Self-efficacy as a prognostic factor for pain, disability, and quality of life in chronic low back pain: a 24-month cohort study

Objective This study measured the prognostic value of self-efficacy for outcomes pertaining to chronic pain over 24 months. Design Retrospective cohort study. Setting National pain research registry from April 2016 to August 2024. Subjects Community-dwelling patients with chronic low back pain. Methods The Pain Self-Efficacy Questionnaire was used at baseline to classify patients as having low, moderate, or high levels of self-efficacy based on tercile cutpoints. Patient-reported outcomes were measured with a numerical rating scale for low back pain intensity, the Roland-Morris Disability Questionnaire, and the Patient-Reported Outcomes Measurement Information System with 29 items. Results The mean age (SD) of 1772 patients was 53.1 (13.1) years and 1309 (73.9%) were female. The mean (SD) score on the Pain Self-Efficacy Questionnaire was 33.5 (14.9). Inverse associations between self-efficacy and both low back pain intensity and back-related disability were observed in multivariable analyses that included 9504 patient encounters over time. For low back pain intensity, β-coefficients (95% CIs) were −0.276 (−0.454 to −0.097) for moderate self-efficacy (P = .002) and −0.619 (−0.840 to −0.398) for high self-efficacy (P < .001) compared with low self-efficacy. For back-related disability, β-coefficients (95% CIs) were −1.821 (−2.325 to −1.318) for moderate self-efficacy (P < .001) and −5.143 (−5.771 to −4.516) for high self-efficacy (P < .001). There were similar inverse associations between self-efficacy and health-related quality-of-life deficits. Patients with high self-efficacy consistently exceeded the threshold for clinically relevant outcomes (Cohen’s d ≥ 0.2) and reported large effects (Cohen’d ≥ 0.8) indicating greater physical function and participation in social roles and lesser pain interference. Conclusions These findings support self-efficacy as a prognostic factor for long-term outcomes among patients with chronic low back pain and underscore the urgent need for more research on interventions to improve self-efficacy in this population.