Relação entre o lócus de controle da saúde e os desfechos relacionados à dor lombar crônica: uma revisão crítica da literatura

Abstract

Low back pain is one of the most common musculoskeletal disorders and the largest cause of disability in adults under 45 years of age and the second among individuals aged 45 to 60 years. The costs related to this conditions reaches millions of dollars around the world, as a result of decreased productivity in the work place, work absenteeism, high employee’s changes in the workforce, and increased expenses related to treatment or sick leaves. Studies have suggested that psychosocial factors such as anxiety, catastrophizing, kinesiophobia, depression, stress, and health locus of control may be correlated with low back pain outcomes, and the last one has been widely investigated. The health locus of control is defined as the judgment of one’s perception about who is responsible for her/his health and what should be her/his coping behavior toward it. The objective of this study was to review the literature to verify the relationship between the health locus of control and various health outcomes related to chronic non-specific low back pain. To accomplish that, a search was conducted in the Medline, LILACS, SciELO and Google Scholar databases looking for studies that investigated the association of at least one of the three types of health locus of control (internal, external or random) with low back pain. The search yielded 1021 studies. Of these, 890 were excluded after reading the title and abstract, 99 after reading the full text, and 27 were excluded because were repeated. Two studies were found and included after hand search in the reference lists of the selected studies and, therefore, a total of seven studies were included. The results of this review showed that the types of health locus of control were significantly correlated with the following outcomes: pain, disability, quality of life, prognosis, function, treatment, psychological distress, and pain coping strategies. Overall, subjects with external locus of control were more dependent on the health system and passive treatment. Thus, they adhered less to the intervention program while those with internal locus of control adhered more to treatment and participated actively in the rehabilitation program, resulting in better outcomes. Furthermore, the internal locus of control was associated with lower levels of disability and less use of pain coping strategies. On the other hand, individuals who had the locus of control by chance showed higher levels of psychological distress, higher pain severity and lower quality of life. Yet, these individuals were likely to report anxiety and obsessive- compulsive symptoms. This review concluded that knowing how each type of health locus of control is associated with outcomes related to low back pain may help therapists better understanding the patient’s health condition and planning specific therapeutic actions. Future studies on that issue are needed to help healthcare professionals to manage psychosocial factors related to back pain, such as health locus of control.