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Data-driven pathway analysis of physical and psychological factors in low back pain

  • Bernard X.W. Liew
    Correspondence
    Address for reprint requests and other correspondence: Bernard Liew, School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom; ; Tel: +44 120 687 3522
    Affiliations
    School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
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  • Jan Hartvigsen
    Affiliations
    Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

    Chiropractic Knowledge Hub, Odense, Denmark
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  • Marco Scutari
    Affiliations
    Istituto Dalle Molle di Studi sull'Intelligenza Artificiale (IDSIA), Lugano, Switzerland
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  • Alice Kongsted
    Affiliations
    Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

    Chiropractic Knowledge Hub, Odense, Denmark
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Open AccessPublished:November 14, 2022DOI:https://doi.org/10.1016/j.jclinepi.2022.11.010
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      Highlights

      • Low back pain (LBP) intensity and psychological factors directly predicted disability overall
      • Pain and physical factor drive psychological factors in those with severe symptoms
      • Psychological factors drive pain and physical factor in those with milder symptoms
      • Both physical and psychological factors contribute to disability in individuals with LBP

      Abstract

      Objective

      To understand the physical, activity, pain and psychological pathways contributing to low back pain (LBP) -related disability, and if these differ between subgroups.

      Methods

      Data came from the baseline observations (n = 3849) of the “GLA:D Back” intervention program for long-lasting non-specific LBP. 15 variables comprising demographic, pain, psychological, physical, activity, and disability characteristics were measured. Clustering was used for subgrouping, Bayesian networks (BN) was used for structural learning, and structural equation model (SEM) was used for statistical inference.

      Results

      Two clinical subgroups were identified with those in subgroup 1 having worse symptoms than those in subgroup 2. Psychological factor was directly associated with disability in both subgroups. For subgroup 1, psychological factor was most strongly associated with disability (β=0.363). Physical factors were directly associated with disability (β=-0.077), and indirectly via psychology. For subgroup 2, pain was most strongly associated with disability (β=0.408). Psychological factor was a common predictor of physical factors (β=0.078), pain (β=0.518), activity (=0.101), and disability (β=0.382).

      Conclusion

      The importance of psychological factor in both subgroups suggests their importance for treatment. Physical, pain, and psychological factors interact, albeit differently in different clinical subgroups, to contribute to disability, confirming the need for biopsychosocial management of LBP.

      Keywords