Illness perceptions as an independent predictor of chronic low back pain and pain-related disability: a prospective cohort study

Abstract

Objectives

To investigate whether illness perceptions, measured with the Brief Illness Perception Questionnaire, are an independent predictor of chronic low back pain and pain-related disability at 12 weeks.

Design

A prospective, observational cohort study.

Setting

26 outpatient primary care physiotherapy practices throughout the Netherlands.

Participants

Acute nonspecific low back pain patients between the age of 18 and 60 years, with or without radiating pain, and a pain-free episode of at least three months before onset.

Interventions

Standard physiotherapy care according to Dutch clinical practice guidelines.

Outcome measure

Chronic low back pain defined as pain ≥3/10 on the Numeric Pain Rating Scale and as pain-related disability ≥19/70 on the Pain Disability Index measured after 12 weeks.

Results

Two hundred and four people with acute nonspecific low back pain completed both assessments. In the multivariable analyses, adjusted for pain intensity, disability, duration, radiating pain, depressed mood, associations of illness perceptions were OR 1.04 (95% CI: 1.01 to 1.08) for pain and 1.04 (95% CI: 0.99 to 1.09) for pain-related disability.

Conclusions

Illness perceptions independently predicted chronic low back pain but not pain-related disability at 12 weeks. The added predictive value of illness perceptions was relatively low.

Abbreviations:

CBT (Cognitive Behavioral Treatment), 4DSQ (Four-Dimensional Symptom Questionnaire), ALBP (acute low back pain), IPQ-B (Brief Illness Perception Questionnaire), CLBP (chronic low back pain), LBP (low back pain), NPRS (Numeric Pain Rating Scale), OR (odds ratio), PDI (Pain Disability Index)