title: Health locus of control and self-efficacy predict back pain rehabilitation outcomes.
abstract: BACKGROUND
  Chronic back pain treatments have generally been costly and/or ineffective despite advances in medical technology. Patient selection and factors intrinsic to patients, including beliefs and behaviors, have been increasingly looked upon as possible predictive factors for success following multidisciplinary intervention for chronic back pain. The current study investigated the value of using patients' perceived control over health changes (health locus of control) and their perceived ability to engage in pain management behaviors (pain-related self-efficacy) to predict physical and mental health outcomes.
  
  
  METHODS
  We retrospectively analyzed 61 patients who completed a two-week multidisciplinary chronic back pain rehabilitation program at our institution between 2007 and 2009. Patient demographics were identified and categorized. Pre- and post-intervention functional surveys, including the Multidimensional Health Locus of Control Form C, Chronic Pain Self-Efficacy Scale, Medical Outcomes Study Short Form-36 Version 2, Beck Depression Inventory-II, and Oswestry Disability Index Version 2, were used to evaluate benefit from back pain intervention and to examine patient factors that may predict physical and mental health outcomes.
  
  
  RESULTS
  Participants included 28 males and 33 females, ages 28 to 72, completing chronic back pain rehabilitation. Locus of control, self-efficacy, and physical and mental health demonstrated treatment-related changes, with notable improvements in physical and mental health. Regression analyses examined the value of pre-treatment health locus of control and pain-related self-efficacy as predictors of physical and mental health one month following treatment. Higher internal and lower doctor health locus of control, and higher self-efficacy at baseline predicted higher lift scores one month after treatment (p <. 05; p <. 01; p <. 01, respectively). Higher baseline self-efficacy also predicted better physical functioning (p <. 01) and lower disability (p <. 01) at one month.
  
  
  CONCLUSIONS
  In addition to supporting the multiple benefits of multidisciplinary rehabilitation, this study suggests that pain-related self-efficacy and health locus of control may be valuable predictors of treatment benefit for chronic back pain patients. These results provide direction in screening for factors that may maximize the potential to benefit from multidisciplinary intervention for chronic back pain.
authors.affiliation: Department of Psychological and Quantitative Foundations University of Iowa.
authors.forename: Nicole H
authors.initials: NH
authors.lastname: Keedy
authors.affiliation: Department of Orthopaedics and Rehabilitation University of Iowa.
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Keffala
authors.affiliation: Department of Psychological and Quantitative Foundations University of Iowa.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Altmaier
authors.affiliation: Department of Orthopaedics and Rehabilitation University of Iowa.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000523:psychology* / Q000534:rehabilitation*; D059350:Chronic Pain / Q000523:psychology* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life; D012189:Retrospective Studies; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: chronic back pain; health locus of control; multidisciplinary; self-ef ficacy; treatment outcomes