379: Readiness to Change Profiles in Chronic Low Back Pain Using the Pain Stages of Change Questionnaire

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Assessment and Measurement of Pain/Nociception, Physiotherapy

Background and Aims: Readiness for change is an important construct for understanding engagement in self-management behaviors in chronic low back pain (CLBP) (Kerns et al., 2005). This construct suggests that individuals go through different motivational stages throughout behavioral change, which may vary among themselves (Kerns et al., 1997). Some studies indicate that patients can be classified into subgroups based on their readiness for change profiles, which may be associated with clinically relevant differences (Kerns et al., 2005). The subgroups vary in pre-contemplation, contemplation, action, and maintenance. However, this heterogeneity is often overlooked when using simplified approaches (Jensen et al., 2000). The PSOCQ is a multidimensional measure developed to assess readiness to adopt a self-management approach to pain (Carr et al., 2006). Therefore, this study aimed to identify subgroups of individuals with chronic low back pain (CLBP) based on PSOCQ response profiles and to examine these varied subgroups in clinically relevant depth.

Methods: This cross-sectional study recruited participants with CLBP from the community. Participants completed self-report questionnaires, including the Pain Stages of Change Questionnaire (PSOCQ), Tampa Scale for Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), Pain Self-Efficacy Questionnaire (PSEQ), Survey of Pain Attitudes (SOPA), Oswestry Disability Index (ODI), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Numeric Pain Rating Scale (NPRS). K-means clustering was applied to standardized PSOCQ subscales to identify subgroups. Linear discriminant analysis (LDA) assessed classification accuracy. Differences between clusters were examined using Welch’s ANOVA with Games–Howell post hoc tests. Statistical significance was set at .05.

Results: The study included 150 participants with CLBP (97 women; mean age = 41.28 years, SD = 11.77). K-means clustering identified five subgroups: Action/Maintenance (n = 41), Contemplation (n = 32), Aware Precontemplation (n = 29), Precontemplation (n = 21), and Ambivalent (n = 27). LDA showed high classification accuracy (96.7%). Welch’s ANOVA revealed significant differences for TSK, F(4, 66.4) = 5.66, p < .001, PCS, F(4, 66.5) = 4.20, p = .004, PSEQ, F(4, 64.5) = 4.86, p = .002, and SOPA medical care, F(4, 65.2) = 3.13, p=.020. The Ambivalent (M = 44.07) and Aware Precontemplation (M = 42.86) groups showed higher TSK scores than Action/Maintenance (M = 38.44) and also showed higher PCS scores (31.63; 31.69 vs. 23.24). Aware Precontemplation showed lower PSEQ scores than Action/Maintenance (38.21 vs. 45.49), and the Ambivalent group showed a lower SOPA medical cure score compared to Action/Maintenance (2.39 vs. 2.99).

Conclusions: This study identified distinct subgroups of individuals with CLBP based on PSOCQ response profiles, supporting the relevance of a multidimensional approach to readiness for change. The observed differences in psychological variables suggest that these profiles capture clinically meaningful patterns beyond single scale scores. In particular, Ambivalent and Aware Precontemplation profiles were associated with less adaptive characteristics, such as maladaptive beliefs about pain and movement and catastrophizing, and lower pain self-efficacy. These findings highlight the potential utility of profile-based classification to inform more targeted and individualized interventions. Future research should investigate the predictive value of these subgroups for treatment engagement and outcomes.

References: Kerns, R. D., Wagner, J., Rosenberg, R., Haythornthwaite, J., & Caudill-Slosberg, M. (2005). Identification of subgroups of persons with chronic pain based on profiles on the pain stages of change questionnaire. Pain, 116(3), 302–310. https://doi.org/10.1016/j.pain.2005.04.022
Kerns, R. D., Rosenberg, R., Jamison, R. N., Caudill, M. A., & Haythornthwaite, J. (1997). Readiness to adopt a self-management approach to chronic pain: the Pain Stages of Change Questionnaire (PSOCQ). Pain, 72(1-2), 227–234. https://doi.org/10.1016/s0304-3959(97)00038-9
Carr, J. L., Moffett, J. A., Sharp, D. M., & Haines, D. R. (2006). Is the Pain Stages of Change Questionnaire (PSOCQ) a useful tool for predicting participation in a self-management programme? Further evidence of validity, on a sample of UK pain clinic patients. BMC musculoskeletal disorders, 7, 101. https://doi.org/10.1186/1471-2474-7-101
Jensen, M. P., Nielson, W. R., Romano, J. M., Hill, M. L., & Turner, J. A. (2000). Further evaluation of the pain stages of change questionnaire: is the transtheoretical model of change useful for patients with chronic pain?. Pain, 86(3), 255–264. https://doi.org/10.1016/S0304-3959(00)00257-8

Presenting Author: Laís Braga Agostinho
Submitting Author: Laís Agostinho

Senior Author: Thais Cristina Chaves

IASP 2026 Global Year theme of Neuropathic Pain: No

• Laís Braga Agostinho: Master Degree in Physical Therapy in progress - Universidade Federal de São Carlos - UFSCar
• Roger Berg: Ph. D. in Physical Therapy in progress - Universidade Federal de São Carlos - UFSCar
• Thamiris Costa de Lima: Ph. D. in Physical Therapy in progress - Universidade Federal de São Carlos - UFSCar
• Thais Cristina Chaves: Ph. D. in Rehabilitation - Universidade Federal de São Carlos - UFSCar