Assessment of psychological distress is important in patients presenting with low back pain

P. Hope, M.J. Forshaw

Research output: Contribution to journalArticle (journal)peer-review

33 Citations (Scopus)


Background and Methods:
Psychological distress and fear avoidance beliefs have been suggested to be important elements in the aetiology of low back pain disability. One hundred and sixty patients referred with a diagnosis of low back or low back and leg pain were assessed for levels of psychological distress and fear avoidance beliefs to establish if these factors could predict the outcome of physiotherapy. Seventy-one patients were reassessed on the same dimensions following physiotherapy. Outcome of physiotherapy was measured by the Roland and Morris Disability Questionnaire.

71% of patients classified as distressed had a poor treatment outcome compared with only 20% of those patients classified as ‘at risk' of becoming distressed. No patients classified as normal had a poor treatment outcome. The best predictors of the outcome of treatment were depression and disability levels, these together predicting 49% of the variance. The level of fear avoidance was of little predictive value.

Physiotherapy proved effective in managing patients presenting with low back disability when this disability had its basis in physical pathology and not psychological distress. It is suggested that the employment of a measure of psychological distress as part of physiotherapy assessment may help in choosing the best treatment for patients presenting with low back pain.
Original languageUndefined/Unknown
Pages (from-to)563-570
Issue number10
Publication statusPublished - 27 Mar 1999


  • back pain
  • psychological distress
  • physiotherapy
  • efficacy

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