Predictors of self-management in patients with chronic low back pain

Banerjee, Anirban (2019) Predictors of self-management in patients with chronic low back pain. PhD thesis, University of Nottingham.

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Abstract

Background: Self-management (SM) is a key strategy for managing chronic low back pain (CLBP) and defines how individuals manage their disease, symptoms, treatment and roles. However, no longitudinal study has examined the predictive relationships between SM and biopsychosocial outcome measures in patients with CLBP. This PhD thesis outlines the body of research that examined the predictive relationship between SM constructs and biopsychosocial outcome measures in patients with CLBP.

Aims: This PhD research had three main aims: 1) synthesise and appraise the literature on outcome measures used to assess change in SM in patients with chronic musculoskeletal pain and to identify a valid and reliable SM outcome measure to be used in this PhD study for assessing a range of SM constructs; 2) to estimate the reliability and agreement between paper and non-paper alternative methods of survey completion for an identified SM measure; and 3) to examine the predictive relationship between SM constructs and biopsychosocial outcome measures in patients with CLBP.

Methods: A systematic review was conducted to identify and synthesise quantitative measures used to assess SM in patients with chronic musculoskeletal pain [Aim 1]. A test-retest study was conducted to estimate the intraclass correlation and Bland and Altman Limits of Agreement between paper and non-paper alternative methods of survey completion for a SM measure [Aim 2].

Finally, a multi-site longitudinal cohort study was conducted collecting self-reported validated measures for SM, pain intensity, disability, physical activity level, kinesiophobia, catastrophising, and depression at baseline and six-months, including working age individuals (n=270, 18-65 years) who attended physiotherapy for their CLBP [Aim 3].

Results: The systematic review identified 14 different outcome measures. The Health Education Impact Questionnaire (heiQ) assesses eight different SM constructs and was utilised in this PhD research [Aim 1]. The heiQ demonstrated good reliability (Cronbach’s  0.89-0.95 and intraclass correlation 0.89-0.96) and acceptable Limits of Agreement between paper and non-paper alternative survey completion methods [Aim 2]. Physical activity level and healthcare use (positively); and levels of disability, depression, kinesiophobia, catastrophising (negatively) predicted (p<0.05, adjusted R2 ranged from .07 to .55) SM constructs at baseline in patients with CLBP. At six-month follow-up, SM constructs were improved (p<0.05, adjusted R2 ranged from .30 to .55) in those patients who had higher scores on SM constructs at baseline; lower levels of depression or kinesiophobia; were educated, living as married; of white ethnic background; and attended a pain-management programme. Changes in SM constructs (from baseline to six months) were predicted (p<0.05, adjusted R2 ranged from .13 to .32) by changes in levels of depression, kinesiophobia, catastrophising, physical activity, use of analgesics; and presence of leg pain; and being employed and married [Aim 3].

Conclusion: The heiQ is a suitable outcome measure to assess multiple constructs of SM in patients with chronic musculoskeletal pain conditions [Aim 1]. The paper and non-paper alternative methods of survey completion produced equivalent data quality for the heiQ in patients with CLBP [Aim 2]. The main results indicate levels of disability, physical activity, depression, catastrophising and kinesiophobia predicted multiple constructs of SM measured using the heiQ in working-age adults with CLBP [Aim 3]. This is the first longitudinal study investigating predictive relationship between SM constructs and biopsychosocial outcome measures. Future research is required to validate these results.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Hendrick, Paul
Blake, Holly
Keywords: Low back pain, Chronic low back pain, Self-management, Longitudinal study, Mixed-mode survey, Survey research, Regression analysis, Health Education Impact Questionnaire
Subjects: W Medicine and related subjects (NLM Classification) > WE Muscoskeletal system
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Health Sciences
Item ID: 56662
Depositing User: Banerjee, Anirban
Date Deposited: 30 Aug 2019 14:02
Last Modified: 07 May 2020 10:01
URI: http://eprints.nottingham.ac.uk/id/eprint/56662

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