The objective of this study was to determine whether psychological characteristics predict outcome and/or response to physiotherapist-directed exercise- or advice-based treatment of subacute low back pain. The study was a secondary analysis of a factorial, placebo-controlled trial (n = 259). The psychological characteristics were catastrophizing, coping, pain self-efficacy, fear of injury/movement, depression, anxiety, and stress. We used mixed models to predict pain and function outcomes (both scored on a 0-10 scale). The models include a term for treatment group, a term for the psychological characteristic (which tested prediction of outcome), and an interaction term between the treatment group and psychological characteristic (which tested treatment effect modification). All of the psychological characteristics except coping predicted outcome, but none appeared to be important treatment effect modifiers. Only 5 of the 56 tests of treatment modification were statistically significant, and none of the 95% confidence intervals for the interactions included clinically important effects.
Most of the psychological characteristics we tested predicted outcome, but none predicted response to physiotherapist-guided exercise and/or advice.
Smeets RJ, Maher CG, Nicholas MK, Refshauge KM, Herbert RD. Do psychological characteristics predict response to exercise and advice for subacute low back pain? Arthritis Rheum. 2009 Sep 15;61(9):1202-9