The Effect of Psychosocial Measures of Resilience and Self-Efficacy in Patients with Neck and Lower Back Pain

Publication date: Available online 12 June 2018
Source:The Spine Journal
Author(s): Shaan A. Ahmed, Govind Shantharam, Adam E.M. Eltorai, Davis A. Hartnett, Avi Goodman, Alan H. Daniels
BACKGROUND CONTEXTPsychosocial risk factors may predispose to progression of back and neck pain to chronic pain or disability. Resilience (the ability to recover from stress) and pain self-efficacy (confidence that one can perform daily activities despite pain) are important psychometric properties shown to affect health and illness.PURPOSETo examine the relationships among resilience, pain self-efficacy, and disability in spine patients.STUDY DESIGN/SETTINGProspective, single-center orthopedic spine clinic.PATIENT SAMPLE195 patients in a tertiary spine practice recruited between December 2016 and March 2017.OUTCOME MEASURESSelf-reported measures: Brief Resilience Scale (BRS), Pain Self-Efficacy Questionnaire Short-Form (PSEQ-2), Neck Disability Index (NDI), Oswestry Disability Index (ODI).METHODSA prospective study was conducted of new patients visiting an orthopaedic spine clinic complaining of neck pain or low back pain, with or without radiculopathy. Enrolled patients completed a survey of demographic information, the 6-question Brief Resilience Scale (BRS), the 2-question Pain Self-Efficacy Questionnaire Short Form (PSEQ-2), and Neck Disability Index (NDI) or Oswestry Disability Index (ODI) for neck or back pain, respectively. The relationship between BRS and NDI or ODI was examined, and the relationship between PSEQ-2 and NDI or ODI was also examined.RESULTSA total of 195 patients were evaluated. After excluding those with incomplete NDI or ODI, 180 patients were included in the analysis (46.1% male (83/180); mean age 53 (SD: 17) years). 139 (77.2%) subjects complained of low back pain and 41 (22.8%) subjects complained of neck pain. BRS was strongly negatively correlated with NDI (r = -0.61, p<0.0001) and moderately negatively correlated with ODI (r = -0.34, p<0.0001). PSEQ-2 was strongly negatively correlated with NDI (r = -0.69, p<0.0001) and strongly negatively correlated with ODI (r = -0.62, p<0.0001). BRS was moderately positively correlated with PSEQ-2 (r = 0.36, p<0.0001). For the low back pain cohort, the correlation between PSEQ-2 and ODI was significantly greater than the correlation between BRS and ODI (p=0.0003); this difference was not noted in the neck pain cohort (p=0.34).CONCLUSIONSLow resilience and low pain self-efficacy are both independently associated with greater functional disability in neck and low back pain patients. Spine surgeons may find it useful to incorporate the BRS and PSEQ-2 into preoperative assessment. Future studies should examine the utility of these simple validated questionnaires in predicting response to treatments, including surgical intervention.



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