Yellow flags as predictors of rehabilitation outcome in chronic low back pain.

OBJECTIVE: While it is agreed that yellow flags (prognostic psychosocial factors for poor recovery in low back pain) predict pain-related outcomes, uncertainty remains regarding which constructs are the central ones, particularly as there is considerable conceptual overlap between constructs. Therefore, the aim of our study was to analyze the distinctiveness of different psychological factors in predicting rehabilitation outcomes in a sample of patients with chronic low back pain (CLBP) in a rehabilitation setting. Research Method/Design: We conducted a longitudinal study using multivariable modeling taking into account a broad set of psychological variables as potential predictors. Rehabilitation outcome was assessed via health related quality of life (HRQL) and disease-specific functioning at the end of rehabilitation and six months later. The sample comprised N = 214 patients.

RESULTS: When considered separately, a range of psychological factors were significant predictors of HRQL and functioning at the end of rehabilitation and at six months follow-up, even if baseline values of outcome variables, sociodemographic variables, and baseline pain intensity are controlled. When considered in combination, a better work prognosis, self-efficacy and intensity of depressive symptoms were verified as independently significant predictors of HRQL. None of the psychological constructs remained significant predictors for disease-specific functioning. The incremental variance explained by the psychological constructs varied between 3 and 24%.

CONCLUSIONS: The contribution of psychological factors may be different depending on the sample (acute vs. chronic) and the outcome domain. Future research should validate these results with respect to other patient-centered outcomes and in other CLBP samples. (PsycINFO Database Record