Original research| Volume 99, ISSUE 1, P121-128, January 2018

Psychological Features and Their Relationship to Movement-Based Subgroups in People Living With Low Back Pain

  • Nicholas V. Karayannis
    Corresponding author Nicholas V. Karayannis, MPT, PhD, Stanford University, School of Medicine, Dept of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Palo Alto, CA 94304.
    National Health and Medical Research Council Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia

    Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA
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  • Gwendolen A. Jull
    National Health and Medical Research Council Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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  • Michael K. Nicholas
    Northern Clinical School Kolling Institute of Medical Research, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia
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  • Paul W. Hodges
    National Health and Medical Research Council Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Published:October 06, 2017DOI:



      To determine the distribution of higher psychological risk features within movement-based subgroups for people with low back pain (LBP).


      Cross-sectional observational study.


      Participants were recruited from physiotherapy clinics and community advertisements. Measures were collected at a university outpatient-based physiotherapy clinic.


      People (N=102) seeking treatment for LBP.


      Participants were subgrouped according to 3 classification schemes: Mechanical Diagnosis and Treatment (MDT), Treatment-Based Classification (TBC), and O'Sullivan Classification (OSC).

      Main Outcome Measures

      Questionnaires were used to categorize low-, medium-, and high-risk features based on depression, anxiety, and stress (Depression, Anxiety, and Stress Scale–21 Items); fear avoidance (Fear-Avoidance Beliefs Questionnaire); catastrophizing and coping (Pain-Related Self-Symptoms Scale); and self-efficacy (Pain Self-Efficacy Questionnaire). Psychological risk profiles were compared between movement-based subgroups within each scheme.


      Scores across all questionnaires revealed that most patients had low psychological risk profiles, but there were instances of higher (range, 1%–25%) risk profiles within questionnaire components. The small proportion of individuals with higher psychological risk scores were distributed between subgroups across TBC, MDT, and OSC schemes.


      Movement-based subgrouping alone cannot inform on individuals with higher psychological risk features.


      List of abbreviations:

      DASS-21 (Depression, Anxiety, and Stress Scale–21 Items), FABQ (Fear-Avoidance Beliefs Questionnaire), LBP (low back pain), MDT (Mechanical Diagnosis and Treatment), OSC (O'Sullivan Classification), PRSS (Pain-Related Self-Symptoms), PSEQ (Pain Self-Efficacy Questionnaire), TBC (Treatment-Based Classification)
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