Does a physiotherapy cognitive behavioural chronic low back pain programme alter patients’ health locus of control?

BACKGROUND: Health locus of control (HLOC) is a person’s belief of where responsibilities for his/her health condition lies. It is associated with health attitudes, behaviours and outcomes in non-specific chronic low back pain (NSCLBP). It is unknown whether a physiotherapy cognitive-behavioural chronic low back pain (CBCLBP) programme affects patients’ HLOC. AIMS: To examine: (1) the effect of a six-week CBCLBP programme on the patients’ primary outcome-HLOC, and also pain intensity, disability, fear-avoidance belief (FAB) and self-care attitude; (2) the association between changes in pain intensity, disability and FAB and changes in HLOC; and (3) the cost of producing any effect. METHODS: In an A-B-A same-subject design, patients referred to the CBCLBP programme with high FAB (TSK score> 37) were recruited. Patients attended a six-week programme. Outcomes were measured four weeks before (-4 weeks), at the start, at completion, 3- and 6-months after the programme. Friedman’s ANOVA and Wilcoxon signed-rank tests determined changes between phases. Multiple regression determined the relationship between HLOC and outcome of interest. Significance was set at 0.05. RESULTS: A total of 70 patients were recruited. Fifty-five patients entered the programme and all completed 6-months follow-up. The CBCLBP programme significantly improved HLOC (p