INVESTIGATION OF PSYCHOSOCIAL AND FUNCTIONAL DYNAMICS IN INDIVIDUALS WITH CHRONIC LOW BACK PAIN

Abstract

Purpose: The aim of this study was to compare the functional status, psychological status, quality of life and disability levels of individuals with chronic low back pain (LBP) of different origins with healthy individuals. Methods: A total of 141 individuals, including healthy, nonspecific, non-radiculopathy and radiculopathy groups, participated in the study. Measurements included, the International Physical Activity Questionnaire, physical endurance tests, Visual Analogue Scale, Roland Morris Disability Questionnaire, Trait Anxiety Inventory, Fear Avoidance Beliefs questionnaire and Nottingham Health Profile. Results: Psychological status, disability level and quality of life scores except anxiety level in individuals with chronic LBP differed significantly in the lowest nonspecific group and the highest in the radiculopathy group (p<0.001). Trunk extensor endurance showed a significant difference in favour of the healthy group compared to the other groups, whereas trunk flexion endurance showed a significant difference between all groups. A good correlation was found between the pain level of the patients with the quality of life and fear avoidance behavior, and a very good correlation was found with the disability level (p<0.001, r=0.666, r=0.790, r=0.865, respectively). Conclusion: Due to the differences in the endurance levels and psychosocial situation between patients with low back pain, it is important to plan for the treatment taking into account both the physical and psychological needs of the individual change.

Keywords

• Anxiety
• Fear
• Low Back Pain
• Quality of Life

KRONİK BEL AĞRISI OLAN BİREYLERDE PSİKOSOSYAL VE FONKSİYONEL DİNAMİKLERİN İNCELENMESİ

Öz

Amaç: Bu çalışmanın amacı farklı kökenlere sahip kronik bel ağrısı olan bireyler ile sağlıklı bireyler arasında fonksiyonel durum, psikolojik durum, yaşam kalitesi ve dizabilite düzeyini karşılaştırmaktır. Yöntem: Çalışmaya sağlıklı, nonspesifik, non-radikülopati ve radikülopati gruplarına dahil olan toplam 141 kişi katıldı. Ölçüm parametreleri olarak Uluslararası Fiziksel Aktivite Anketi, fiziksel endurans testleri, Görsel Analog Skala, Roland Morris Dizabilite Anketi, Sürekli Kaygı Envanteri, Korkudan Kaçınma İnançları anketi ve Nottingham Sağlık Profili kullanıldı. Sonuçlar: Kronik bel ağrısı olan bireylerde anksiyete düzeyi dışındaki psikolojik durum, dizabilite düzeyi ve yaşam kalitesi puanları, en düşük nonspesifik grupta ve en yüksek radikülopati grubunda anlamlı farklılık gösterdi (p<0,001). Gövde ekstansör dayanıklılığı diğer gruplara göre sağlıklı grup lehine anlamlı farklılık gösterirken, gövde fleksiyon dayanıklılığı tüm gruplar arasında anlamlı farklılık gösterdi. Hastaların ağrı düzeyi ile yaşam kalitesi ve korkudan kaçınma davranışı arasında iyi bir korelasyon olduğu, dizabilite düzeyi arasında ise çok iyi bir korelasyon olduğu belirlendi (p<0,001, r=0,666, r=0,790, r=0,865, sırasıyla). Tartışma: Gruplar arasındaki endurans düzeyi ve psikososyal durum farklılıklarından dolayı, bireyin hem fiziksel hem de psikolojik ihtiyaçlarının değiştiği göz önünde bulundurularak tedavinin planlanması önemlidir.

Anahtar Kelimeler

• Anksiyete
• Korku
• Bel Ağrısı
• Yaşam Kalitesi

Kaynakça

1. Mbada CE, Ayanniyi O, Ogunlade SO. Comparative efficacy of three active treatment modules on psychosocial variables in patients with long-term mechanical low-back pain: a randomized-controlled trial. Arch Physiother. 2015;21(5):10. doi: 10.1186/s40945-015-0010-0
2. Hauser RA, Matias D, Woznica D, Rawlings B, Woldin BA. Lumbar instability as an etiology of low back pain and its treatment by prolotherapy: A review. J Back Musculoskelet Rehabil. 2022;35(4):701-712. doi:10.3233/BMR-210097
3. Grabovac I, Dorner TE. Association between low back pain and various everyday performances : Activities of daily living, ability to work and sexual function. Wien Klin Wochenschr. 2019;131(21-22):541-549. doi: 10.1007/s00508-019-01542-7
4. Taylor JB, Goode AP, George SZ, Cook CE. Incidence and risk factors for first-time incident low back pain: A systematic review and meta-analysis. The Spine Journal. 2014;14(10):2299-2319. doi: 10.1016/j.spinee.2014.01.026
5. Zheng YL, Wang XF, Chen BL et al. Effect of 12-Week Whole-Body Vibration Exercise on Lumbopelvic Proprioception and Pain Control in Young Adults with Nonspecific Low Back Pain. Med Sci Monit. 2019;15;25:443-452. doi: 10.12659/MSM.912047
6. Parreira P, Maher CG, Steffens D, et al. Risk factors for low back pain and sciatica: an umbrella review. Spine J. 2018;18(9):1715–21. doi: 10.1016/j.spinee.2018.05.018
7. Zale EL, Lange KL, Fields SA, Ditre JW. The Relation Between Pain-Related Fear and Disability: A Meta-Analysis. J Pain. 2013;14(10):1019–1030. doi: 10.1016/j.jpain.2013.05.005
8. Luque-Suarez A, Martinez-Calderon J, Falla D. Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. Br J Sports Med. 2019;53(9):554–559. doi: 10.1136/bjsports-2017-098673

9. Crombez G, Eccleston C, Van Damme S, Vlaeyen JW, Karoly P. Fear-avoidance model of chronic pain: the next generation. Clin J Pain. 2012 Jul;28(6):475-83. doi: 10.1097/AJP.0b013e3182385392
10. Bunzli S, Smith A, Schütze R, Lin I, O'Sullivan P. Making Sense of Low Back Pain and Pain-Related Fear. J Orthop Sports Phys Ther. 2017 Sep;47(9):628-636. doi: 10.2519/jospt.2017.7434
11. Oliveira CB, Maher CG, Pinto RZ et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791–2803. doi: 10.1007/s00586-018-5673-2
12. Pincus T, Burton AK, Vogel S, Field AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine. (Phila Pa 1976). 2002;1;27(5):E109-20. doi: 10.1097/00007632-200203010-00017
13. Santos MCF, Santos JPM, Júnior RAS, et al. Emotional and disability status in patients with chronic low back pain. Int J Radiol Radiat Ther. 2020;7(2):57‒61. doi: 10.15406/ijrrt.2020.07.00265
14. Garbi Mde O, Hortense P, Gomez RR, da Silva Tde C, Castanho AC, Sousa FA. Pain intensity, disability and depression in individuals with chronic back pain. Rev Lat Am Enfermagem. 2014;22(4):569-75. doi: 10.1590/0104-1169.3492.2453
15. Cho KH, Beom JW, Lee TS, Lim JH, Lee TH, Yuk JH. Trunk muscles strength as a risk factor for nonspecific low back pain: A pilot study. Ann Rehabil Med. 2014; 38: 234-240. doi: 10.5535/arm.2014.38.2.234
16. Guclu DG, Guclu O, Ozaner A, Senormanci O, Konkan R. The relationship between disability, quality of life and fear-avoidance beliefs in patients with chronic low back pain. Turk Neurosurg. 2012;22(6):724-31. doi: 10.5137/1019-5149.JTN.6156-12.1
17. Kovascs FM, Abraira V, Zamora J, Fernandez C: The transition from acute to subacute and chronic low back pain: A study based on determinants of quality of life and prediction of chronic disability. Spine. 2005;30:1786-1792. doi: 10.1097/01.brs.0000172159.47152.dc
18. Agnus Tom A, Rajkumar E, John R, Joshua George A. Determinants of quality of life in individuals with chronic low back pain: a systematic review. Health Psychol Behav Med. 2022;10(1):124-144. doi: 10.1080/21642850.2021.2022487
19. Biering-Sorensen F. Physical measurements as risk indicators for low-back trouble over a one-year period. Spine 1984;9;106–19. doi: 10.1097/00007632-198403000-00002
20. McGill SM, Childs A, Liebenson C. Endurance times for low back stabilization exercises: Clinical targets for testing and training from a normal database. Arch Phys Med Rehabil. 1999;(80):941-944. doi: 10.1016/s0003-9993(99)90087-4
21. Durall CJ Greene PF Kernozek TW. A comparison of two isometric tests of trunk flexor endurance. J Strength Cond Res. 2012;26:1939-1944. doi: 10.1519/JSC.0b013e318237ea1c
22. Saglam M, Arikan H, Savci S, Inal-Ince D, Bosnak-Guclu M, Karabulut E, Tokgozoglu L. International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills. 2010;111(1):278-84. doi: 10.2466/06.08.PMS.111.4.278-284
23. Stevens ML, Lin CCW, Maher CG. The Roland Morris Disability Questionnaire. Journal of Physiotherapy. 2016;62:116. doi: 10.1016/j.jphys.2015.10.003
24. Kucukdeveci AA, Tennant A, Elhan AH, Niyazoglu H. Validation of the Turkish version of the Roland-Morris Disability Questionnaire for use in low back pain. Spine. 2001;15;26(24):2738-43. doi: 10.1097/00007632-200112150-00024
25. Uutela T, Hakala M, Kautiainen H. Validity of the Nottingham Health Profile in a Finnish out-patient population with rheumatoid arthritis. Rheumatology (Oxford). 2003;42(7):841-5. doi: 10.1093/rheumatology/keg229
26. Öner N, Le Compte A. Durumluk—sürekli kaygı envanteri el kitabı [Manual for state-trait anxiety inventory]. Istanbul: 2nd Edition, Boğaziçi University Publications; 1998. 2. Basım, Bogazici Universitesi Yayınevi, Istanbul (1998).
27. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear Avoidance Beliefs Questionnaire (FABQ) And The Role Of Fear-avoidance Beliefs In Chronic Low Back Pain And Disability. Pain. 1993;52(2), 157-168. doi: 10.1016/0304-3959(93)90127-B
28. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J. 2000;9(4):266-72. doi: 10.1007/s005860000190
29. Li X, Hu L. The Role of Stress Regulation on Neural Plasticity in Pain Chronification. Neural Plast. 2016;2016:6402942. doi: 10.1155/2016/6402942
30. Lundberg U. Stress hormones in health and illness: the roles of work and gender. Psychoneuroendocrinology. 2005;30(10):1017-21. doi: 10.1016/j.psyneuen.2005.03.014
31. Mathew J, Singh SB, Garis S, Diwan AD. Backing up the stories: The psychological and social costs of chronic low-back pain. Int J Spine Surg. 2013;7:e29-38. doi: 10.1016/j.ijsp.2013.02.001
32. Ramond A, Bouton C, Richard I, Roquelaure Y, Baufreton C, Legrand E, Huez JF. Psychosocial risk factors for chronic low back pain in primary careda systematic review. Family Practice. 2011;28:12e21. doi: 10.1093/fampra/cmq072
33. Alhowimel A, AlOtaibi M, Radford K, Coulson N. Psychosocial factors associated with change in pain and disability outcomes in chronic low back pain patients treated by physiotherapist: A systematic review. SAGE Open Med. 2018;6:2050312118757387. doi: 10.1177/2050312118757387
34. Zale EL, Ditre JW. Pain-Related Fear, Disability, and the Fear-Avoidance Model of Chronic Pain. Curr Opin Psychol. 2015;1;5:24-30. doi: 10.1016/j.copsyc.2015.03.014
35. Hussain SM, Urquhart DM, Wang Y, Shaw JE, Magliano DJ, Wluka AE, Cicuttini FM. Fat mass and fat distribution are associated with low back pain intensity and disability: results from a cohort study. Arthritis Res Ther. 2017;19:26. doi: 10.1186/s13075-017-1242-z
36. Bohannon RW, Steffl M, Glenney SS, Green M, Cashwell L, Prajerova K, Bunn J. The prone bridge test: Performance, validity, and reliability among older and younger adults. J Bodyw Mov Ther. 2018;22(2):385-389. doi: 10.1016/j.jbmt.2017.07.005