Does a physiotherapy cognitive behavioural chronic low back pain programme alter patients’ health locus of control?

Braddock, Sharon (2016) Does a physiotherapy cognitive behavioural chronic low back pain programme alter patients’ health locus of control? Doctoral thesis (Degree of Professional Doctorate), Manchester Metropolitan University.

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Abstract

BACKGROUND: Health locus of control (HLOC) is a person’s belief of where responsibilities for his/her health condition lies. It is associated with health attitudes, behaviours and outcomes in non-specific chronic low back pain (NSCLBP). It is unknown whether a physiotherapy cognitive-behavioural chronic low back pain (CBCLBP) programme affects patients’ HLOC. AIMS: To examine: (1) the effect of a six-week CBCLBP programme on the patients’ primary outcome-HLOC, and also pain intensity, disability, fear-avoidance belief (FAB) and self-care attitude; (2) the association between changes in pain intensity, disability and FAB and changes in HLOC; and (3) the cost of producing any effect. METHODS: In an A-B-A same-subject design, patients referred to the CBCLBP programme with high FAB (TSK score> 37) were recruited. Patients attended a six-week programme. Outcomes were measured four weeks before (-4 weeks), at the start, at completion, 3- and 6-months after the programme. Friedman’s ANOVA and Wilcoxon signed-rank tests determined changes between phases. Multiple regression determined the relationship between HLOC and outcome of interest. Significance was set at 0.05. RESULTS: A total of 70 patients were recruited. Fifty-five patients entered the programme and all completed 6-months follow-up. The CBCLBP programme significantly improved HLOC (p<0.001), pain intensity (p<0.001), disability (p<0.001), FAB (p<0.001) and self-care attitude (p<0.001), with such improvement being sustained for 6 months. Changes in HLOC explained 6%, 0.5% and 31.9% variances in changes in pain, disability and FAB respectively, after controlling other variables. Increased internal locus of control (ILOC) was a significant predictor of reduction in FAB (p=0.002). HLOC was not predictive of reduction in pain intensity or disability. Mean provider cost of the programme was £285.82 per patient. CONCLUSION: Our 6-week CBCLBP programme was effective in changing a person’s belief about where responsibility for his/her health condition lies. It also improved their pain, disability, FAB and attitude to self-care. Making patients believe that they can take control, and they are the one responsible for their NSCLBP management is linked to reduction in FAB, highlighting the potential importance of improving ILOC in attaining better FAB outcome. We have also provided guidance to managers and budget allocators that this costs £285.82 per patient.