Negative beliefs about back pain are associated with persistent, high levels of low back disability in community-based women

Key points

1. 01Women with persistent high disability held more negative beliefs about back pain than those with no, developing, or resolving disability (BBQ mean 26.1 vs 31.3, P = 0.002)
2. 02Negative beliefs were not significantly associated with persistent high-intensity pain (P = 0.2), only with disability
3. 03Women with persistent disability were most likely to believe back pain would stop them from working (63.6%), mean periods of pain for life (77.3%), and cause long absences from work (22.7%)
4. 04Postmenopausal status was associated with persistent high pain (OR 3.32, 95% CI 1.28-8.6, P = 0.01) and persistent high disability (OR 5.6, 95% CI 1.2-25.8, P = 0.03)
5. 05Back beliefs did not change over the 2-year follow-up in any group, suggesting these beliefs are stable without targeted intervention

How it was conducted

Design

2-year prospective cohort study

Participants

506 community-based women aged 18-75 years recruited from the Victorian Electoral Roll; 442 (87.4%) completed 2-year follow-up

Beliefs measure

Back Beliefs Questionnaire (BBQ), 9-item scored 9-45; lower scores indicate more negative beliefs

Pain and disability measure

Chronic Pain Grade Questionnaire (CPG) at baseline and 2-year follow-up; score >= 50 defined high-intensity pain or disability

Groups

Participants classified as no, developing, resolving, or persistent high-intensity pain and separately for disability

Primary analysis

Estimated marginal means comparing BBQ scores across groups, adjusted for age, BMI, and depression

What they found

• 442 of 506 women (87.4%) completed follow-up; mean age 56.7 (SD 12.5) years, mean BMI 27.3 (SD 5.7) kg/m2
• 108 women (24.4%) reported high-intensity low back pain over 2 years; 69 women (15.6%) reported high levels of disability
• Persistent high disability group had significantly more negative back beliefs than the no disability group: mean (SE) 26.1 (1.4) vs 31.3 (0.31), P = 0.002
• Persistent high-intensity pain group did not differ significantly from no pain group on back beliefs: mean (SE) 28.9 (1.02) vs 31.2 (0.33), P = 0.2
• In the persistent disability group, 77.3% believed back pain means periods of pain for the rest of life vs 26.7% in no-disability group (P < 0.001)
• 63.6% of persistent disability group believed back pain would eventually stop them from working vs 13.4% in no-disability group (P < 0.001)
• 59.1% of persistent disability group believed back trouble makes everything in life worse vs 30.5% in no-disability group (P = 0.004)
• Postmenopausal status associated with persistent high pain: OR 3.32 (95% CI 1.28-8.6), P = 0.01
• Postmenopausal status associated with persistent high disability: OR 5.6 (95% CI 1.2-25.8), P = 0.03
• No significant change in back beliefs over 2 years in any pain or disability group (pain groups P = 0.10-0.63; disability groups P = 0.07-0.93)

Limitations

• Study recruited women from a prior cross-sectional androgen study, introducing potential selection bias
• Sample was limited to women, so findings may not generalise to men
• Smaller subgroups (developing, resolving, persistent) reduced statistical power to detect associations in those specific groups
• Beliefs and pain/disability were self-reported; no objective clinical measures of back function were used

Why it matters

For patients

Women with low back problems who hold pessimistic views about their future may be at higher risk of long-term disability, and targeting those beliefs through education or cognitive behavioural approaches could help.

For clinicians

Screening for negative back beliefs using a tool such as the Back Beliefs Questionnaire may identify community-based women at risk for persistent low back disability, warranting belief-focused interventions.

For readers

This is the first longitudinal study to show that negative back beliefs predict persistent disability specifically in community-based women, adding prospective evidence to earlier cross-sectional findings.