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Self-efficacy beliefs mediate the association between pain intensity and pain interference in acute/subacute whiplash-associated disorders

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Abstract

Purpose

To evaluate whether a set of pre-accident demographic, accident-related, post-accident treatment and psychosocial factors assessed in people with acute/subacute whiplash-associated disorders (WAD) mediate the association between pain intensity and: (1) pain interference and (2) expectations of recovery, using Bayesian networks (BNs) analyses. This study also explored the potential mediating pathways (if any) between different psychosocial factors.

Methods

This was a cross-sectional study conducted on a sample of 173 participants with acute/subacute WAD. Pain intensity, pain interference, pessimism, expectations of recovery, pain catastrophizing, and self-efficacy beliefs were assessed. BN analyses were conducted to analyse the mediating effects of psychological factors on the association between pain intensity and pain-related outcomes.

Results

The results revealed that self-efficacy beliefs partially mediated the association between pain intensity and pain interference. Kinesiophobia partially mediated the association between self-efficacy and pain catastrophizing. Psychological factors did not mediate the association between pain intensity and expectations of recovery.

Conclusion

These results indicate that individuals with acute/subacute WAD may present with lesser pain interference associated with a determined pain intensity value when they show greater self-efficacy beliefs. As the cross-sectional nature of this study limits firm conclusions on the causal impact, researchers are encouraged to investigate the role that patient’s self-efficacy beliefs play in the transition to chronic WAD via longitudinal study designs.

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References

  1. Elliott JM, Walton DM (2017) How do we meet the challenge of whiplash? J Orthop Sports Phys Ther 47:444–446. https://doi.org/10.2519/jospt.2017.0106

    Article  PubMed  Google Scholar 

  2. Bin CH, Yang KH, Wang ZG (2009) Biomechanics of whiplash injury. Chin J Traumatol—English Ed 12:305–314. https://doi.org/10.3760/cma.j.issn.1008-1275.2009.05.011

    Article  Google Scholar 

  3. Pink J, Petrou S, Williamson E et al (2016) Economic and health-related quality of life outcomes of whiplash associated disorders. Spine 41:1378–1386. https://doi.org/10.1097/BRS.0000000000001512

    Article  PubMed  Google Scholar 

  4. Yadla S, Ratliff JK, Harrop JS (2007) Whiplash: diagnosis, treatment, and associated injuries. Curr Rev Musculoskelet Med 1:65–68. https://doi.org/10.1007/s12178-007-9008-x

    Article  PubMed Central  Google Scholar 

  5. Hogg-Johnson S, van der Velde G, Carroll LJ et al (2008) The burden and determinants of neck pain in the general population. Eur Spine J 17:39–51. https://doi.org/10.1007/s00586-008-0624-y

    Article  PubMed Central  Google Scholar 

  6. Ritchie C, Hendrikz J, Kenardy J, Sterling M (2013) Derivation of a clinical prediction rule to identify both chronic moderate/severe disability and full recovery following whiplash injury. Pain 154:2198–2206. https://doi.org/10.1016/j.pain.2013.07.001

    Article  PubMed  Google Scholar 

  7. Ritchie C, Sterling M (2016) Recovery pathways and prognosis after whiplash injury. J Orthop Sports Phys Ther 46:851–861. https://doi.org/10.2519/jospt.2016.6918

    Article  PubMed  Google Scholar 

  8. Kamper SJ, Rebbeck TJ, Maher CG et al (2008) Course and prognostic factors of whiplash: a systematic review and meta-analysis. Pain 138:617–629. https://doi.org/10.1016/j.pain.2008.02.019

    Article  PubMed  Google Scholar 

  9. Walton DEJ (2017) An integrated model of chronic whiplash-associated disorder. J Orthop Sport Phys Ther 47:462–471

    Article  Google Scholar 

  10. Nieto R, Miró J, Huguet A (2009) The fear-avoidance model in whiplash injuries. Eur J Pain 13:518–523. https://doi.org/10.1016/j.ejpain.2008.06.005

    Article  PubMed  Google Scholar 

  11. Vangronsveld K, Peters M, Goossens M et al (2007) Applying the fear-avoidance model to the chronic whiplash syndrome. Pain 131:258–261. https://doi.org/10.1016/j.pain.2007.04.015

    Article  PubMed  Google Scholar 

  12. Campbell L, Smith A, McGregor L, Sterling M (2018) Psychological factors and the development of chronic whiplash associated disorder(s). Clin J Pain 34:755–768

    Article  PubMed  Google Scholar 

  13. Söderlund A, Sandborgh M, Johansson A-C (2017) Is self-efficacy and catastrophizing in pain-related disability mediated by control over pain and ability to decrease pain in whiplash-associated disorders? Physiother Theory Pract 33:376–385. https://doi.org/10.1080/09593985.2017.1307890

    Article  Google Scholar 

  14. Söderlund A, Åsenlöf P (2010) The mediating role of self-efficacy expectations and fear of movement and (re)injury beliefs in two samples of acute pain. Disabil Rehabil 32:2118–2126. https://doi.org/10.3109/09638288.2010.483036

    Article  PubMed  Google Scholar 

  15. Kamper SJ, Maher CG, Menezes Costa LDC et al (2012) Does fear of movement mediate the relationship between pain intensity and disability in patients following whiplash injury? A prospective longitudinal study. Pain 153:113–119. https://doi.org/10.1016/j.pain.2011.09.023

    Article  PubMed  Google Scholar 

  16. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PCVJSI (2014) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 12:1495–1499. https://doi.org/10.1016/j.ijsu.2014.07.013

    Article  Google Scholar 

  17. Karcioglu O, Topacoglu H, Dikme O, Dikme O (2018) A systematic review of the pain scales in adults: which to use? Am J Emerg Med 36:707–714. https://doi.org/10.1016/j.ajem.2018.01.008

    Article  PubMed  Google Scholar 

  18. Lorig KR, Ritter PL, González VM (2003) Hispanic chronic disease self-management: a randomized community-based outcome trial. Nurs Res 52:361–369. https://doi.org/10.1097/00006199-200311000-00003

    Article  PubMed  Google Scholar 

  19. Ramírez-Maestre C, Esteve R, López-Martínez AE et al (2019) Goal adjustment and well-being: the role of optimism in patients with chronic pain. Ann Behav Med 53:597–607. https://doi.org/10.1093/abm/kay070

    Article  PubMed  Google Scholar 

  20. Hirsch JK, Britton PC, Conner KR (2010) Psychometric evaluation of the life orientation test-revised in treated opiate dependent individuals. Int J Ment Health Addict 8:423–431. https://doi.org/10.1007/s11469-009-9224-2

    Article  Google Scholar 

  21. Ferrando PJ, Chico E, Tous M (2002) Propiedades psicométricas del test de optimismo Life Orientation Test. Psicothema 14:673–680

    Google Scholar 

  22. Sterling M, Jull G, Kenardy J (2006) Physical and psychological factors maintain long-term predictive capacity post-whiplash injury. Pain 122:102–108. https://doi.org/10.1016/j.pain.2006.01.014

    Article  PubMed  Google Scholar 

  23. Gómez L, López E, Ruiz GT (2011) Psychometric properties of the spanish version of the tampa scale for kinesiophobia (TSK). J Pain 12(4):425–35. https://doi.org/10.1016/j.jpain.2010.08.004

    Article  Google Scholar 

  24. García Campayo J, Rodero B, Alda M et al (2008) Validación de la versión española de la escala de la catastrofización ante el dolor (Pain Catastrophizing Scale) en la fibromialgia. Med Clin (Barc) 131:487–492. https://doi.org/10.1157/13127277

    Article  Google Scholar 

  25. Andrade Ortega JA, Delgado Martínez AD, Ruiz RA (2010) Validation of the Spanish version of the neck disability index. Spine (Phila Pa 1976) 35:E114–E118. https://doi.org/10.1157/13115352

    Article  Google Scholar 

  26. Scutari M (2010) Learning bayesian networks with the bn learn R package. J Stat Softw 35:22

    Article  Google Scholar 

  27. Scutari M, Nagarajan R (2013) Identifying significant edges in graphical models of molecular networks. Artif Intell Med 57:207–217. https://doi.org/10.1016/j.artmed.2012.12.006

    Article  PubMed  PubMed Central  Google Scholar 

  28. Crombez G, Eccleston C, Van DS et al (2012) Fear-Avoidance model of chronic pain. Clin J Pain 28:475–483. https://doi.org/10.1097/AJP.0b013e3182385392

    Article  PubMed  Google Scholar 

  29. Hinkle D, Wiersma WJS (2003) Applied statistics for the behavioral sciences. Houghton Mifflin, Boston

    Google Scholar 

  30. Nagarajan R, Scutari MLS (2013) Bayesian networks in R with applications in systems biology. Verlag, New York

    Book  Google Scholar 

  31. Nicholas MK (2007) The pain self-efficacy questionnaire: taking pain into account. Eur J Pain 11:153–163. https://doi.org/10.1016/j.ejpain.2005.12.008

    Article  PubMed  Google Scholar 

  32. Jackson T, Wang Y, Wang Y, Fan H (2014) Self-efficacy and chronic pain outcomes: a meta-analytic review. J Pain 15:800–814. https://doi.org/10.1016/j.jpain.2014.05.002

    Article  PubMed  Google Scholar 

  33. Martinez-Calderon J, Zamora-Campos C, Navarro-Ledesma S, Luque-Suarez A (2018) The role of self-efficacy on the prognosis of chronic musculoskeletal pain: a systematic review. J Pain 19:10–34. https://doi.org/10.1016/J.JPAIN.2017.08.008

    Article  PubMed  Google Scholar 

  34. Peck KR, Smitherman TA (2015) Mediator variables in headache research: methodological critique and exemplar using self-efficacy as a mediator of the relationship between headache severity and disability. Headache 55:1102–1111. https://doi.org/10.1111/head.12633

    Article  PubMed  Google Scholar 

  35. Schulz S, Brenk-Franz K, Kratz A et al (2015) Self-efficacy in multimorbid elderly patients with osteoarthritis in primary care—influence on pain-related disability. Clin Rheumatol 34:1761–1767. https://doi.org/10.1007/s10067-014-2766-0

    Article  PubMed  Google Scholar 

  36. Costa LDCM, Maher CG, McAuley JH et al (2011) Self-efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain. Eur J Pain 15:213–219. https://doi.org/10.1016/j.ejpain.2010.06.014

    Article  Google Scholar 

  37. Wallis BJ, Lord SM, Bogduk N (1997) Resolution of psychological distress of whiplash patients following treatment by radiofrequency neurotomy: a randomised, double-blind, placebo-controlled trial. Pain 73:15–22. https://doi.org/10.1016/s0304-3959(97)00060-2

    Article  CAS  PubMed  Google Scholar 

  38. Paré C, Thibault P, Côté P et al (2019) The relation between level of catastrophizing and mental health comorbidity in individuals with whiplash injuries. Clin J Pain 35:880–886. https://doi.org/10.1097/AJP.0000000000000749

    Article  PubMed  Google Scholar 

  39. Wicksell RK, Olsson GL, Hayes SC (2010) Psychological flexibility as a mediator of improvement in acceptance and commitment therapy for patients with chronic pain following whiplash. Eur J Pain 14:1059.e1-1059.e11. https://doi.org/10.1016/j.ejpain.2010.05.001

    Article  Google Scholar 

  40. Lee H, Hübscher M, Moseley GL et al (2015) How does pain lead to disability? A systematic review and meta-analysis of mediation studies in people with back and neck pain. Pain 156:988–997. https://doi.org/10.1097/j.pain.0000000000000146

    Article  PubMed  Google Scholar 

  41. Vlaeyen JWS, Linton SJ (2000) Fear-avoidance and its consequences in muscle skeleton pain: a state of the art. Pain 85:317–332

    Article  PubMed  Google Scholar 

  42. Sullivan MJL, Thorn B, Rodgers W, Ward LC (2004) Path model of psychological antecedents to pain experience: experimental and clinical findings. Clin J Pain 20:164–173. https://doi.org/10.1097/00002508-200405000-00006

    Article  PubMed  Google Scholar 

  43. He C-H, Yu F, Jiang Z-C et al (2014) Fearful thinking predicts hypervigilance towards pain-related stimuli in patients with chronic pain. PsyCh J 3:189–200. https://doi.org/10.1002/pchj.57

    Article  PubMed  PubMed Central  Google Scholar 

  44. Ohman A, Mineka S (2001) Fears, phobias, and preparedness: toward an evolved module of fear and fear learning. Psychol Rev 108:483–522. https://doi.org/10.1037/0033-295x.108.3.483

    Article  CAS  PubMed  Google Scholar 

  45. Mathews A (1990) Why worry? The cognitive function of anxiety. Behav Res Ther 28:455–468. https://doi.org/10.1016/0005-7967(90)90132-3

    Article  CAS  PubMed  Google Scholar 

  46. Ozegovic D, Carroll LJ, Cassidy JD (2010) Factors associated with recovery expectations following vehicle collision: a population-based study. J Rehabil Med 42:66–73. https://doi.org/10.2340/16501977-0466

    Article  PubMed  Google Scholar 

  47. Picha KJ, Howell DM (2017) A model to increase rehabilitation adherence to home exercise programmes in patients with varying levels of self-efficacy. Musculoskelet Care. https://doi.org/10.1002/msc.1194

    Article  Google Scholar 

  48. Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84:191

    Article  CAS  PubMed  Google Scholar 

  49. Martinez-Calderon J, Flores-Cortes M, Morales-Asencio M et al (2020) Which interventions enhance pain self-efficacy in people with chronic musculoskeletal pain? A systematic review and meta analysis of randomized controlled trials including over 12,000 participants. J Orthop Sport Phys Ther 50:418–430

    Article  Google Scholar 

  50. Ludvigsson ML, Peterson G, O’Leary S et al (2015) The effect of neck-specific exercise with, or without a behavioral approach, on pain, disability, and self-efficacy in chronic whiplash-associated disorders: a randomized clinical trial. Clin J Pain 31:294–303. https://doi.org/10.1097/AJP.0000000000000123

    Article  PubMed  PubMed Central  Google Scholar 

  51. Bring A, Åsenlöf P, Söderlund A (2016) What is the comparative effectiveness of current standard treatment, against an individually tailored behavioural programme delivered either on the Internet or face-to-face for people with acute whiplash associated disorder? A randomized controlled trial. Clin Rehabil 30:441–453. https://doi.org/10.1177/0269215515581503

    Article  PubMed  Google Scholar 

  52. Marshall PWM, Schabrun S, Knox MF (2017) Physical activity and the mediating effect of fear, depression, anxiety, and catastrophizing on pain related disability in people with chronic low back pain. PLoS ONE 12:1–15. https://doi.org/10.1371/journal.pone.0180788

    Article  CAS  Google Scholar 

  53. Shigetoh H, Tanaka Y, Koga M et al (2019) The mediating effect of central sensitization on the relation between pain intensity and psychological factors: a cross-sectional study with mediation analysis. Pain Res Manag 2019:3916135. https://doi.org/10.1155/2019/3916135

    Article  PubMed  PubMed Central  Google Scholar 

  54. Liew BXW, Scutari M, Peolsson A et al (2019) Investigating the causal mechanisms of symptom recovery in chronic whiplash-associated disorders using bayesian networks. Clin J Pain 35:647–655. https://doi.org/10.1097/AJP.0000000000000728

    Article  PubMed  Google Scholar 

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Acknowledgements

Dr. Javier Martinez-Calderon is supported by the Universidad de Malaga through a postdoctoral grant. All authors state that they have no conflicts of interest to declare.

Funding

Dr. Javier Martinez-Calderon is supported by the University of Malaga through a postdoctoral grant.

Author information

Authors and Affiliations

  1. Department of Physiotherapy, Faculty of Health Sciences, Universidad de Malaga, Malaga, Spain

    Yolanda Pedrero-Martin, Javier Martinez-Calderon & Alejandro Luque-Suarez

  2. Universidad Gimbernat, Cantabria, Spain

    Yolanda Pedrero-Martin

  3. Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK

    Deborah Falla

  4. Instituto de La Investigacion Biomedica de Malaga, Malaga, Spain

    Javier Martinez-Calderon & Alejandro Luque-Suarez

  5. School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Essex, UK

    Bernard X. W. Liew

  6. Istituto Dalle Molle di Studi Sull’Intelligenza Artificiale (IDSIA), Manno, Switzerland

    Marco Scutari

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  1. Yolanda Pedrero-Martin
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Correspondence to Alejandro Luque-Suarez.

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Pedrero-Martin, Y., Falla, D., Martinez-Calderon, J. et al. Self-efficacy beliefs mediate the association between pain intensity and pain interference in acute/subacute whiplash-associated disorders. Eur Spine J 30, 1689–1698 (2021). https://doi.org/10.1007/s00586-021-06731-5

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  • DOI: https://doi.org/10.1007/s00586-021-06731-5

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