A Structural Equation Model for Low Back Pain Management Behavior in Patients With Spinal Disease.

Abstract

Background: Low back pain (LBP) in patients with spinal diseases significantly reduces quality of life by causing not only physical disability but also psychological issues. LBP has a high prevalence worldwide and imposes substantial economic and social burdens, making its management critically important.

Purpose: This study aimed to develop and validate a model explaining LBP management behavior in patients with spinal diseases based on Self-Determination Theory (SDT).

Design: The hypothetical model of this study was developed based on Deci and Ryan's SDT and a literature review.

Methods: A cross-sectional online survey was conducted with 220 patients diagnosed with spinal diseases, such as herniated intervertebral disc and spinal stenosis, who were members of a self-help group in South Korea. The survey included a total of 95 items, covering general characteristics, LBP management behavior, healthcare provider's autonomy support (support for making decisions and acting independently), social support, internal health locus of control (belief in one's ability to manage health independently), basic psychological needs (autonomy, competence, relatedness), and autonomous motivation (motivation based on intrinsic values). Data were analyzed using structural equation modeling.

Results: Autonomous motivation showed a significant direct and total effect on LBP management behavior (β = 0.60, p < .001). Healthcare provider's autonomy support also had a significant direct (β = 0.20, p = .042) and total effect (β = 0.35, p = .003). Internal health locus of control and basic psychological needs had indirect effects on LBP management behavior (β = 0.18, p = .042; β = 0.33, p = .019), while social support did not show significant direct (β = 0.06, p = .840), indirect (β = 0.07, p = .733), or total effects (β = 0.12, p = .406) on LBP management behavior. These variables collectively explained 52.2% of the variance in LBP management behavior among patients with spinal diseases.

Conclusions: This study confirmed that autonomous motivation and healthcare provider's autonomy support significantly influence LBP management behaviors in patients with spinal disease. Additionally, internal health locus of control and basic psychological needs indirectly impacted these behaviors through autonomous motivation.

Clinical implications: The findings underscore the importance of developing programs that enhance patients' autonomous motivation and providing autonomy-supportive interventions by healthcare providers. By identifying patients' internal health locus of control tendencies and tailoring interventions to meet their psychological needs, healthcare professionals can provide effective support for sustained LBP management behavior in patients with spinal disease.

Registration: None.