBP. This study aimed to use this approach to describe similarities and differences by which different health professionals think about LBP. METHODS Participants from different disciplines (n=28), who have contributed significantly to the understanding of LBP (eg, publications, contributions to societies, etc.), were selectively recruited for this study and represented the following disciplines: (1) basic science (n=6), (2) chiropractic (n=4), (3) spine surgery (n=2), (4) physical medicine & rehabilitation (n=2), (5) physical or exercise therapy (n=12), and (6) psychology (n=2). Each participant underwent a structured one-on-one interview to construct an FCM that represented the individual's understanding (mental model) of how factors related to LBP using Mental Modeler software ( www.mentalmodeler.org ). This process involved nomination of factors contributing to patients’ outcomes (ie, pain, disability, and quality of life) and the weighting of the connections (strength of the effect) between these factors. Factors from each model were tabulated and categorized into eight domains: (1) nociceptive detection and processing, (2) behavioral or lifestyle (3) tissue injury or pathology, (4) contextual, (5) psychological(6) social or work, (7) biomechanical, and (8) individual factors. To determine the importance of each factor expressed in the FCM, centrality was computed as: Centrality = |a|*(# of connections in)+|b|*(# of connections out), where a and b are the weighting or strength of the connections. Based on this definition, centrality of a factor increases by the number of connections to and from the specific factor in the FCM, as well as by the weighting of these connections. Centrality of each domain (sum of centrality for each factor within the designated domain) was expressed as a percentage of the eight domains and grouped by discipline. RESULTS A total of 263 factors were generated from the 28 FCM. Psychological factors was the most prominent domain accounting for 33% of the centrality across all six participant groups, and was the most “central” domain for four groups (chiropractic, physical medicine and rehabilitation, physical or exercise therapy, and psychology). Tissue injury or pathology accounted for 14.7% of the centrality across all groups and was the most “central” for the remaining two groups (basic science and spinal surgery). CONCLUSIONS Psychological factors were considered to be the most central or important to understanding LBP across disciplines, yet many of these professions do not specialize in the psychology of LBP. Although the selection of individuals and the relatively small sample size representing each discipline may bias the results, such findings support the notion that multidisciplinary interventions (which includes consideration of psychological factors) to treating patients with LBP is sensible.