Biopsychosocial beliefs in patients with chronic low back pain as predictors for discharge time, pain intensity, global improvement perception and functionality degree

Abstract

Introduction: Low back pain is the world's leading cause of years of sick leave due to disability. Biopsychosocial factors are frequently investigated in patients with chronic non-specific low back pain (DLCI), and among them is the Health Locus of Control
(LCS), which consists of the individual's perception of their health. The main guidelines point out that the approach to these patients should prioritize active rather than passive interventions as the first line of treatment. Physiotherapy and chiropractic have Concept A - Strong recommendation for treating DCLI. Objective: The objective of this study was to identify whether LCS is a predictor for pain intensity, degree of functionality, perception of global improvement and time to discharge in individuals with CILD treated with general physiotherapy and chiropractic. Methods: This is a longitudinal observational study, where participants were divided into two groups (G1: general physiotherapy; G2: chiropractic), being evaluated at baseline and re-evaluated at the time of discharge or after three months of intervention. At baseline, sociodemographic data was collected from the participants and the Multidimensional Health Locus of Control Questionnaire (QMLCS), the Numerical Pain Scale (END) and the Patient Specific Functional Scale (EFEP) were self-completed. At the time of discharge or after three months of intervention, the QMLCS, the END and the EFEP were handed over to be completed, in addition to the Global Perception of Improvement Scale. Discharge time was measured by the number of days the participant spent in treatment. Results: 58 participants were included with a mean age of 51,2 ± 15,6 years, where 32 (55.17%) participants had an “internal” locus, 25 (43.10%) an “external” locus and 1 (1.72%) “random” locus. Regardless of the type of locus and intervention, it was found that there was no significant change in the locus after 3 months (p=0.753). When evaluating whether the type of locus was a predictor for the primary outcomes, it was found that there was no significant difference in the interaction between the groups and the types of locus of control in pain (p=0.156) and functionality (p=0.053). When checking whether the type of locus interfered in the secondary outcomes, it was observed that there was no significant difference in the perception of global improvement (p=0.757) and discharge time (p=0.415). Conclusion: The type of LCS was not a predictor for improving pain intensity, decreasing the degree of functionality, increasing the perception of global improvement, or reducing discharge time. Regarding the type of locus of control, there were no significant changes between the groups after discharge or after three months of intervention.