State anxiety improves prediction of pain and pain-related disability after 12 weeks in patients with acute low back pain: a cohort study

J Physiother. 2020 Jan;66(1):39-44. doi: 10.1016/j.jphys.2019.11.011. Epub 2019 Dec 18.


Question: Do measures of state anxiety and trait anxiety in people with acute low back pain (ALBP) improve prediction of chronic low back pain (CLBP), defined as pain or pain-related disability at 12 weeks?

Design: Observational multi-centre prospective cohort study in primary physiotherapy care with measurements at baseline and at 12 weeks of state and trait anxiety, as well as other established prognostic factors for CLBP.

Participants: People with nonspecific ALBP, aged 18 to 60 years, who had been pain free for ≥ 3 months before their current ALBP, and who were being treated according the Dutch clinical guidelines.

Outcome measures and analysis: CLBP was defined as a pain score ≥ 3/10 on the Numerical Pain Rating Scale (primary outcome), and as a pain-related disability score ≥ 19/70 on the Pain Disability Inventory. Univariate and multivariate logistic regression analyses estimated how the risk of CLBP differed with state and trait anxiety and other established prognostic factors.

Results: Most (204 of 225) participants completed both assessments. State anxiety was an independent predictor of CLBP, whether defined as pain or pain-related disability at 12 weeks, in contrast to trait anxiety. State anxiety improved the predictive performance of the model, with area under the curve (AUC) increasing from 0.64 (95% CI 0.56 to 0.71) to 0.75 (95% CI 0.68 to 0.82) and Nagelkerke's R2 increasing from 0.08 to 0.24 for the primary outcome measure, pain. For the secondary outcome measure, pain-related disability: AUC 0.63 (95% CI 0.54 to 0.72) improved to 0.73 (95% CI 0.65 to 0.82) and Nagelkerke's R2 increased from 0.05 to 0.16. Adding trait anxiety to the prognostic model for pain improved the AUC from 0.64 (95% CI 0.56 to 0.71) to 0.70 (95% CI 0.62 to 0.77) and Nagelkerke's R2 from 0.08 to 0.15.

Conclusion: State anxiety in patients with ALBP improved prediction of CLBP, defined as pain and pain-related disability at 12 weeks.

Keywords: Anxiety; Prediction; Prognostic factor; Psychological; Risk; Spinal low back pain.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Acute Disease / psychology
  • Adolescent
  • Adult
  • Anxiety / psychology*
  • Disability Evaluation
  • Female
  • Humans
  • Low Back Pain / psychology*
  • Male
  • Middle Aged
  • Pain Measurement
  • Prognosis
  • Prospective Studies
  • Young Adult