Why is a treatment aimed at psychosocial factors not effective in patients with (sub)acute low back pain?

P. Jellema, D.A.W.M. van der Windt-Mens, H.E. van der Horst, A.H. Blankenstein, L.M. Bouter, W.A.B. Stalman

    Research output: Contribution to JournalArticleAcademicpeer-review

    Abstract

    Psychosocial factors have been shown to play an important role in the development of chronic low back pain (LBP). In our recently completed cluster-randomized trial we found, however, no evidence of an effect of our minimal intervention strategy (MIS) aimed at psychosocial factors, over usual care (UC) in patients with (sub)acute LBP. To explore the reasons why, this paper presents an evaluation of the processes presumably underlying the effectiveness of MIS. General practitioner (GP) attitude was evaluated by the Pain Attitudes and Beliefs Scale and two additional questions. GP behaviour was evaluated by analysing treatment registration forms and patients' responses to items regarding treatment content. Patients also scored items on satisfaction and compliance. Modification of psychosocial measures was evaluated by analysing changes after 6 and 52 weeks on the Fear Avoidance and Beliefs Questionnaire, the Coping Strategies Questionnaire and the 4-Dimensional Symptom Questionnaire. A total of 60 GPs and 314 patients participated in the study. GPs in the MIS-group adopted a less biomedical orientated attitude than in the UC-group, but were only moderately successful in identification of psychosocial factors. Treatment contents as perceived by the patient and patient satisfaction differed significantly between both groups. Changes on psychosocial measures, however, did not differ between groups. The suboptimal identification of psychosocial factors in the MIS-group and the absence of a relevant impact on psychosocial factors may explain why MIS was not more effective than UC. © 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
    Original languageEnglish
    Pages (from-to)350-9
    JournalPain
    Volume118
    Issue number3
    Early online date12 Nov 2005
    DOIs
    Publication statusPublished - 2005

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    Low Back Pain
    Psychology
    General Practitioners
    Therapeutics
    Patient Satisfaction
    Compliance
    Fear
    Patient Care
    Pain
    Surveys and Questionnaires

    Cite this

    Jellema, P., van der Windt-Mens, D. A. W. M., van der Horst, H. E., Blankenstein, A. H., Bouter, L. M., & Stalman, W. A. B. (2005). Why is a treatment aimed at psychosocial factors not effective in patients with (sub)acute low back pain? Pain, 118(3), 350-9. https://doi.org/10.1016/j.pain.2005.09.002
    Jellema, P. ; van der Windt-Mens, D.A.W.M. ; van der Horst, H.E. ; Blankenstein, A.H. ; Bouter, L.M. ; Stalman, W.A.B. / Why is a treatment aimed at psychosocial factors not effective in patients with (sub)acute low back pain?. In: Pain. 2005 ; Vol. 118, No. 3. pp. 350-9.
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    abstract = "Psychosocial factors have been shown to play an important role in the development of chronic low back pain (LBP). In our recently completed cluster-randomized trial we found, however, no evidence of an effect of our minimal intervention strategy (MIS) aimed at psychosocial factors, over usual care (UC) in patients with (sub)acute LBP. To explore the reasons why, this paper presents an evaluation of the processes presumably underlying the effectiveness of MIS. General practitioner (GP) attitude was evaluated by the Pain Attitudes and Beliefs Scale and two additional questions. GP behaviour was evaluated by analysing treatment registration forms and patients' responses to items regarding treatment content. Patients also scored items on satisfaction and compliance. Modification of psychosocial measures was evaluated by analysing changes after 6 and 52 weeks on the Fear Avoidance and Beliefs Questionnaire, the Coping Strategies Questionnaire and the 4-Dimensional Symptom Questionnaire. A total of 60 GPs and 314 patients participated in the study. GPs in the MIS-group adopted a less biomedical orientated attitude than in the UC-group, but were only moderately successful in identification of psychosocial factors. Treatment contents as perceived by the patient and patient satisfaction differed significantly between both groups. Changes on psychosocial measures, however, did not differ between groups. The suboptimal identification of psychosocial factors in the MIS-group and the absence of a relevant impact on psychosocial factors may explain why MIS was not more effective than UC. {\circledC} 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.",
    author = "P. Jellema and {van der Windt-Mens}, D.A.W.M. and {van der Horst}, H.E. and A.H. Blankenstein and L.M. Bouter and W.A.B. Stalman",
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    Jellema, P, van der Windt-Mens, DAWM, van der Horst, HE, Blankenstein, AH, Bouter, LM & Stalman, WAB 2005, 'Why is a treatment aimed at psychosocial factors not effective in patients with (sub)acute low back pain?' Pain, vol. 118, no. 3, pp. 350-9. https://doi.org/10.1016/j.pain.2005.09.002

    Why is a treatment aimed at psychosocial factors not effective in patients with (sub)acute low back pain? / Jellema, P.; van der Windt-Mens, D.A.W.M.; van der Horst, H.E.; Blankenstein, A.H.; Bouter, L.M.; Stalman, W.A.B.

    In: Pain, Vol. 118, No. 3, 2005, p. 350-9.

    Research output: Contribution to JournalArticleAcademicpeer-review

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    AU - Jellema, P.

    AU - van der Windt-Mens, D.A.W.M.

    AU - van der Horst, H.E.

    AU - Blankenstein, A.H.

    AU - Bouter, L.M.

    AU - Stalman, W.A.B.

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    N2 - Psychosocial factors have been shown to play an important role in the development of chronic low back pain (LBP). In our recently completed cluster-randomized trial we found, however, no evidence of an effect of our minimal intervention strategy (MIS) aimed at psychosocial factors, over usual care (UC) in patients with (sub)acute LBP. To explore the reasons why, this paper presents an evaluation of the processes presumably underlying the effectiveness of MIS. General practitioner (GP) attitude was evaluated by the Pain Attitudes and Beliefs Scale and two additional questions. GP behaviour was evaluated by analysing treatment registration forms and patients' responses to items regarding treatment content. Patients also scored items on satisfaction and compliance. Modification of psychosocial measures was evaluated by analysing changes after 6 and 52 weeks on the Fear Avoidance and Beliefs Questionnaire, the Coping Strategies Questionnaire and the 4-Dimensional Symptom Questionnaire. A total of 60 GPs and 314 patients participated in the study. GPs in the MIS-group adopted a less biomedical orientated attitude than in the UC-group, but were only moderately successful in identification of psychosocial factors. Treatment contents as perceived by the patient and patient satisfaction differed significantly between both groups. Changes on psychosocial measures, however, did not differ between groups. The suboptimal identification of psychosocial factors in the MIS-group and the absence of a relevant impact on psychosocial factors may explain why MIS was not more effective than UC. © 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

    AB - Psychosocial factors have been shown to play an important role in the development of chronic low back pain (LBP). In our recently completed cluster-randomized trial we found, however, no evidence of an effect of our minimal intervention strategy (MIS) aimed at psychosocial factors, over usual care (UC) in patients with (sub)acute LBP. To explore the reasons why, this paper presents an evaluation of the processes presumably underlying the effectiveness of MIS. General practitioner (GP) attitude was evaluated by the Pain Attitudes and Beliefs Scale and two additional questions. GP behaviour was evaluated by analysing treatment registration forms and patients' responses to items regarding treatment content. Patients also scored items on satisfaction and compliance. Modification of psychosocial measures was evaluated by analysing changes after 6 and 52 weeks on the Fear Avoidance and Beliefs Questionnaire, the Coping Strategies Questionnaire and the 4-Dimensional Symptom Questionnaire. A total of 60 GPs and 314 patients participated in the study. GPs in the MIS-group adopted a less biomedical orientated attitude than in the UC-group, but were only moderately successful in identification of psychosocial factors. Treatment contents as perceived by the patient and patient satisfaction differed significantly between both groups. Changes on psychosocial measures, however, did not differ between groups. The suboptimal identification of psychosocial factors in the MIS-group and the absence of a relevant impact on psychosocial factors may explain why MIS was not more effective than UC. © 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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    DO - 10.1016/j.pain.2005.09.002

    M3 - Article

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    JO - Pain

    JF - Pain

    SN - 0304-3959

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    ER -