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- specific and performance-specific cognitive variables on lifting tasks using empirically derived measures. Objectives. To determine the relative contributions of self efficacy expectancies of lifting performance, perceptions of pain control, and anxiety on 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. This study extended the scope of recent research, with findings indicating that patients with a stronger functional self efficacy expectancy-the belief that one can perform essential work tasks successfully achieve higher levels of function than those with a low functional self efficacy expectancy. Moreover, as a performance-specific variable, functional self efficacy expectancy was hypothesized to be a better predictor of lifting than pain-specific cognitions, which presumably influence function in an indirect manner, if at all. Methods. Before undergoing a standardized, graded lifting assessment, 100 work-disabled patients with chronic back pain rated their confidence to perform load-lifting tasks essential to their job (functional self efficacy expectancy), their ability to control and decrease pain, and psychological distress. Results. Multiple regression analyses found that functional self efficacy expectancy accurately predicted lifting. It was found to be a better predictor of lifting tasks than either of the perceived pain control measures or psychological distress. Conclusion. Data suggest that what patients believed they could achieve accurately determined their actual spinal function, independent of their sense of control over pain or their distress. Approaches to low back disorders emphasizing perceived pain control as a central cognitive determinant of disability were unsupported.