Relationship between psychological factors and performance-based and self-reported disability in chronic low back pain

Eur Spine J. 2008 Nov;17(11):1448-56. doi: 10.1007/s00586-008-0772-0. Epub 2008 Sep 16.


Cross sectional study, performed in an outpatient university based pain rehabilitation setting. To analyze the relationship between psychological factors (psychosocial distress, depression, self efficacy, self-esteem, fear of movement, pain cognitions and coping reactions) and performance-based and self-reported disability, as measured with a Functional Capacity Evaluation (FCE) and the Roland Morris Disability Questionnaire (RMDQ), in patients with chronic low back pain (CLBP). It has been suggested that a strong relationship exists between psychological factors and disability in patients with CLBP. In former research disability was often measured by self-report and seldom performance-based. Study sample consisted of 92 patients with CLBP admitted for multidisciplinary rehabilitation. Prior to treatment, all patients completed questionnaires to measure psychological factors and self-reported disability, and performed an FCE to measure performance-based disability. Correlation coefficients between psychological variables and FCE and self-reported disability were calculated. Multivariate linear regression analyses were performed with self-reported or performance based disability measures as outcome variables, and psychological measures as predictor variables. Out of 42 relations analyzed, 5 were statistically significant. This concerned one significant correlation between kinesiophobia and a subtest of FCE, and four correlations between psychological factors and RMDQ. No correlation was significant after the Bonferroni correction was applied (P < 0.001). The strength of significant correlations ranged from r = -0.33 to r = 0.25. The multivariate analysis revealed that psychological variables measured in this study could explain 19% of the variance of self-reported disability, with kinesiophobia being the only psychological variable that contributed significantly. The suggested strong relationship between psychological factors and performance-based and self-reported disability could not be confirmed in this study. This may implicate that the relationship between psychological factors and disability in patients with CLBP is not as unambiguous as suggested.

MeSH terms

  • Activities of Daily Living / psychology*
  • Adaptation, Psychological
  • Adult
  • Chronic Disease / psychology
  • Comorbidity
  • Cross-Sectional Studies
  • Disability Evaluation*
  • Fear / psychology
  • Female
  • Humans
  • Illness Behavior*
  • Low Back Pain / epidemiology*
  • Low Back Pain / psychology*
  • Male
  • Middle Aged
  • Phobic Disorders / epidemiology
  • Phobic Disorders / psychology
  • Psychology
  • Regression Analysis
  • Self Concept
  • Self-Assessment
  • Stress, Psychological / epidemiology*
  • Surveys and Questionnaires