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Income as a Predictor of Self-Efficacy for Managing Pain and for Coping With Symptoms Among Patients With Chronic Low Back Pain - PubMed

Income as a Predictor of Self-Efficacy for Managing Pain and for Coping With Symptoms Among Patients With Chronic Low Back Pain

Margaret D Whitley et al. J Manipulative Physiol Ther. 2021 Jul-Aug.

Abstract

Objectives: The purpose of this study was to evaluate pain self-efficacy (PSE) and coping self-efficacy (CSE) for people with chronic low back pain (CLBP), and to assess whether lower income may be associated with less PSE and CSE in the United States.

Methods: We conducted a cross-sectional study using survey data collected between June 2016 and February 2017 from n = 1364 patients with CLBP from chiropractic clinics in the United States to measure the relationship between income and both types of self-efficacy. We created 4 multivariate models predicting PSE and CSE scores. We used both a parsimonious set of covariates (age, sex) and a full set (age, sex, education, neck pain comorbidity, catastrophizing, and insurance). We also calculated effect sizes (Cohen's d) for unadjusted differences in PSE and CSE score by income.

Results: Lower income was associated with lower PSE and CSE scores across all 4 models. In the full models, the highest-income group had an average of 1 point (1-10 scale) higher PSE score and CSE score compared to the lowest income group. Effect sizes for the unadjusted differences in PSE and CSE scores between the highest and lowest income groups were 0.94 and 0.84, respectively.

Conclusions: Our findings indicate that people with lower income perceive themselves as less able to manage their pain, and that this relationship exists even after taking into account factors like health insurance and educational attainment. There is a need to further investigate how practitioners and policymakers can best support low-income patients with chronic pain.

Keywords: Coping Behavior; Income; Low Back Pain; Pain Management; Self-Efficacy.

Copyright © 2021. Published by Elsevier Inc.

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Figures

Figure 1.
Figure 1.

Predicted average scores for pain self-efficacy (PSE) and coping self-efficacy (CSE) based on income among chronic low back pain patients (n= 1364). The average predicted scores (marginal effects) depicted are based on the linear mixed effects models shown in Table 2. Model 1 (PSE) and Model 3 (CSE) controlled for age and sex, as well as clustering at the clinic level. Model 2 (PSE) and Model 4 (CSE) controlled for age, sex, education, CNP comorbidity, catastrophizing score and insurance status, as well as clustering at the clinic level.

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