Structural Equation Model of Disability in Low Back Pain

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Study Design.

The effects of participant characteristics along with descriptions of pain and psychological involvement, such as fear avoidance, were assessed using structural equation modeling (SEM) to identify relationships between these factors and disability as a result of low back pain (LBP).


The aim of this study was to evaluate the relationship between factors related to pain description, participants’ characteristics, psychological involvement, and disability through SEM.

Summary of Background Data.

LBP is a complex multifactorial condition that can lead to disability. Understanding which factors contribute to disability and how those factors interact is important for predicting and minimizing disability in patients with LBP.


We analyzed data from 156 participants (63% female) with LBP. A stepwise SEM was built with patient characteristics, pain intensity, depression, anxiety, and fear avoidance to predict disability in LBP.


Participants were 23–84 years (49.7 ± 15.1 yrs) of age and experienced 0.03 to 300 months duration (25.5 ± 36.4 months) of current LBP. The final model explained 62% of the variance in disability and included female gender, full-time employment, depression, and fear avoidance beliefs as significant predictors. Full-time employment was the only significant predictor that reduced disability; all other significant predictors increased disability in the model.


Understanding the relationship between these predictors and disability provides a foundation for predicting and managing disability for individual patients who suffer from LBP.


Level of Evidence: 3

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