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Stress and Self-Efficacy as Long-Term Predictors for Chronic Low Back Pain: A Prospective Longitudinal Study

Authors Puschmann AK, Drießlein D, Beck H, Arampatzis A, Moreno Catalá M, Schiltenwolf M, Mayer F, Wippert PM

Received 19 July 2019

Accepted for publication 20 January 2020

Published 24 March 2020 Volume 2020:13 Pages 613—621


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Michael Schatman

Anne-Katrin Puschmann, 1 David Drießlein, 2 Heidrun Beck, 3 Adamantios Arampatzis, 4 Maria Moreno Catalá, 4 Marcus Schiltenwolf, 5 Frank Mayer, 6 Pia-Maria Wippert 1, 7

1Sociology of Health and Physical Activity, University of Potsdam, Potsdam, Germany; 2Statistical Consulting Unit, Ludwig-Maximilians-University Munich, Munich, Germany; 3University Center of Orthopedics and Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany; 4Department of Training and Movement Sciences, Humboldt-University of Berlin, Berlin, Germany; 5Conservative Orthopaedics and Pain Management, Center of Orthopaedics and Trauma Surgery, University Hospital Heidelberg, Heidelberg, Germany; 6University Outpatient Clinic, University of Potsdam, Potsdam, Germany; 7Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland

Correspondence: Anne-Katrin Puschmann
University of Potsdam, Am Neuen Palais 10, House 12, Potsdam 14469, Germany
Tel +49 331 9771075

Purpose: Psychosocial variables are known risk factors for the development and chronification of low back pain (LBP). Psychosocial stress is one of these risk factors. Therefore, this study aims to identify the most important types of stress predicting LBP. Self-efficacy was included as a potential protective factor related to both, stress and pain.
Participants and Methods: This prospective observational study assessed n = 1071 subjects with low back pain over 2 years. Psychosocial stress was evaluated in a broad manner using instruments assessing perceived stress, stress experiences in work and social contexts, vital exhaustion and life-event stress. Further, self-efficacy and pain (characteristic pain intensity and disability) were assessed. Using least absolute shrinkage selection operator regression, important predictors of characteristic pain intensity and pain-related disability at 1-year and 2-years follow-up were analyzed.
Results: The final sample for the statistic procedure consisted of 588 subjects (age: 39.2 (± 13.4) years; baseline pain intensity: 27.8 (± 18.4); disability: 14.3 (± 17.9)). In the 1-year follow-up, the stress types “tendency to worry”, “social isolation”, “work discontent” as well as vital exhaustion and negative life events were identified as risk factors for both pain intensity and pain-related disability. Within the 2-years follow-up, Lasso models identified the stress types “tendency to worry”, “social isolation”, “social conflicts”, and “perceived long-term stress” as potential risk factors for both pain intensity and disability. Furthermore, “self-efficacy” (“internality”, “self-concept”) and “social externality” play a role in reducing pain-related disability.
Conclusion: Stress experiences in social and work-related contexts were identified as important risk factors for LBP 1 or 2 years in the future, even in subjects with low initial pain levels. Self-efficacy turned out to be a protective factor for pain development, especially in the long-term follow-up. Results suggest a differentiation of stress types in addressing psychosocial factors in research, prevention and therapy approaches.

Keywords: low back pain, psychosocial risk factors, stress, self-efficacy, MiSpEx

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