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The role of psychological factors in the onset of low back pain
Author
Chan, Mark Anthony Wen Kein
Supervisor
Kawabata, Masato
Abstract
Low back pain (LBP) is a leading cause of disability worldwide with significant costs to individuals, their families, and society at large. Despite the burden it poses on our society, there is still insufficient emphasis on primary prevention of LBP, i.e. to prevent its occurrence or recurrence. Contemporary theoretical models of health and well-being advocate for an approach where biological factors are considered along with psychological and social factors. Clinical practice however is incongruent with these theoretical positions, with psychological factors often not featured in LBP prevention interventions. In order to support greater psychologically informed practice in LBP preventive action, the evidence-based practice (EBP) model was first used to frame the research and knowledge gaps that contribute to the lack of psychologically informed practice from a clinical decision-making perspective. According to the EBP model, applied clinical practice is informed by four inter-related spheres; the body of available research evidence, the clinical state and setting, the patient’s personal preferences for assessment and management; and the clinician’s clinical expertise. Three research studies were conducted to address barriers to psychologically informed practice arising in three of these spheres.
In Study 1, the gap in the understanding of physiotherapists opinions on the importance of psychological risk factors in the development of LBP was examined. Through an online survey of physiotherapists practising in Singapore, it was found that physiotherapists do consider psychological factors as important in the development of LBP. Factors such as LBP beliefs, pain catastrophising cognitions, work-related stress and psychological distress were perceived as amongst the topmost important risk factors. The study also demonstrated a favourable perspective on psychological risk factors in LBP development with psychological factors emerging as more important than many non-psychological factors.
In Study 2, the gap related to insufficient recommendations for psychological measurement tools for LBP primary prevention was addressed. Following the emergence of LBP beliefs, pain catastrophising cognitions, work-related stress and psychological distress as important risk factors in Study 1, three psychological measurement tools were selected and evaluated to check if they were suitable for use for LBP primary prevention purposes in Singapore. To achieve this, factorial validity and the measurement invariance across people with and without LBP of the 10-item Back-Pain Attitudes Questionnaire (Back-PAQ-10), Pain Catastrophising Scale (PCS) and Screening Tool for Psychological Distress (STOP-D) were examined. Results from the study revealed that some of the measures tools required revisions in order to achieve good psychometric fit within this Singaporean cohort. Examination of the measurement invariance also showed that the measurement tools were invariant across people with and without LBP. Therefore the Back-PAQ-10, the revised bifactor, 2-factor PCS, and the composite STOP-D were suitable to assess psychological factors related to the development of LBP.
In Study 3, two research gaps were addressed related to understanding the role of psychological factors in the possible aetiology of LBP. Through a series of structural models, the relationship between key psychological factors identified in Study 1, and the presence of LBP, characterised by pain severity and disability, were examined. The results provided substantive evidence for the important role of psychological factors in the presence of LBP. The results showed that psychological factors are associated with the onset of LBP, where some result in the presence of LBP characterised by greater pain severity and some in terms of greater disability. The models also provided evidence supporting the explanatory mechanisms of the Generic Cognitive Model (GCM), for the pattern of interrelationships between psychological factors as well as the direct associations with LBP outcomes.The findings from this research project have several key implications. From a practical and clinical perspective, it provides a model of how to consider key psychological factors in LBP, along with suitable instruments for their assessment. This is of particular relevance to physiotherapists who characteristically do not have extensive education or training in psychology, therefore an operational framework is valuable for facilitating clinical application. From a theoretical perspective, it extends our currently limited knowledge regarding how psychological factors influence LBP, facilitating further research into possible explanatory mechanisms for the role of psychological factors.
In Study 1, the gap in the understanding of physiotherapists opinions on the importance of psychological risk factors in the development of LBP was examined. Through an online survey of physiotherapists practising in Singapore, it was found that physiotherapists do consider psychological factors as important in the development of LBP. Factors such as LBP beliefs, pain catastrophising cognitions, work-related stress and psychological distress were perceived as amongst the topmost important risk factors. The study also demonstrated a favourable perspective on psychological risk factors in LBP development with psychological factors emerging as more important than many non-psychological factors.
In Study 2, the gap related to insufficient recommendations for psychological measurement tools for LBP primary prevention was addressed. Following the emergence of LBP beliefs, pain catastrophising cognitions, work-related stress and psychological distress as important risk factors in Study 1, three psychological measurement tools were selected and evaluated to check if they were suitable for use for LBP primary prevention purposes in Singapore. To achieve this, factorial validity and the measurement invariance across people with and without LBP of the 10-item Back-Pain Attitudes Questionnaire (Back-PAQ-10), Pain Catastrophising Scale (PCS) and Screening Tool for Psychological Distress (STOP-D) were examined. Results from the study revealed that some of the measures tools required revisions in order to achieve good psychometric fit within this Singaporean cohort. Examination of the measurement invariance also showed that the measurement tools were invariant across people with and without LBP. Therefore the Back-PAQ-10, the revised bifactor, 2-factor PCS, and the composite STOP-D were suitable to assess psychological factors related to the development of LBP.
In Study 3, two research gaps were addressed related to understanding the role of psychological factors in the possible aetiology of LBP. Through a series of structural models, the relationship between key psychological factors identified in Study 1, and the presence of LBP, characterised by pain severity and disability, were examined. The results provided substantive evidence for the important role of psychological factors in the presence of LBP. The results showed that psychological factors are associated with the onset of LBP, where some result in the presence of LBP characterised by greater pain severity and some in terms of greater disability. The models also provided evidence supporting the explanatory mechanisms of the Generic Cognitive Model (GCM), for the pattern of interrelationships between psychological factors as well as the direct associations with LBP outcomes.The findings from this research project have several key implications. From a practical and clinical perspective, it provides a model of how to consider key psychological factors in LBP, along with suitable instruments for their assessment. This is of particular relevance to physiotherapists who characteristically do not have extensive education or training in psychology, therefore an operational framework is valuable for facilitating clinical application. From a theoretical perspective, it extends our currently limited knowledge regarding how psychological factors influence LBP, facilitating further research into possible explanatory mechanisms for the role of psychological factors.
Date Issued
2022
Call Number
RD771.B217 Cha
Dataset
https://doi.org/10.25340/R4/L1C6K0
Date Submitted
2022