Papers of the Week

Theoretical frameworks explain how pain-related psychological factors may influence physical performance. In this systematic review and meta-analysis, we evaluated the evidence regarding the relationship between pain-related psychological factors and maximal physical performance in patients with low back pain (LBP). Pubmed, Embase, CINAHL and Web of Science databases were searched from inception to May 2022. Cross-sectional or longitudinal studies reporting cross-sectional measures of association between at least one pain-related psychological factor and a quantitatively measured outcome of maximal physical performance in patients with LBP were eligible for inclusion. Thirty-eight studies (n=2490; 27 cross-sectional studies, n=1647 (66%); 11 longitudinal studies, n=843 (34%)) were included, with 92% of participants (n=2284) having chronic LBP. Results showed that pain-related fear, pain catastrophising and anticipated pain were consistently and negatively associated with maximal physical performance in chronic LBP, whereas pain-self efficacy showed positive correlations. Overall, magnitudes of absolute pooled r-values were small (r≤0.25), except for anticipated pain, which was moderately associated with maximal physical performance (r=-0.34 to -0.37). Subanalyses and sensitivity analyses yielded similar pooled correlation coefficients. Certainty of evidence using the GRADE recommendations was very low to moderate for pain-related fear, and very low to low for the other pain-related psychological factors. Prospero registration: CRD42021227486. Perspective: Overall, small pooled correlation coefficients were shown between pain-related psychological factors and maximal physical performance in chronic LBP. Certainty of evidence was very low to low for all pain-related psychological factors other than pain-related fear. Future studies taking into account limitations of the current literature may therefore change these conclusions.