Advertisement

The role of self-efficacy and catastrophizing in explaining improvements in disability, pain and fatigue among patients with chronic widespread pain treated with physiotherapy: an exploratory analysis

  • Dave P. Thompson
    Correspondence
    Correspondence: Bury Integrated Pain Service, Rocket Suite, Radcliffe Primary Care Centre, 69 Church Street West, Radcliffe, Manchester M26 2SP, UK.
    Affiliations
    Bury Integrated Pain Service, Radcliffe Primary Care Centre, Northern Care Alliance NHS Group, 69 Church Street West, Radcliffe, Manchester M26 2SP, UK

    School of Health Sciences, University of Salford, Allerton Building, University of Salford, Salford, Manchester M6 6PU, UK

    Department of Sport & Exercise Sciences, Faculty of Science & Engineering Manchester Metropolitan University, All Saints Building, Manchester M15 6BH, UK
    Search for articles by this author
  • Deborah Antcliff
    Affiliations
    Bury Integrated Pain Service, Radcliffe Primary Care Centre, Northern Care Alliance NHS Group, 69 Church Street West, Radcliffe, Manchester M26 2SP, UK

    School of Healthcare, Faculty of Medicine and Health, Baines Wing, University of Leeds, Leeds LS2 9JT, UK
    Search for articles by this author
  • Steve R. Woby
    Affiliations
    School of Health Sciences, University of Salford, Allerton Building, University of Salford, Salford, Manchester M6 6PU, UK

    Department of Sport & Exercise Sciences, Faculty of Science & Engineering Manchester Metropolitan University, All Saints Building, Manchester M15 6BH, UK

    Department of Research and Innovation, Northern Care Alliance NHS Group, Summerfield House, 544 Eccles New Road, Salford, Greater Manchester M5 5AP, UK
    Search for articles by this author

      Abstract

      Objectives

      Most research exploring the relationship between cognitive factors (catastrophizing and self-efficacy beliefs) and levels of pain, disability and fatigue in patients with chronic widespread pain has been performed in multidisciplinary environments. It is less clear whether these associations are valid in other clinical environments. This study therefore aimed to establish whether changes in cognitive factors were related to changes in pain, disability and fatigue among patients treated in a physiotherapy-led symptom management programme.

      Design

      A longitudinal pre–post treatment study. Regression analyses were performed with change in pain, disability, physical and mental fatigue as the dependent measures. Demographics, change in pain and fatigue (when not dependent variables) and cognitive factors were entered as independent variables. β values were calculated for the final model.

      Setting

      Two out-patient physiotherapy departments in Manchester, UK.

      Participants

      Fifty patients with persistent widespread pain.

      Intervention

      A physiotherapist-led symptom management programme.

      Main outcome measures

      Disability (Fibromyalgia Impact Questionnaire), Pain (Numeric Pain Rating Scale and Fatigue (Chalder Fatigue Scale)

      Results

      Significant changes in disability, fatigue and cognitive factors were observed after treatment. Changes in self-efficacy beliefs (β = −0.38, P < 0.05) and catastrophizing (β = 0.41, P < 0.05) were significantly related to reductions in disability. There was no significant relationship between change in the cognitive variables and change in pain or fatigue.

      Conclusions

      Self-efficacy beliefs and catastrophizing were important determinants of change in disability, but not pain or fatigue among patients with chronic widespread pain attending physiotherapy. Cognitively-informed physiotherapy appeared to be effective in reducing disability and fatigue and modifying cognitive factors. Such interventions may offer an effective treatment option for patients with chronic widespread pain and future randomised controlled trials are required to fully assess this.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Physiotherapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cimmino M.A.
        • Ferrone C.
        • Cutolo M.
        Epidemiology of chronic musculoskeletal pain.
        Best Pract Res Clin Rheumatol. 2011; 25: 173-183
        • British Pain Society
        Guidelines for pain management programmes for adults.
        British Pain Society, London2013
        • Campbell C.M.
        • McCauley L.
        • Bounds S.C.
        • Vani A.M.
        • Conn L.
        • Simango M.
        • et al.
        Changes in pain catastrophizing predict later changes in fibromyalgia clinical and experimental pain report: cross-lagged panel analyses of dispositional and situational catastrophizing.
        Arthritis Res Ther. 2012; 14: R231
        • Börsbo B.
        • Gerdle B.
        • Peolsson M.
        Impact of the interaction between self-efficacy, symptoms and catastrophising on disability, quality of life and health in with chronic pain patients.
        Disabil Rehabil. 2010; 32: 1387-1396
        • Thompson D.P.
        • Antcliff D.
        • Woby S.R.
        Cognitive factors are associated with disability and pain, but not fatigue among physiotherapy attendees with persistent pain and fatigue.
        Physiotherapy. 2020; 106: 94-100
        • Hill J.C.
        • Whitehurst G.D.T.
        • Lewis M.
        • Sterling B.
        • Dunn K.M.
        • Foster N.E.
        • et al.
        Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial.
        Lancet. 2011; 378: 1560-1571
        • Foster N.E.
        • Mullis R.
        • Hill J.C.
        • Lewis M.
        • Whitehurst D.G.
        • Doyle C.
        • et al.
        • IMPaCT Back Study team
        Effect of stratified care for low back pain in family practice (IMPaCT Back): a prospective population-based sequential comparison.
        Ann Fam Med. 2014; 12: 102-111
        • Aggarwal V.R.
        • McBeth J.
        • Zakrzewska J.M.
        • Lunt M.
        • McFarlane G.J.
        The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors?.
        Int J Epidemiol. 2006; 35: 468-476
        • Kroenke K.
        • Sharpe M.
        • Sykes R.
        Revising the classification of somatoform disorders: key questions and preliminary recommendations.
        Psychosomatics. 2007; 48: 277-285
        • Nijs J.
        • Meeus M.
        • De Meirleir K.
        Chronic musculoskeletal pain in chronic fatigue syndrome: recent developments and therapeutic implications.
        Man Ther. 2006; 11: 187-191
        • Woby S.R.
        • Loach N.K.
        • Urmston M.
        • Watson P.J.
        Outcome following a physiotherapist-led intervention for chronic low back pain: the important role of cognitive factors.
        Physiotherapy. 2008; 94: 115-124
        • Bennett R.M.
        • Friend R.
        • Jones K.D.
        • Ward R.
        • Han B.K.
        • Ross R.L.
        The Revised Fibromyalgia Impact Questionnaire (FIQR): validation and psychometric properties.
        Arthritis Res Ther. 2009; 11: R120
        • Salaffi F.
        • Stancati A.
        • Silvestri C.A.
        • Ciapetti A.
        • Grassi W.
        Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale.
        Eur J Pain. 2004; 8: 283-291
        • Chalder T.
        • Berelowitz G.
        • Pawlikowska T.
        • Watts L.
        • Wessely S.
        • Wright D.
        • et al.
        Development of a fatigue scale.
        J Psychosom Res. 1993; 37: 147-153
        • Fong T.C.T.
        • Chan J.S.M.
        • Chan C.L.W.
        • Ho R.T.H.
        • Ziea E.T.C.
        • Wong V.C.W.
        • et al.
        Psychometric properties of the Chalder Fatigue Scale revisited: an exploratory structural equation modelling approach.
        Qual Life Res. 2015; 24: 2273-2278
        • Sullivan M.J.L.
        • Bishop S.R.
        • Pivik J.
        The pain catastrophizing scale: development and validation.
        Psychol Assess. 1995; 7: 524-532
        • Osman A.
        • Barrios F.X.
        • Kopper B.A.
        • Hauptmann W.
        • Jones J.
        • O’Neill E.
        Factor structure and validity of the pain catastrophizing scale.
        J Behav Med. 1997; 20: 589-605
        • D’Eon J.L.
        • Harris C.A.
        • Ellis J.
        Testing factorial validity and gender invariance of the pain catastrophizing scale.
        J Behav Med. 2004; 27: 361-372
        • Woby S.R.
        • Roach N.K.
        • Urmston M.
        • Watson P.J.
        The relation between cognitive factors and levels of pain and disability in chronic low back pain patients presenting for physiotherapy.
        Eur J Pain. 2007; 11: 869-877
        • Cohen J.
        A power primer.
        Psychol Bull. 1992; 112: 155-159
        • Field A.
        Discovering statistics using SPSS for windows.
        2nd ed. SAGE Publication, London2005
        • White P.D.
        • Goldsmith K.A.
        • Johnson A.L.
        • Potts L.
        • Walwyn R.
        • De Cesare J.C.
        • et al.
        Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial.
        Lancet. 2011; 377: 8236
        • Larun L.
        • Brurberg K.G.
        • Odgaard-Jensen J.
        • Price J.R.
        Exercise therapy for chronic fatigue syndrome.
        Cochrane Database Syst Rev. 2019; : 10
        • Chalder T.
        • Goldsmith K.A.
        • White P.D.
        • Sharpe M.
        • Pickles A.R.
        Rehabilitative therapies for chronic fatigue syndrome: a secondary mediation analysis of the PACE trial.
        Lancet Psychiatry. 2015; 2: 141-152
        • Ericsson A.
        • Palstam A.
        • Larsson A.
        • Löfgren M.
        • Bileviciute-Ljungar I.
        • Bjersing J.
        • et al.
        Resistance exercise improves physical fatigue in women with fibromyalgia: a randomized controlled trial.
        Arthritis Res Ther. 2016; 18: 176
        • Heijnen S.
        • Hommel B.
        • Kibele A.
        • Colzato L.S.
        Neuromodulation of aerobic exercise – a Review.
        Front Psychol. 2016; 6: 1890
        • Lamb S.E.
        • Hansen Z.
        • Lall R.
        • Castelnuovo E.
        • Withers E.J.
        • Nichols V.
        • et al.
        Back Skills Training Trial investigators. Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis.
        Lancet. 2010; 375: 916-923
        • Tabachnick B.G.
        • Fidell L.S.
        Using multivariate statistics.
        6th ed. Pearson, Essex2014