Jonathan Hill|Julie M. Fritz
Psychosocial Influences on Low Back Pain, Disability, and Response to Treatment
Keele University|Intermountain Healthcare|University of Utah
evidence suggests psychosocial factors influence outcome physical therapy treatment extent influence differs considerably among patients consequence substantial research efforts focused developing new clinical tools designed identify highlight psychosocial factors present level relevant decision making conceptual differences ways psychosocial factors influence outcome described structured around 3 common research terms 1 prognostic factors 2 treatment effect modifiers moderators 3 treatment mediators prognostic factors characteristics help estimate patients likely outcome irrespective chosen management treatment effect modifiers moderators factors measured baseline influence relationship specific intervention outcome treatment mediators factors intermediary role link treatment outcome different influences outcome translated useful complementary tools aim reduce treatment variability clinical practice described one approach use prognostic factors develop screening tools identify individuals risk status typically based predictive psychosocial factors catastophizing depression another approach identify specific treatment effect modifiers derive treatment decision aids prediction rules help match patients characteristics interventions available third approach use treatment mediators eg selfefficacy develop monitoring tools inform clinician aspects treatment strengthen