Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain

BACKGROUND: Unhelpful pain cognitions of patients with chronic low back pain (LBP) may limit physical performance and undermine physical assessment. It is not known whether a direct relationship exists between pain cognitions and physical performance. AIMS: To determine if a relationship exists between change in pain cognitions and change in physical performance when chronic LBP patients participate in a single one-to-one education intervention during which they have no opportunity to be active. METHODS: In a quasi-experiment using a convenience sample, moderately disabled chronic LBP patients (n=121) participated in a one-to-one education session about either lumbar spine physiology or pain physiology. Multiple regression analysis evaluated the relationship between change in pain cognitions measured by the survey of pain attitudes (SOPA) and the pain catastrophising scale (PCS) and change in physical performance, measured by the straight leg raise (SLR) and standing forward bending range. RESULTS: There was a strong relationship between cognitive change and change in straight leg raise (SLR) and forward bending (r=0.88 and 0.79, respectively, P<0.01), mostly explained by change in the conviction that pain means tissue damage and catastrophising. CONCLUSIONS: Change in pain cognitions is associated with change in physical performance, even when there is no opportunity to be physically active. Unhelpful pain cognitions should be considered when interpreting physical assessments.