How Does Self-Efficacy Influence Pain Perception, Postural Stability and Range of Motion in Individuals with Chronic Low Back Pain?

BACKGROUND: Low back pain (LBP) is the most prevalent musculoskeletal problem among adults. Individuals with chronic LBP (CLBP) can present a psychological disorder and a lack of pain self-efficacy.

OBJECTIVES: The objective of this study was to compare the process of repetition-induced summation of activity-related pain, the lumbar range of motion, and the postural stability of patients with non-specific LBP (NSLBP) based on their level of self-efficacy.

STUDY DESIGN: This research used a descriptive, cross-sectional study design.

METHODS: This research included 60 patients with NSCLBP. Patients were classified as having "high" or "low" self-efficacy based on a median split of scores on the Chronic Pain Self-Efficacy Scale. All patients received a sociodemographic questionnaire, a psychological self-reported measures (Tampa scale of Kinesiophobia; Pain Catastrophizing Scale; Rumination subscale, Magnification subscale; Helplessness subscale; Roland-Morris Disability Questionnaire; Fear-Avoidance Belief Questionnaire; Physical Activity subscale; Work subscale); and completed the Temporal Summation Lifting Task, Lumbar Range of Motion, and Multi-Directional Functional Reach Test (MDFRT).

RESULTS: The results indicated that the low self-efficacy group had a shorter lumbar range of motion and lower postural stability, in addition to greater pain intensity in the temporal summation lifting task, compared with the high self-efficacy group. The analysis showed that the strongest correlation for the high self-efficacy was between fear of movement and the temporal summation lifting task, and greater scores at the psychological questionnaires, compared with the high self-efficacy group (r = 0.711; P < 0.01). The strongest correlations found for the low self-efficacy group, showed a positive relationship between pain catastrophizing and the temporal summation lifting task (r = 0.765; P < 0.01), and a strong negative association between pain catastrophizing for the magnification subscale and lumbar range of motion (r = -0.759; P < 0.01).

LIMITATIONS: The results of this study should be interpreted with caution because of its cross-sectional design, and therefore causal relationships cannot be established. A significant limitation of the study is that patients' physical activity levels were not assessed, which could have influenced their ability to perform motor tasks at the perceived difficulty and fear level.

CONCLUSIONS: The high self-efficacy group had less pain in the temporal summation lifting task, a greater range of motion, and a greater functional range, in addition to a lower influence of psychological factors.

KEY WORDS: Low back pain, chronic pain, self-efficacy, temporal summation, range of motion, postural stability, fear of movement, pain catastrophizing, low back disability.