The effect of multidisciplinary rehabilitation on pain self-efficacy, fear-avoidance beliefs and psychological distress in people with chronic low back pain

Abstract

Chronic low back pain (LBP) is globally a major cause of pain-related disability. This thesis looks at the association of psychological factors and pain-related disability arising from chronic LBP with the effect of multidisciplinary rehabilitation. It is currently unknown how the changes within pathways in pain self-efficacy, fear-avoidance beliefs, depression, anxiety and stress mediate the relationship within multidisciplinary rehabilitation in people with chronic LBP. Improved understanding of the mechanisms by which changes in psychological factors mediate changes in pain-related disability in the population that have chronic LBP can assist in the improvement of multidisciplinary rehabilitation programs. The aim of this thesis was to investigate the extent to which psychological factors associated with pain-related disability in people with chronic LBP improved through an 8-week multidisciplinary rehabilitation program for chronic LBP and document the associations between psychological factors and the outcomes. The thesis aimed: to 1) investigate the effects of multidisciplinary rehabilitation on pain self-efficacy, fear-avoidance beliefs, depression, anxiety, stress and disability in people with chronic LBP, and 2) document the mediating effects of changes in pain self-efficacy, fear-avoidance beliefs, depression, anxiety and stress on the changes in pain-related disability in people with chronic LBP... This thesis contributes to the understanding of the effect of multidisciplinary rehabilitation for people with chronic LBP and the psychological factors associated with pain-related disability. These results have shown multidisciplinary rehabilitation for people with chronic LBP has a beneficial effect on the psychological factors associated with pain-related disability. However, pain self-efficacy, fear-avoidance beliefs, depression, anxiety and stress did not mediate the relationship of pain-related disability in people with chronic LBP. Although pain self-efficacy, fear-avoidance beliefs and psychological distress were not found to be mediators of pain-related disability, these findings still provide researchers with preliminary results and methodological considerations for a future high-powered study. The findings also prompt practitioners to identify modifiable factors of multidisciplinary rehabilitation outcomes.

Date of Thesis submission	2023
Original language	English
Awarding Institution	Western Sydney University
Supervisor	Karen Liu (Supervisor), Paul Fahey (Supervisor), Paul Marshall (Supervisor) & Alex Gavino (Supervisor)