INFLUENCE OF BELIEFS IN THE DECREASE OF QUALITY OF LIFE ASSOCIATED
WITH BACK PAIN
Title.
Influence of fear and avoidance beliefs
in the decrease in quality of life of low back pain patients.
Background.
It is known that in patients with low back
pain, pain intensity and degree of disability influence their
quality of life. Additionally it is known that that influence
varies over time; both factors explain 27% of overall quality
of life the first day the patient seeks medical care, but
only 14 days later, they are already the main factors determining
the quality of life, responsible for 58%.
However, even in that moment, 44% of the patient's quality
of life continues to be explained without reference to pain
or disability. It is possible that that part of the quality
of life depends on factors not related to his or her low back
pain or general health, but it is also possible that it depends
on factors that are related to the low back pain but are different
from pain intensity and degree of disability.
In fact, studies made previously in other settings suggest
that the beliefs that the patient has in relation to his or
her low back pain and the suffering it means, as well as his
or her ideas about what a future with low back pain holds,
also influence his or her quality of life.
If this were so, quantifying the influence of beliefs on
the quality of life would allow for the identification of
patients in whom it may be appropriate to adopt measures in
this regard. Thus, in the cases in which mistaken beliefs
cause an inevitable decrease in the quality of life, measures
to correct it would be applied. This possibility is especially
attractive bearing in mind that it could easily be translated
to clinical practice; currently simple instruments are being
developed to assess patients' beliefs, which would allow those
persons in whom this is an important factor to be identified
routinely.
Objectives.
-
To quantify the influence of beliefs regarding back pain
on the quality of life of those who suffer it.
-
To quantify the relation between pain intensity, degree
of disability and beliefs regarding back pain and their
joint influence on the patient's quality of life.
Design.
Prospective, cohort study.
Methodology.
The study was made with a sample of convenience
of 200 patients who consulted their doctors for low back pain,
with or without referred pain, and who could read and write
and were actively employed.
The patients' situation was evaluated on two occasions: when
they were first treated and 14 days later. On each occasion,
among other variables, the intensity of the low back pain
and that of the radiated pain (by means of independent visual
analog scales), the degree of disability (by means of the
validated Spanish version of the Roland-Morris scale), the
quality of life (measured by means of the validated Spanish
version of the SF-12 scale) and the patient's beliefs about
the meaning and prognosis of his or her pain (by means of
the validated Spanish version of the FAB questionnaire) were
collected.
In the analysis phase, the correlation between the results
of the scales (VAS, RM, FAB and SF-12) was studied day 1 and
day 15.
Participants, along with the Foundation's
Science Department.
Unit of Clinical Biostatistics at the Hospital
Ramón y Cajal, Madrid; Provincial Delegation of Social
Services, Granada; Departments of Neurosurgery and Traumatology
at the Hospital Universitario de Son Dureta, Palma de Mallorca;
Department of Preventative Medicine, Hospital Virgen de las
Nieves, Granada; 14 Primary Care Health Centers in 6 Autonomous
Communities (Regions of Spain); Spinal Surgery Unit at the
Valld'Hebrón, Barcelona; Department of Rheumatology
at the Hospital Clinic, Barcelona; Mutua Asepeyo, Madrid;
Physiotherapy Unit, Pain Clinic and Spine Unit at the Hospital
de Sabadell (Corporación Sanitaria Parc Taulí),
Barcelona; Department of Psychology at the Universidad Autónoma,
Bellaterra, Barcelona; Department of Traumatology at the Fundación
Jimenez Díaz, Madrid; Advanced Research Techniques
in Health Services (TAISS), Madrid; who are members of the
Spanish Network of Researchers in Back Disorders.
The study was funded in its entirety by the Kovacs Foundation.
Status.
In progress.
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