Cognitive factors are associated with disability and pain, but not fatigue among physiotherapy attendees with persistent pain and fatigue.


Bury Integrated Pain Service, Radcliffe Primary Care Centre, Northern Care Alliance NHS Group, 69 Church Street West, Radcliffe, Manchester, M26 2SP, UK; School of Health Sciences, University of Salford, Allerton Building, Salford, Manchester, M6 6PU, UK; Department of Physiotherapy, Northern Care Alliance NHS Group, Fairfield General Hospital, Rochdale Old Road, Bury, Greater Manchester, BL9 7TD, UK. Electronic address: [Email]


OBJECTIVE : Most research exploring the relationship between cognitive factors and pain, disability and fatigue in patients with persistent pain/fatigue has been performed in multi disciplinary environments. It is unclear whether these associations are consistent in other contexts. This study therefore aimed to establish the relationships between these factors in patients with persistent pain/fatigue referred for physiotherapy treatment.
METHODS : Cross-sectional observational study assessing the association between cognitive factors (self-efficacy and catastrophizing) and levels of pain, disability, mental fatigue and physical fatigue in patients with persistent pain/fatigue disorders. Data were analysed using regression analyses.
METHODS : Two out-patient physiotherapy departments, Manchester, UK.
METHODS : 166 patients with persistent pain and fatigue disorders chronic widespread pain, fibromyalgia and chronic fatigue syndrome/myalgic encephalopathy).
METHODS : Disability was assessed using the Fibromyalgia Impact Questionnaire, whilst mental and physical fatigue were assessed with the sub-scales of the Chalder Fatigue Scale. Pain intensity was measured with a Numeric Pain Rating Scale, self-efficacy with the Chronic Pain Self-efficacy Questionnaire and catastrophizing with the Pain Catastrophizing Scale.
RESULTS : Cognitive factors were significantly associated with pain (self-efficacy beliefs β=-0.30, P<0.05; catastrophizing β=0.24, P<0.05) and disability (self-efficacy beliefs β=-0.62, P<0.05), but not fatigue.
CONCLUSIONS : Similar associations were observed in patients referred to physiotherapy as to those observed in patients treated in multi disciplinary clinical environments. Self-efficacy beliefs appear to be particularly strong determinants of disability, but exert a lesser influence over pain or fatigue. Targeting self-efficacy may be an effective method to reduce disability in patients with persistent pain and fatigue disorders.


Catastrophization,Chronic pain,Fatigue,Rehabilitation,Self-efficacy,