Are Changes in Fear-Avoidance Beliefs and Self-efficacy Mediators of Function and Pain at Discharge in Patients With Acute and Chronic Low Back Pain?

OBJECTIVE: To examine the mediating role of changes in fear-avoidance beliefs and self-efficacy on pain and physical functioning at discharge in patients with acute and chronic low back pain (LBP). DESIGN: Retrospective study. METHODS: Baseline and discharge data from 418 participants with acute and chronic LBP were analyzed. At discharge, functional status and pain intensity were analyzed to assess their role as a predictor of acute and chronic LBP status and as a mediator of fear-avoidance beliefs and self-efficacy from baseline to discharge. RESULTS: In multivariable analyses, patients with chronic LBP had lower discharge functional status (β = -7.4; 95% confidence interval [CI]: -10.5, -4.3), lower self-efficacy for physical function (β = -5.3; 95% CI: -10.2, -0.4), higher pain intensity (β = 0.9; 95% CI: 0.3, 1.5), and no difference in discharge fear-avoidance beliefs compared to patients with acute LBP. Change in self-efficacy for physical function had a small indirect association (β = -1.1; 95% bias-corrected CI: -2.5, -0.004), mediating the relationship between chronic LBP and discharge functional status. CONCLUSION: Fear-avoidance beliefs were not a mediator of pain or function at discharge in patients with chronic LBP. Self-efficacy may be an important mediating factor for function at discharge in patients with chronic LBP who receive physical therapy. J Orthop Sports Phys Ther 2020;50(6):301-308. Epub 6 Jan 2020. doi:10.2519/jospt.2020.8982.

Duke Scholars

Author Rogelio Adrian Coronado Orthopaedic Surgery