Experienced disability of the activity level of chronic low back pain patients: the role of self-discrepancies.

Patients with chronic low back pain often avoid activities. The fear-avoidance
model offers an adequate explanation for this behavior. However, out of
clinical observations and recent research findings it has appeared that there
is also a group of patients who tend to persist in activities rather then to
avoid activities. The fear-avoidance model cannot offer an explanation for this
type of behavior.The self-discrepancy theory of Higgins is a good candidate for
explaining avoidance and persistence and can therefore be an essential addition
to the fear-avoidance model. Higgins divides the self into the actual self, the
person you are now, the ideal self, the person you ideally would like to be and
the ought self, the person you think you ought to be. Actual-ideal
discrepancies lead to dejection-related emotions whereas actual-ought
discrepancies lead to agitation-related emotions. Later, Carver and colleagues
added the feared self, the self you fear to be.
We hypothesise that patients with large ideal or ought discrepancies tend to
persist in activities whereas patients with small feared discrepancies, who are
close to their feared self, tend to avoid activities. Considering the ideal
discrepancy, the eagerness to approach a goal will be most important. The ought
discrepancy will be more involved with a vigilance towards not living up to
expectations. The feared discrepancy may be nourished by catastrophizing
thoughts and may elicit a proces that is comparable to the processes described
within the fear-avoidance model.

The main objective of this study is to find an answer to the question: " What
is the role of self-discrepancies in patients with chronic low back pain and
more specifically, in their activity level?" The answer to this question offers
more insight to the psychological processes in the chronification of pain. This
offers new perspectives on the prevention and treatment of chronic low back
pain.
The research questions of this study are:
1. What is the relationship between specific self-discrepancies and specific
negative emotions in patients with chronic low back pain?
2. What is the relationship between self-discrepancies on the one hand and an
avoidant and persistent activitypattern on the other hand and what influence do
these behaviours have on the perceived disability and quality of life.
3. What is the relationship between self-discrepancies, pain intensity and the
physical activitypattern (avoidance or persistence)?
4. What is the relationship between the activity level the patient reports and
the objective measured activitylevel in patients with chronic low back pain.

A longitudinal follow-up study will be started with two measurement moments,
baseline (t=1) and six months follow-up (t=2). At every measurement moment
several questionnaires and an interview are assessed. Patients also get an
accelerometer and a electronic diary for a registration period of 15 days.

A total of 17 questionnaires will be assessed (including the interview) which
will take 120 minutes to complete. Patients are asked to fill in these
questionnaires two times, at baseline and six months later. Furthermore,
patients are asked to register an electronic diary (palmtop) and wear an
accelerometer around their waste during two weeks. Registering the diary and
taking on and off the accelerometer will take around 15 minutes a day.