Illness perceptions; exploring mediators and/or moderators in disabling persistent low back pain

Authors Edwin de Raaij, Harriët Wittink, François Maissan, Jos Twisk, Raymond Ostelo
Published in BMC Musculoskeletal Disorders
Publication date 2022
Research groups Lifestyle and Health
Type Article


Introduction: Illness Perceptions (IPs) may play a role in the management of persistent low back pain. The mediation and/or moderation effect of IPs on primary outcomes in physiotherapy treatment is unknown. Methods: A multiple single-case experimental design, using a matched care physiotherapy intervention, with three phases (phases A-B-A’) was used including a 3 month follow up (phase A’). Primary outcomes: pain intensity, physical functioning and pain interference in daily life. Analyzes: linear mixed models, adjusted for fear of movement, catastrophizing, avoidance, sombreness and sleep. Results: Nine patients were included by six different primary care physiotherapists. Repeated measures on 196 data points showed that IPs Consequences, Personal control, Identity, Concern and Emotional response had a mediation effect on all three primary outcomes. The IP Personal control acted as a moderator for all primary outcomes, with clinically relevant improvements at 3 month follow up. Conclusion: Our study might indicate that some IPs have a mediating or a moderating effect on the outcome of a matched care physiotherapy treatment. Assessing Personal control at baseline, as a relevant moderator for the outcome prognosis of successful physiotherapy management of persistent low back pain, should be further eplored.

On this publication contributed

Language English
Published in BMC Musculoskeletal Disorders
Key words low back pain, illness perceptions, mediation, moderation, SCED-study, physiotherapy
Digital Object Identifier 10.1186/s12891-022-05031-3

Edwin de Raaij