Psychosocial factors associated with change in pain and disability outcomes in chronic low back pain patients treated by physiotherapist: A systematic review
Open accessAbstract
Background: Almost 80% of people have low back pain at least once in their life. Clinical guidelines emphasize the use of conservative physiotherapy and the importance of staying active. While the psychological factors predicting poor recovery following surgical intervention are understood, the psychosocial factors associated with poor outcomes following physiotherapy have yet to be identified. Methods: Electronic searches of PubMed, Medline, CINAHL, PsycINFO and EBSCO were conducted using terms relating to psychosocial factors, chronic low back pain, disability and physiotherapy. Papers examining the relationship between psychosocial factors and pain and disability outcomes following physiotherapy were included. Two reviewers selected, appraised and extracted studies independently. Results: In total, 10 observational studies were identified that suggested an association between fear of movement, depression, self-efficacy and catastrophizing in modifying pain and disability outcomes following physiotherapy. Discussion: Although limited by methodological shortcomings of included studies, and heterogeneity of physiotherapy interventions and measures of disability and psychosocial outcomes, the findings are consistent with other research in the context of back pain and physiotherapy, which suggest an association between psychosocial factors, including fear of movement, catastrophizing and self-efficacy and pain and disability outcomes in chronic low back pain patients treated by physiotherapist. However, a direct relationship cannot be concluded from this study. Conclusion: Findings suggest an association between psychosocial factors, including fear of movement, catastrophizing and self-efficacy and pain and disability outcomes in chronic low back pain patients treated by physiotherapist, which warrants further study.
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Fear-avoidance beliefs are consistently associated with a poor prognosis.
“which is consistently associated with a poor prognosis [60,94,95,96].”
From Digital Rehabilitation for Elbow Pain Musculoskeletal Conditions: A Prospective Longitudinal Cohort Study (2022) · cites this paper as [94]
The Results (Fear avoidance; page not specified) report that fear-avoidance factors influenced disability scores in eight studies. But one study found that higher fear-avoidance scores did not predict pain levels, so the unqualified claim of a consistent association with poor prognosis overstates the review's findings in physiotherapist-treated chronic low back pain. (LLM, conf=0.86)
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- Authors
- Alhowimel, A., AlOtaibi, M., Radford, K., & Coulson, N.
- Affiliations
- University of Nottingham (GB)
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
- Corresponding author
- Alhowimel, Ahmed
- Venue
- SAGE Open Medicine
- Publisher
- SAGE Publications
- Published
- 2018-01-01
- Volume
- 6
- Pages
- 2050312118757387-2050312118757387
- ISSN
- 2050-3121 (ISSN-L)
- PMC
- PMC5808969
- OpenAlex
- W2793287328
- Cited by
- 144
- References
- 30
- Citations by year
- 2026: 15 · 2025: 16 · 2024: 20 · 2023: 22 · 2022: 18 · 2021: 23 · 2020: 20 · 2019: 8 · 2018: 2
- FWCI
- 1.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- SAGE Open Medicine (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Nottingham ePrints (University of Nottingham) (submittedVersion, cc-by-nc)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- chronic low back pain, psychosocial factors, physiotherapy, pain outcomes, disability outcome, kinesiophobia, catastrophizing, self-efficacy, depression, conservative treatment
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