Cited by 526Musculoskeletal pain and rehabilitationMedical Practices and RehabilitationPediatric Pain Management Techniques

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How does pain lead to disability? A systematic review and meta-analysis of mediation studies in people with back and neck pain

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Lee, Hopin, Hübscher, Markus, Moseley, G. Lorimer, Kamper, Steven J., Traeger, Adrian C., Mansell, Gemma, McAuley, James H.·2015·Pain

DOI 10.1097/j.pain.0000000000000146

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Abstract

Disability is an important outcome from a clinical and public health perspective. However, it is unclear how disability develops in people with low back pain or neck pain. More specifically, the mechanisms by which pain leads to disability are not well understood. Mediation analysis is a way of investigating these mechanisms by examining the extent to which an intermediate variable explains the effect of an exposure on an outcome. This systematic review and meta-analysis aimed to identify and examine the extent to which putative mediators explain the effect of pain on disability in people with low back pain or neck pain. Five electronic databases were searched. We found 12 studies (N = 2961) that examined how pain leads to disability with mediation analysis. Standardized regression coefficients (β) of the indirect and total paths were pooled. We found evidence to show that self-efficacy (β = 0.23, 95% confidence interval [CI] = 0.10 to 0.34), psychological distress (β = 0.10, 95% CI = 0.01 to 0.18), and fear (β = 0.08, 95% CI = 0.01 to 0.14) mediated the relationship between pain and disability, but catastrophizing did not (β = 0.07, 95% CI = -0.06 to 0.19). The methodological quality of these studies was low, and we highlight potential areas for development. Nonetheless, the results suggest that there are significant mediating effects of self-efficacy, psychological distress, and fear, which underpins the direct targeting of these constructs in treatment.

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Authors: Lee, H., Hübscher, M., Moseley, G. L., Kamper, S. J., Traeger, A. C., Mansell, G., & McAuley, J. H.
Affiliations: The University of Sydney (AU)
UNSW Sydney (AU)
University of South Australia (AU)
Arthritis Research UK (GB)
Corresponding author: McAuley, James H.
ORCID: Lee, Hopin
Hübscher, Markus
Moseley, G. Lorimer
Kamper, Steven J.
Traeger, Adrian C.
Mansell, Gemma
McAuley, James H.
Venue: Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2015-06
Volume: 156
Issue: 6
Pages: 988-997
ISSN: 0304-3959 (ISSN-L)
DOI: 10.1097/j.pain.0000000000000146
OpenAlex: W2007701602
Cited by: 526
References: 82
Citations by year: 2026: 41 · 2025: 43 · 2024: 61 · 2023: 67 · 2022: 68 · 2021: 57 · 2020: 51 · 2019: 40 · 2018: 38 · 2017: 27 · 2016: 25 · 2015: 6
FWCI: 4.01
Type: journal article
Language: en
Open access: green
pure.amsterdamumc.nl
Licence: other-oa
Locations: Pain (publishedVersion)
PubMed (publishedVersion)
Pure Amsterdam UMC (publishedVersion, other-oa)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
Keele Research Repository (Keele University) (submittedVersion, cc-by)
Aston Publications Explorer (Aston University) (submittedVersion)
VU Research Portal (submittedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Funders: McGill University
Australian Institute of Sport
Medical Research Council
National Health and Medical Research Council (1061279)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords: disability, low back pain, neck pain, mediation analysis, self-efficacy, psychological distress, fear, pain catastrophizing
MeSH terms: Back Pain, Persons with Disabilities, Humans, Databases, Factual, Disease Progression, Neck Pain

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How does pain lead to disability? A systematic review and meta-analysis of mediation studies in people with back and neck pain

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