ArticlePloS one2017
Physical activity and the mediating effect of fear, depression, anxiety, and catastrophizing on pain related disability in people with chronic low back pain.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 96 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Efficacy of a Supervised Physical Therapy Rehabilitation Program vs Nonsupervised on Pain, Disability, Quality of Life and Kinesiophobia in Patients With Non-specific Low Back Pain
Effect of Deep Tissue Massage on Subjective and Objective Parameters in Office Workers With Chronic Low Back Pain
Who cites it
96 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Relationship Between Fear of Movement and Physical Activity in Patients With Cardiac, Rheumatologic, Neurologic, Pulmonary, or Pain Conditions: A Systematic Review and Meta-Analysis.Physical therapy · 2025Pooled it
- The effect of Jintiange capsules on pain in patients with primary osteoporosis: a systematic review and meta-analysis.BMC musculoskeletal disorders · 2025Pooled it
- COVID-19 Pandemic Increases the Impact of Low Back Pain: A Systematic Review and Metanalysis.International journal of environmental research and public health · 2022Pooled it
- Is transcranial direct current stimulation beneficial for treating pain, depression, and anxiety symptoms in patients with chronic pain? A systematic review and meta-analysis.Frontiers in molecular neuroscience · 2022Pooled it
- Coccygectomy for refractory coccygodynia: a systematic review and meta-analysis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2022Pooled it
- The Physical and Psychological Effects of Telerehabilitation-Based Exercise for Patients With Nonspecific Low Back Pain: Prospective Randomized Controlled Trial.JMIR mHealth and uHealth · 2024Trial
- The effects of Pilates on pain, functionality, quality of life, flexibility and endurance in lumbar disc herniation.Journal of comparative effectiveness research · 2023Trial
- Kinesiophobia could affect shoulder function after repair of rotator cuff tears.BMC musculoskeletal disorders · 2022Trial
- Depressive symptoms exacerbate disability in older adults: A prospective cohort analysis of participants in the MemAID trial.PloS one · 2022Trial
- Optimization of Spinal Manipulative Therapy Protocols: A Factorial Randomized Trial Within a Multiphase Optimization Framework.The journal of pain · 2021Trial
- Trial
- Trial
- Effective Interventions in Restoring Mobility and Relieving Pain After Lower Limb Amputation.Journal of orthopaedics and sports medicine · 2026Article
- El Dolor Es Lo Que Me Saluda: A Qualitative Study on Multilevel and Intersectional Factors Impacting Physical Activity Among Latino Persons With Chronic Spine Pain.Journal of physical activity & health · 2026Article
- Implementation status and barriers to multimodal management of low back pain among physical therapists: A cross-sectional study.Scientific reports · 2026Article
- Disability in subjects who survive road traffic injuries in 2 regions of southwest Colombia: A causal mediation analysis.Chinese journal of traumatology = Zhonghua chuang shang za zhi · 2026Article
- A Longitudinal Study of Coping Strategies and Differences by Sex in Patients with Chronic Low Back Pain.Journal of clinical medicine · 2026Article
- Impact of Postoperative Chronic Back Pain Syndrome on the Incidence of Psychiatric and Brain Disorders, and All-Cause Mortality.Journal of pain research · 2026Article
- Non-invasive brain stimulation for chronic low back pain: current techniques and future perspectives.Frontiers in human neuroscience · 2026Article
- The mediating role of physical activity self-efficacy between knowledge, psychological factors, and early physical activity in elderly post-PCI patients: a cross-sectional study.BMC geriatrics · 2025Article
36 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundChronic low back pain is a worldwide burden that is not being abated with our current knowledge and treatment of the condition. The fear-avoidance model is used to explain the relationship between pain and disability in patients with chronic low back pain. However there are gaps in empirical support for pathways proposed within this model, and no evidence exists as to whether physical activity moderates these pathways.
methodsThis was a cross-sectional study of 218 people with chronic low back pain. Multiple mediation analyses were conducted to determine the role of fear, catastrophizing, depression, and anxiety in the relationship between pain and disability. Separate analyses were performed with physical activity as the moderator. Individuals were classified as performing regular structured physical activity if they described on average once per week for > 30-minutes an activity classified at least moderate intensity (≥ 4-6 METs), activity prescribed by an allied health professional for their back pain, leisure time sport or recreation, or self-directed physical activity such as resistance exercise.
resultsFear, catastrophizing, and depression significantly mediated the relationship between pain and disability (p<0.001). However the mediating effect of catastrophizing was conditional upon weekly physical activity. That is, the indirect effect for catastrophizing mediating the relationship between pain and disability was only significant for individuals reporting weekly physical activity (B = 1.31, 95% CI 0.44 to 2.23), compared to individuals reporting no weekly physical activity (B = 0.21, 95% CI -0.50 to 0.97). Catastrophizing also mediated the relationship between pain and fear (B = 0.37, 95% CI 0.15 to 0.62), with higher scores explaining 53% of the total effect of pain on fear.
conclusionsThese results support previous findings about the importance of fear and depression as factors that should be targeted in low back pain patients to reduce back pain related disability. We have also extended understanding for the mediating effect of catastrophizing on back pain related disability. Back pain patients engaged with regular physical activity may require counselling with regards to negative pain perceptions.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.