Mediators of pain neuroscience education on disability of patients with nonspecific chronic low back pain

Objective. The objective of this study was to explore the mediators (pain self-efficacy, pain catastrophizing, back pain beliefs) of Pain Neuroscience Education (PNE) on disability for patients with chronic low back pain (LBP) in Saudi Arabia (SA). Methods. An observational multisite pre-post study design was utilized. This study was done at the Physical Therapy (PT) Clinics related to the Ministry of Health in SA, from December 2020 to December 2021. Chronic LBP patients were recruited into a 2-week PT program. Ten eligible physical therapists across six PT clinics were involved in the study who treat musculoskeletal and LBP patients. There were two groups (usual care of physical therapy “US-PT” vs. “PNE”). The mediators and disability were evaluated at the baseline (T0) and 2-week follow-up (T1). Results. A total of 249 patients met the selection criteria and consented to participate in the study. 131 patients received UC-PT only and 118 patients received PNE in addition to UC-PT. Baseline patient characteristics showed the mean age was 41.41 (SD = 12.03), and 144 of the participants (57.8%) were female. Increased pain self-efficacy (95% CI = −3.99, −1.15), decreased pain catastrophizing (95% CI = −3.42, −0.88), and decreased belief that they were disabled by pain (95% CI = −2.43, −0.33) fully mediated the PNE effect on disability at a 2-week interval. Conclusion. PNE participants showed greater improvement from baseline to 2 weeks on each cognitive factor hypothesized to mediate the effect of PNE on disability. The study results provided guidance on how to target treatment recommendations to gain the maximum benefits from PNE. Also, this study generated evidence that is useful for physical therapists and researchers to improve PNE to optimize chronic LBP patient outcomes.