Allan Abbott1,2, Michael Allard1, Marie Kierkegaard3,4,5, Anneli Peolsson2, Åsa Dedering6,7. 1. Faculty of Health Science and Medicine, Bond University, Gold Coast, Australia. 2. Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping, Sweden. 3. Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, SE-171 76, Stockholm, Sweden. 4. Academic Specialist Center, Stockholm Health Services, SE-113 65, Stockholm, Sweden. 5. Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, SE-141 83, Huddinge, Sweden. 6. Allied Health Professionals Function, Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, 171 76, Stockholm, Sweden. 7. Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.
Abstract
BACKGROUND: No previous studies have investigated what biopsychosocial factors are associated with self-reported work ability in conservatively managed patients with cervical radiculopathy. OBJECTIVE: To develop a theoretical model of factors and potential processes associated with variation in work ability based on a thorough assessment of biopsychosocial variables in conservatively managed patients with cervical radiculopathy. DESIGN: Cross-sectional observational study. SETTING: Tertiary neurosurgery clinic. PATIENTS: A total of 144 conservatively managed patients with cervical pain and radiculopathy participated in the study. METHODS: From 64 biopsychosocial candidate variables, significant (P < .05) bivariate correlators with Work Ability Index (WAI) were entered as independent variables in a categorical regression. Elastic net regularization maintained the most parsimonious set of independent variables significantly associated with variation in WAI as the dependent variable. Process analysis of significant independent variable associations with WAI was performed. MAIN OUTCOME MEASUREMENT: WAI. RESULTS: From 42 bivariate correlates of WAI, multivariate regression displayed a total of seven variables that were significantly (F [25,98] = 5.74, P < .05) associated with 65.8% of the variation in WAI. The Neck Disability Index (NDI) and Fear-Avoidance Beliefs Questionnaire Work subscale (FABQ-W) were significant individual factors within the final regression model. Process analysis displayed FABQ-W having a significant specific indirect association with the direct association between NDI and WAI, with the model associated with 77% of the variability in WAI (F [2,84] = 141.17, P < .001). CONCLUSION: Of 64 candidate biopsychosocial factors, NDI and FABQ-W were the most significant multivariate correlates with work ability. FABQ-W has a significant indirect association with baseline NDI scores and perceived work ability. This warrants future research trialing work-related fear avoidance interventions in conservatively managed patients with cervical radiculopathy. LEVEL OF EVIDENCE: III.
BACKGROUND: No previous studies have investigated what biopsychosocial factors are associated with self-reported work ability in conservatively managed patients with cervical radiculopathy. OBJECTIVE: To develop a theoretical model of factors and potential processes associated with variation in work ability based on a thorough assessment of biopsychosocial variables in conservatively managed patients with cervical radiculopathy. DESIGN: Cross-sectional observational study. SETTING: Tertiary neurosurgery clinic. PATIENTS: A total of 144 conservatively managed patients with cervical pain and radiculopathy participated in the study. METHODS: From 64 biopsychosocial candidate variables, significant (P < .05) bivariate correlators with Work Ability Index (WAI) were entered as independent variables in a categorical regression. Elastic net regularization maintained the most parsimonious set of independent variables significantly associated with variation in WAI as the dependent variable. Process analysis of significant independent variable associations with WAI was performed. MAIN OUTCOME MEASUREMENT: WAI. RESULTS: From 42 bivariate correlates of WAI, multivariate regression displayed a total of seven variables that were significantly (F [25,98] = 5.74, P < .05) associated with 65.8% of the variation in WAI. The Neck Disability Index (NDI) and Fear-Avoidance Beliefs Questionnaire Work subscale (FABQ-W) were significant individual factors within the final regression model. Process analysis displayed FABQ-W having a significant specific indirect association with the direct association between NDI and WAI, with the model associated with 77% of the variability in WAI (F [2,84] = 141.17, P < .001). CONCLUSION: Of 64 candidate biopsychosocial factors, NDI and FABQ-W were the most significant multivariate correlates with work ability. FABQ-W has a significant indirect association with baseline NDI scores and perceived work ability. This warrants future research trialing work-related fear avoidance interventions in conservatively managed patients with cervical radiculopathy. LEVEL OF EVIDENCE: III.