Is there a relationship between self-efficacy, disability, pain and sociodemographic characteristics in chronic low back pain? A multicenter retrospective analysis

Background: Pain-related self-efficacy is defined as the beliefs held by people with chronic pain that certain activities can be carried out despite the pain. Poor self-efficacy is an obstacle to the recovery and predicts longterm disability. The aims of this study are to investigate the prevalence of poor pain self-efficacy in Italian subjects with chronic low back pain (LBP), and to inquire the relationships between self-efficacy, disability, pain, and main demographic and clinical characteristics. Methods: A secondary multicenter retrospective analysis was done on 310 outpatients with chronic non-specific LBP. The pain self-efficacy measured with the Pain Self-Efficacy Questionnaire (PSEQ), the disability measured with the Roland & Morris Disability Questionnaire, and the pain intensity measured with the Numerical Rating Scale were considered variables to investigate, whereas demographic and clinical variables were considered predictors or potential confounders. A 40/60 PSEQ score was adopted as cut-off to distinguish between good and poor selfefficacy. Results: 199 subjects (64.2% of the sample) showed poor self-efficacy. The odds of having poor self-efficacy appeared significantly related to female gender (OR=1.80, 95%CI [1.12;2.90]; p =0.015) and drugs use (OR=1.68, 95%CI [1.06;2.70]; p=0.029). Significant relationships also emerged between disability and higher age (β=0.07, 95%CI [0.01; 0.12]; p =0.02), being female (β=1.80, 95%CI [0.32;3.29]; p=0.018), low educational level (β=−1.68, 95%CI [−2.59;-3.29]; p<0.001), higher height (β=−0.08, 95%CI [−0.158;-0.002]; p=0.045), pain duration [mos] (β= 0.01, 95%CI [0.001;0.021]; p=0.041), and drugs use (β=2.86, 95%CI [1.44;4.27]; p<0.001). The amount of pain appeared significantly related to educational level (β=−0.47, 95%CI [−0.76;-0.182]; p <0.001), smoking (β=0.56, 95%CI [0.09; 1.03]; p=0.021), height (β=−0.03, 95%CI [−0.05; −0.002]; p=0.036), and drugs use (β=0.81, 95%CI [0.399;1.22]; p <0.001). No significant correlation appeared among weight, body mass index, and referred pain neither in relation to self-efficacy, nor in relation to pain/disability. Conclusions: The majority of our sample, composed of Italian people complained of chronic LBP, shows poor selfefficacy. Female gender and drugs use are significantly related to poor self-efficacy, low educational level negatively influences the amount of perceived pain and disability, and older age and smoking are related to disability and pain intensity, respectively. The knowledge of these sociodemographic and clinical characteristics potentially influencing chronic LBP may be useful to address more efforts towards the most negatively impacted subjects, among the entire population complained of chronic LBP.