Psychosocial Factors Related to Participation and Other Outcomes in Patients with Persistent Back Pain

  • Author / Creator
    McKillop, Ashley B
  • Background: Persistent back pain is a debilitating problem that can threaten many aspects of affected individuals’ lives, including engagement in valued social roles (i.e., participation). Related research often focuses on studying vulnerabilities and deficits, rather than the psychosocial factors that can enhance meaningful outcomes. Focusing on what researchers and health professionals aim to promote may be an important shift to furthering back pain research. Participation has been identified as a particularly important outcome to individuals experiencing persistent back pain. However, participation of those with back pain has received little study, possibly because of the paucity of good measures. To provide unique insights into the defining characteristics and strategies that enhance participation, back pain research should also focus more on individuals who engage in valued socials roles, despite persistent back pain. Objective: The primary objective of this thesis was to identify and better understand psychosocial factors associated with outcomes in individuals with persistent back pain. A particular interest was in identifying modifiable factors that might enhance participation in this population. Methods: A best-evidence synthesis was used to examine the literature on depression as a prognostic factor for outcomes in patients with lumbar spinal stenosis (LSS), which included articles published between 1980 and May 2012. Two authors independently critically appraised the methodological quality of each article that met the initial inclusion criteria and only the studies judged to be scientifically admissible were summarized in the evidence tables. Another study used a prospective cohort study design to investigate social support as a prognostic factor of depressive symptoms and depression recovery in people seeking care for persistent low back pain problems associated with LSS. Multivariable analyses were conducted to examine associations between social support and both depression outcomes. In an effort to identify factors that enhance participation, a qualitative approach was used to examine why some individuals with persistent back pain continue to actively engage in their valued social roles, (e.g., holding a job) despite their persistent back pain. Participants were recruited from three urban physical therapy clinics and one multidisciplinary pain clinic. Semi-structured interviews were conducted and data were analyzed using thematic analysis. As it relates to outcomes, namely participation, the construct validity of the 5-Item Pain Disability Index (PDI) was investigated as a measure of participation using measurement data from a variety of measurement constructs collected at a multidisciplinary pain clinic. Hypothesized associations in support of the construct validity of the 5-Item PDI were tested using Pearson or Point-Biserial correlations. Results: Evidence supported depression as a prognostic factor of disability and LSS-related symptom severity, a combination of pain, numbness, weakness and balance issues. Greater social support was found to be strongly associated with subsequent recovery from depression and to a lesser degree reduced depressive symptoms. Two motivators for continuing to participate in the work role were also identified. These included participating in the work role because it formed part of the participants’ self-schema (cognitive framework that includes one’s experiences and beliefs about oneself) and because it led to a valued outcome. In addition, evidence supported the construct validity of the 5-Item PDI as a proposed measure of participation, with moderate or strong associations found with other participation measures. Conclusions: The findings of this thesis suggest that psychosocial factors are important in enhancing participation and other outcomes in individuals experiencing persistent back pain. Depression, a common comorbidity of persistent pain, negatively influences surgical outcomes in patients with back problems related to LSS and greater social support was strongly associated with recovery from depression – an association worthy of further study as social support is a modifiable factor. The importance of the work role (employment) to one’s self-schema and the perception of valued outcomes from work appear to motivate some individuals to continue with their regular work despite persistent back pain. In addition, this thesis provides evidence that supports the construct validity of the 5-Item PDI as a measure of participation for use in patients with persistent back pain. The hope is that the introduction of this measure, along with the findings from this thesis, will increase the dialogue and inclusion of this important outcome in back pain research and clinical care.

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  • Degree
    Doctor of Philosophy
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    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.