The relative influence of perceived pain control, anxiety, and functional self efficacy on spinal function among patients with chronic low back pain

Study Design. A prospective analysis of the relative influence of pain-spec ific and performance-specific cognitive variables on lifting tasks using em pirically derived measures. Objectives. To determine the relative contributions of self efficacy expect ancies of lifting performance, perceptions. of pain control, and anxiety an actual lifting performance. Summary of Background Information. Although patients' pain beliefs play an important role in the expression of low back pain, there is little research on the influence of performance-specific cognitions on spinal function. Th is study extended the scope of recent research, with findings indicating th at patients with a stronger functional self efficacy expectancy-the belief that one can perform essential work tasks successfully-achieve higher level s of function than those with a low functional self efficacy expectancy. Mo reover, as a performance-specific variable, functional self efficacy expect ancy was hypothesized to be a better predictor of lifting than pain-specifi c cognitions, which presumably influence function in an indirect manner, if at all. Methods. Before undergoing a standardized, graded lifting assessment, 100 w ork-disabled patients with chronic back pain rated their confidence to perf orm load-lifting tasks essential to their job (functional self efficacy exp ectancy), their ability to control and decrease pain, and psychological dis tress. Results. Multiple regression analyses found that functional self efficacy e xpectancy accurately predicted lifting. It was found to be a better predict or of lifting tasks than either of the perceived pain control measures or p sychological distress. Conclusion. Data suggest that what patients believed they could achieve acc urately determined their actual spinal function, Independent of their sense of control over pain or their distress, Approaches to low back disorders e mphasizing perceived pain control as a central cognitive determinant of dis ability were unsupported.