Cited by 702Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyMedical Practices and Rehabilitation

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Psychosocial Predictors of Outcome in Acute and Subchronic Low Back Trouble

Burton, A. Kim, Tillotson, K. Malcolm, Main, Chris J., Hollis, Sally·1995·Spine

DOI 10.1097/00007632-199503150-00014

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Abstract

STUDY DESIGN: A prospective survey of patients seeking primary care for low back pain. Clinical and psychosocial data, available at presentation, were explored for predictors of outcome at 1 year. OBJECTIVES: To determine the relative value of clinical and psychosocial variables for early identification of patients with a poor prognosis. SUMMARY OF BACKGROUND DATA: Current treatment strategies for low back pain have failed to stem the rising levels of disability. Psychosocial factors have been shown to be important determinants of response to therapy in chronic patients, but the contribution from similar data in acute or subchronic patients has not been comprehensively investigated. METHODS: Two hundred fifty-two patients with low back pain, presenting to primary care, underwent a structured clinical interview and completed a battery of psychosocial instruments. Follow-up was done by mail at 1 year; outcome was measured using a back pain disability questionnaire. Predictive relationships were sought between the data at presentation and disability at follow-up. RESULTS: Most patients showed improved disability and pain scores, although more than half had persisting symptoms. Eighteen percent showed significant psychological distress at presentation. Multiple regression analysis showed the level of persisting disability to depend principally on measures in the psychosocial domain; for acute cases outcome is also dependent on the absence or presence of a previous history of low back trouble. Discriminant models successfully allocated typically 76% of cases to recovered/not-recovered groups, largely on the basis of psychosocial factors evident at presentation. CONCLUSIONS: Early identification of psychosocial problems is important in understanding, and hopefully preventing, the progression to chronicity in low back trouble.

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Self-citation
Influence of kinesiophobia and catastrophizing on pain and disability in anterior knee pain patients
Doménech, J., Sanchis‐Alfonso, V., López, L., & Espejo, B. (2012) · Knee Surgery Sports Traumatology Arthroscopy · doi:10.1007/s00167-012-2238-5 · Cited by 188
“It has been suggested that an excessively negative orientation towards pain (catastrophization) and fear of movement and reinjury (kinesiophobia) are related to pain chronification and disability in patients with lumbar pain [3, 36].”
Background
The mediation of disability by self efficacy in different samples of chronic pain patients
Arnstein, P. (2000) · Disability and Rehabilitation · doi:10.1080/09638280050200296 · Cited by 191
Disease and psychological status in ankylosing spondylitis
Martindale, J. H., Smith, J. R., Sutton, C., Grennan, D. M., Goodacre, L., & GOODACRE, J. A. (2006) · Lara D. Veeken · doi:10.1093/rheumatology/kel115 · Cited by 174
Electronic diary assessment of pain, disability and psychological adaptation in patients differing in duration of pain
Peters, M. L., Sorbi, M. J., Kruise, D. A., Kerssens, J. J., Verhaak, P. F. M., & Bensing, J. M. (2000) · Pain · doi:10.1016/s0304-3959(99)00206-7 · Cited by 177
“Pain report usually increases with the progression from the acute to the chronic pain state (Sedlak, 1985; Burton et al., 1995; van der Kloot et al., 1996) and patients with persisting pain were shown to have suffered from more severe pain in the acute phase than patients whose pain resolved…”
Influential
The centralization phenomenon of spinal symptoms—a systematic review
Aina, A., May, S., & Clare, H. A. (2004) · Manual Therapy · doi:10.1016/j.math.2004.03.004 · Cited by 172
“…of psychosocial variables as prognostic factors (Chavannes et al., 1986; Lanier and Stockton, 1988; Goertz, 1990; Hasenbring et al., 1994; Burton et al., 1995; Gatchel et al., 1995; ARTICLE IN PRESS A. Aina et al. / Manual Therapy 9 (2004) 134–143140 Hazard et al., 1996; Smedley et al.,…”
Background
The relation between catastrophizing and the communication of pain experience
Sullivan, M. J. L., Martel, M. O., Tripp, D. A., Savard, A., & Crombez, G. (2006) · Pain · doi:10.1016/j.pain.2006.02.001 · Cited by 183
“E-mail address: michael.jl.sullivan@umontreal.ca (M.J.L. Sullivan). et al., 1997), reduced involvement in daily activities (Keefe et al., 1989), and occupational disability (Burton et al., 1995; Sullivan et al., 1998; Sullivan and Stanish, 2003).”
Background
Are first-time episodes of serious LBP associated with new MRI findings?
Carragee, E. J., Alamin, T. F., Cheng, I., Franklin, T., van den Haak, E., & Hurwitz, E. L. (2006) · The Spine Journal · doi:10.1016/j.spinee.2006.03.005 · Cited by 169
One-Year Follow-up Comparison of the Cost and Effectiveness of Chiropractic and Physiotherapy as Primary Management for Back Pain
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A Prospective Follow-Up Study of Low Back Pain in the Community
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“5,4) 181, 100 1997 110, 61 (54,68) 58, 32 (25,39) 12, 7 (3,10) 180, 100 Intermittent LBP 1994 316, 79 (75,79) 71, 18 (14,22) 12, 3 (1,5) 399, 100 1997 279, 70 (65,74) 105, 26 (22,31) 17, 4 (2,6) 400, 100 Total 1994 1115, 77 (75,79) 217, 15 (13,17) 123, 9 (7,9) 1455, 100 1997 932, 64 (62,67) 396, 27 (25,30) 125, 9 (7,1…”
The relationship between catastrophizing and altered pain sensitivity in patients with chronic low-back pain
Meints, S. M., Mawla, I., Napadow, V., Kong, J., Gerber, J. A., Chan, S., Wasan, A. D., Kaptchuk, T. J., McDonnell, C., Carrière, J. S., et al. (2018) · Pain · doi:10.1097/j.pain.0000000000001461 · Cited by 179
A prospective sequential analysis of the fear-avoidance model of pain
Wideman, T. H., Adams, H., & Sullivan, M. J. L. (2009) · Pain · doi:10.1016/j.pain.2009.04.022 · Cited by 171
Impaired Functioning and Quality of Life in Severe Migraine: The Role of Catastrophizing and Associated Symptoms
Holroyd, K. A., Drew, J., Cottrell, C., Romanek, K., & Heh, V. (2007) · Cephalalgia · doi:10.1111/j.1468-2982.2007.01420.x · Cited by 163
A Systematic Review of the Predictive Ability of the Orebro Musculoskeletal Pain Questionnaire
Hockings, R. L., McAuley, J. H., & Maher, C. G. (2008) · Spine · doi:10.1097/brs.0b013e31817ba3bb · Cited by 161
Clinical Course and Impact of Fear-Avoidance Beliefs in Low Back Pain
Grotle, M., Vøllestad, N. K., & Brox, J. I. (2006) · Spine · doi:10.1097/01.brs.0000214878.01709.0e · Cited by 161
Long-term Outcomes of Lumbar Fusion Among Workers’ Compensation Subjects
Nguyen, T. H., Randolph, D. C., Talmage, J. B., Succop, P. S., & Travis, R. L. (2010) · Spine · doi:10.1097/brs.0b013e3181ccc220 · Cited by 157
Low back pain symptoms show a similar pattern of improvement following a wide range of primary care treatments: a systematic review of randomized clinical trials
Artus, M., van der Windt, D., Jordan, K. P., & Hay, E. M. (2010) · Rheumatology · doi:10.1093/rheumatology/keq245 · Cited by 162
Pain catastrophizing and general health status in a large Dutch community sample
Severeijns, R., van den Hout, M. A., Vlaeyen, J. W. S., & Picavet, S. J. H. (2002) · Pain · doi:10.1016/s0304-3959(02)00219-1 · Cited by 156
“Furthermore, the study design does not permit a judgement on the direction of this association although some prospective studies suggest that catastrophizing is a precursor of pain-related variables such as disability rather than a consequence (Burton et al., 1995; Linton et al., 2000).”
1999 Young Investigator Research Award Winner
McIntosh, G., Frank, J. W., Hogg‐Johnson, S., Bombardier, C., & Hall, H. (2000) · Spine · doi:10.1097/00007632-200001150-00003 · Cited by 153
Fear-Avoidance Beliefs as Measured by the Fear-Avoidance Beliefs Questionnaire: Change in Fear-Avoidance Beliefs Questionnaire Is Predictive of Change in Self-Report of Disability and Pain Intensity for Patients With Acute Low Back Pain
George, S. Z., Fritz, J. M., & McNeil, D. W. (2006) · Clinical Journal of Pain · doi:10.1097/01.ajp.0000148627.92498.54 · Cited by 154
“This finding converges with previous longitudinal studies suggesting that elevated psychosocial factors relevant to chronic disability from low back pain are present during acute stages of injury.(5,6,35,36) This study expands on the previous studies by demonstrating the sensitivity of changes in fear-avoidance belief…”
Result
Análise das propriedades psicométricas da versão brasileira da escala tampa de cinesiofobia
Siqueira, F. B., Teixeira‐Salmela, L. F., & Magalhães, L. D. C. (2007) · Acta Ortopédica Brasileira · doi:10.1590/s1413-78522007000100004 · Cited by 162
A fitness programme for patients with chronic low back pain: 2-year follow-up of a randomised controlled trial
Frost, H., Lamb, S. E., Moffett, K. A. J., Fairbank, T. J. C., & Moser, S. J. (1998) · Pain · doi:10.1016/s0304-3959(98)00005-0 · Cited by 152
Behavioral Responses to Examination
Main, C. J., & Waddell, G. (1998) · Spine · doi:10.1097/00007632-199811010-00025 · Cited by 155
Self-citation
Clinical Course in Patients Seeking Primary Care for Back or Neck Pain: A Prospective 5-Year Follow-Up of Outcome and Health Care Consumption with Subgroup Analysis
Enthoven, P., Skargren, E. I., & Öberg, B. E. (2004) · Spine · doi:10.1097/01.brs.0000143025.84471.79 · Cited by 151
“1) 1–4 wk 81 20 22 (16;25) 23 26 (17;29) 2.”
BackgroundInfluential
Psycho‐social factors and coping strategies as predictors of chronic evolution and quality of life in patients with low back pain: A prospective study
Koleck, M., Mazaux, J., Rascle, N., & Bruchon‐Schweitzer, M. (2005) · European Journal of Pain · doi:10.1016/j.ejpain.2005.01.003 · Cited by 150
“In the context of prospective studies, catastrophizing and fear-avoidance beliefs were found to be the most powerful predictors of pain and disability (Burton et al., 1995; Hasenbring et al., 1994; Klenerman et al., 1995; Linton and Hallden, 1998; Picavet et al., 2002).”
BackgroundResultInfluential
L'Échelle de dramatisation face à la douleur PCS-CF: Adaptation canadienne en langue française de l'échelle «Pain Catastrophizing Scale».
French, D. J., Noël, M., Vigneau, F., French, J. A., Cyr, C. P., & Evans, R. T. (2005) · Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement · doi:10.1037/h0087255 · Cited by 168

Authors: Burton, A. K., Tillotson, K. M., Main, C. J., & Hollis, S.
Affiliations: University of Huddersfield (GB)
Salford Royal NHS Foundation Trust (GB)
Corresponding author: Tillotson, K. Malcolm
ORCID: Main, Chris J.
Venue: Spine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1995-03
Volume: 20
Issue: 6
Pages: 722-728
ISSN: 0362-2436 (ISSN-L)
DOI: 10.1097/00007632-199503150-00014
OpenAlex: W1970664734
Cited by: 700
References: 0
Citations by year: 2026: 4 · 2025: 2 · 2024: 11 · 2023: 9 · 2022: 9 · 2021: 18 · 2020: 13 · 2019: 14 · 2018: 19 · 2017: 13 · 2016: 19 · 2015: 15 · 2014: 22 · 2013: 22 · 2012: 29
FWCI: 15.04
Type: journal article
Language: en
Open access: closed
Locations: Spine (publishedVersion)
PubMed (publishedVersion)
University of Huddersfield Repository (University of Huddersfield) (submittedVersion)
Lancaster EPrints (Lancaster University) (submittedVersion)
Research Explorer (The University of Manchester) (submittedVersion)
Huddersfield Research Portal (University of Huddersfield) (submittedVersion)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Orthopedics and Sports Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords: low back pain, psychosocial factors, prognosis, disability, psychological distress, acute low back pain, outcome prediction, primary care
MeSH terms: Acute Disease, Adult, Chronic Disease, Disability Evaluation, Female, Follow-Up Studies, Humans, Male, Pain Measurement, Prospective Studies, Discriminant Analysis, Low Back Pain

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Psychosocial Predictors of Outcome in Acute and Subchronic Low Back Trouble

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