Maria M Wertli1, Ulrike Held2, Angela Lis3, Marco Campello4, Sherri Weiser4. 1. Department of General Internal Medicine, Bern University Hospital, University of Bern, Freiburgstrasse 8, CH-3010 Bern, Switzerland; Horten Centre for Patient Oriented Research and Knowledge Transfer, Zurich University, Pestalozzistrasse 24, 8032 Zurich, Switzerland. Electronic address: Maria.Wertli@insel.ch. 2. Horten Centre for Patient Oriented Research and Knowledge Transfer, Zurich University, Pestalozzistrasse 24, 8032 Zurich, Switzerland. 3. NYU Hospital for Joint Diseases, Occupational and Industrial Orthopaedic Center (OIOC), New York University, 63 Downing St, New York, NY 10014, USA; Department of Physical Therapy, Seton Hall University, 400 South Orange Ave, South Orange, NJ 07079, USA. 4. NYU Hospital for Joint Diseases, Occupational and Industrial Orthopaedic Center (OIOC), New York University, 63 Downing St, New York, NY 10014, USA.
Abstract
BACKGROUND CONTEXT: Negative beliefs are known to influence treatment outcome in patients with spine pain (SP). The impact of positive beliefs is less clear. PURPOSE: We aimed to assess the influence of positive and negative beliefs on baseline and treatment responses in patients with SP. STUDY DESIGN/ SETTING: A retrospective cross-sectional and longitudinal analysis of prospectively collected data of outpatient physical therapy patients with SP was carried out. Questionnaires administered before and during treatment included the STarT Back distress scale (negative beliefs), and expectation and self-efficacy questions (positive beliefs). PATIENT SAMPLE: Patients with SP with a baseline assessment and follow-up assessment comprised the study sample. OUTCOME MEASURE: Perceived disability was measured using the Oswestry Disability Index (ODI) or the Neck Disability Index (NDI). A clinical meaningful change (minimum clinically important difference [MCID]) was defined as decrease in ODI or NDI of ≥30%. METHODS: We used the Akaike Information Criterion from the first imputed dataset of the prediction model to select predictor variables. Prediction models were fitted to the outcome variables. RESULTS: In the cross-sectional analysis, 1,695 low back pain (LBP) episodes and 487 neck pain (NP) episodes were analyzed. STarT Back Screening Tool (SBST)-distress was positively associated with perceived disability in both LBP (beta 2.31, 95% confidence interval [CI] 1.75-2.88) and NP (beta 2.57, 95% CI 1.47-3.67). Lower self-efficacy was negatively associated with more perceived disability for LBP (beta 0.50, 95% CI 0.29-0.72) but not for NP, whereas less positive expectations was associated with more perceived disability in NP (beta 0.57, 95% CI 0.02-1.12) but not in LBP. In the longitudinal analysis, 607 LBP episodes (36%) and 176 (36%) NP episodes were included. SBST-distress did not predict treatment outcome in spine patients. In LBP, patients with a lower positive expectation were less likely to experience an MCID in perceived disability (odds ratio [OR] per point increase 0.89, 95% CI 0.83-0.96), and there was a similar trend in NP (OR per point increase 0.90, 95% CI 0.79-1.03). In patients with LBP, lower self-efficacy at baseline was associated with a higher likelihood that an MCID was achieved (OR per point increase 1.09, 95% CI 1.01-1.19). In NP, self-efficacy was not included in the final model. CONCLUSIONS: Our study demonstrates that both negative and positive beliefs are associated with perceptions of disability. However, in this study, only positive beliefs were associated with treatment outcome.
BACKGROUND CONTEXT: Negative beliefs are known to influence treatment outcome in patients with spine pain (SP). The impact of positive beliefs is less clear. PURPOSE: We aimed to assess the influence of positive and negative beliefs on baseline and treatment responses in patients with SP. STUDY DESIGN/ SETTING: A retrospective cross-sectional and longitudinal analysis of prospectively collected data of outpatient physical therapy patients with SP was carried out. Questionnaires administered before and during treatment included the STarT Back distress scale (negative beliefs), and expectation and self-efficacy questions (positive beliefs). PATIENT SAMPLE: Patients with SP with a baseline assessment and follow-up assessment comprised the study sample. OUTCOME MEASURE: Perceived disability was measured using the Oswestry Disability Index (ODI) or the Neck Disability Index (NDI). A clinical meaningful change (minimum clinically important difference [MCID]) was defined as decrease in ODI or NDI of ≥30%. METHODS: We used the Akaike Information Criterion from the first imputed dataset of the prediction model to select predictor variables. Prediction models were fitted to the outcome variables. RESULTS: In the cross-sectional analysis, 1,695 low back pain (LBP) episodes and 487 neck pain (NP) episodes were analyzed. STarT Back Screening Tool (SBST)-distress was positively associated with perceived disability in both LBP (beta 2.31, 95% confidence interval [CI] 1.75-2.88) and NP (beta 2.57, 95% CI 1.47-3.67). Lower self-efficacy was negatively associated with more perceived disability for LBP (beta 0.50, 95% CI 0.29-0.72) but not for NP, whereas less positive expectations was associated with more perceived disability in NP (beta 0.57, 95% CI 0.02-1.12) but not in LBP. In the longitudinal analysis, 607 LBP episodes (36%) and 176 (36%) NP episodes were included. SBST-distress did not predict treatment outcome in spine patients. In LBP, patients with a lower positive expectation were less likely to experience an MCID in perceived disability (odds ratio [OR] per point increase 0.89, 95% CI 0.83-0.96), and there was a similar trend in NP (OR per point increase 0.90, 95% CI 0.79-1.03). In patients with LBP, lower self-efficacy at baseline was associated with a higher likelihood that an MCID was achieved (OR per point increase 1.09, 95% CI 1.01-1.19). In NP, self-efficacy was not included in the final model. CONCLUSIONS: Our study demonstrates that both negative and positive beliefs are associated with perceptions of disability. However, in this study, only positive beliefs were associated with treatment outcome.
Authors: Leticia Amaral Corrêa; Stephanie Mathieson; Ney Armando de Mello Meziat-Filho; Felipe José Reis; Arthur de Sá Ferreira; Leandro Alberto Calazans Nogueira Journal: Braz J Phys Ther Date: 2022-04-12 Impact factor: 4.762
Authors: Rogelio A Coronado; Carrie E Brintz; Lindsey C McKernan; Hiral Master; Nicole Motzny; Flavio M Silva; Parul M Goyal; Stephen T Wegener; Kristin R Archer Journal: Pain Rep Date: 2020-09-23