A further investigation of the importance of pain cognition and behaviour in pain rehabilitation: longitudinal data suggest disability and fear of movement are most important

BACKGROUND: Tailored treatments are topical in pain rehabilitation. One key issue for correlational studies is the identification of factors having a potential causal impact on essential treatment outcomes. OBJECTIVE: To study associations between pain beliefs and disability with regard to the amount and time-frame of available data. DESIGN: A prospective, correlational design. SUBJECTS AND SETTING: Ninety-two patients consulting physical therapists in primary care for persistent musculoskeletal pain. MAIN MEASURES: The Pain Disability Index, the Self-Efficacy Scale and the Tampa Scale of Kinesiophobia. RESULTS: Functional self-efficacy and fear of movement/(re)injury explained variance in pain-related disability pretreatment (adj R(2) = 0.41). Self-efficacy was the most salient predictor. Adding data from immediately post treatment decreased explained variance (adj R(2) = 0.25). Functional self-efficacy and fear of movement/ (re)injury lost their significant contribution in favour of pain-related disability at baseline. Change scores in functional self-efficacy and fear of movement/(re)injury accounted for a modest share of explained variance in change scores of disability (adj R(2) = 0.11). Fear of movement/(re)injury but not functional self-efficacy was related to a reliable change in pain-related disability. CONCLUSIONS: Longitudinal data suggest that pretreatment levels of pain-related disability and changes in fear of movement/(re)injury are most important to immediate treatment outcomes and individual reliable change. Disability and elevated fear of movement/(re)injury should therefore be addressed in tailored pain treatments.