Psychological Inflexibility And Physical Disability In Older Patients With Chronic Low Back Pain And Knee Pain

Abstract

Aim: This study examined the associations between psychological inflexibility (PI) and physical disability (PD) among older patients with chronic low back and knee pain. Methods: Pain avoidance and cognitive fusion were assessed in outpatients as components of PI and PD, and sociodemographic and pain-related variables were used as covariates. Hierarchical multiple linear regression was used. The covariates were first entered, followed by PI. Results: Age and pain intensity had significant positive associations with PD. After adding PI, only pain avoidance was significantly and positively associated with PD. Conclusion: Focusing on pain avoidance may be effective for physical disability when acceptance and commitment therapy is administered to older patients with chronic low back and knee pain.

Plain language summary

Recently, psychological inflexibility (PI) as a psychological process of acceptance and commitment therapy (ACT) has attracted attention in the treatment of chronic pain. However, previous studies have not found a relationship between PI and physical disability (PD) in older patients with chronic lower limb pain. This study investigated whether PI is associated with PD in older patients with chronic low back and knee pain. PI, PD and sociodemographic and pain-related variables were measured using a questionnaire. The results showed that pain avoidance in PI was associated with PD, whereas cognitive fusion was not. Focusing on pain avoidance may be effective for physical disability when ACT is administered to older patients with chronic low back and knee pain.

Keywords::

• chronic knee pain
• chronic low back pain
• cognitive fusion
• older patients
• pain avoidance
• physical disability

Author contributions

All authors made a significant contribution to the work reported in either the conception, study design, execution, acquisition of data, analysis and interpretation or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted and agree to be accountable for all aspects of the work.

Acknowledgments

We would like to express our gratitude to the participants and staff at Hasegawa Hospital for their support of the present study.

Financial&competing interests disclosure

This work was supported by the MEXT-Supported Program for the Strategic Research Foundation at Private Universities, 2015–2019, of the Japan Ministry of Education, Culture, Sports, Science and Technology (S1511017). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

This study was approved by the Waseda University Institutional Committee on Human Research (application number 2018-080) and conformed to the principles outlined in the Declaration of Helsinki. All participants gave written informed consent.

Data sharing statement

The datasets used and/or analyzed during the current study is available from the authors on request.

Additional information

Funding

This work was supported by the MEXT-Supported Program for the Strategic Research Foundation at Private Universities, 2015–2019, of the Japan Ministry of Education, Culture, Sports, Science and Technology (S1511017). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.