title: Influence of catastrophizing on treatment outcome in patients with nonspecific low back pain: a systematic review.
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  The aim of this study was to assess the effect of catastrophizing on treatment efficacy and outcome in patients treated for low back pain.
  
  
  BACKGROUND
  Psychological factors including catastrophizing thoughts are thought to increase the risk for chronic low back pain. The influence of catastrophizing is debated.
  
  
  METHODS
  In September 2012, the following databases were searched: BIOSIS, CINAHL, Cochrane Library, EMBASE, OTseeker, PeDRO, PsycINFO, MEDLINE, Scopus, and Web of Science. For 50 of 706 references, full text was assessed. Results based on 11 studies were included in this analysis.
  
  
  RESULTS
  In the 11 studies, a total of 2269 patients were included. Seven studies were of good and 4 of moderate methodological quality. Heterogeneity in study settings, treatments, outcomes, and patient populations impeded meta-analysis. Catastrophizing at baseline was predictive for disability at follow-up in 4 studies and for pain in 2 studies. Three studies found no predictive effect of catastrophizing. A mediating effect was found in all studies (n = 5) assessing the impact of a decrease in catastrophizing during treatment. A greater decrease was associated with better outcome. Most studies that investigated the moderating effects on treatment efficacy found no effect (n = 5). However, most studies did not look for a direct interaction between the treatment and catastrophizing thoughts. No study investigated the influence of catastrophizing on work-related outcomes including return to work.
  
  
  CONCLUSIONS
  Catastrophizing predicted degree of pain and disability and mediated treatment efficacy in most studies. The presence of catastrophizing should be considered in patients with persisting back pain. Limited evidence was found for the moderating effects on treatment efficacy. Future research should aim to clarify the role of catastrophizing as a moderator of outcome and investigate its importance for work-related outcomes.
  
  
  METHODS
  1.
authors.affiliation: *Horten Centre for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Pestalozzistrasse, Zurich, Switzerland; and †NYU Hospital for Joint Diseases, Occupational and Industrial Orthopaedic Center (OIOC), New York University, New York, NY.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Wertli
authors.forename: Jakob M
authors.initials: JM
authors.lastname: Burgstaller
authors.forename: Sherri
authors.initials: S
authors.lastname: Weiser
authors.forename: Johann
authors.initials: J
authors.lastname: Steurer
authors.forename: Reto
authors.initials: R
authors.lastname: Kofmehl
authors.forename: Ulrike
authors.initials: U
authors.lastname: Held
mesh_terms: D058443:Catastrophization / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D010147:Pain Measurement / Q000379:methods / Q000523:psychology*; D016896:Treatment Outcome