Self-efficacy beliefs mediate the association between pain intensity and pain interference in acute/subacute whiplash-associated disorders

Research output: Contribution to journalArticlepeer-review


  • Yolanda Pedrero-Martin
  • Javier Martinez-Calderon
  • Bernard X W Liew
  • Marco Scutari
  • Alejandro Luque-Suarez

External organisations

  • Department of Physiotherapy
  • University of Essex
  • Istituto Dalle Molle di Studi sull'Intelligenza Artificiale (IDSIA), Manno, Switzerland.


PURPOSE: To evaluate whether a set of pre-accident demographic, accident-related, post-accident treatment and psychosocial factors assessed in people with acute/subacute whiplash-associated disorders (WAD) mediate the association between pain intensity and: (1) pain interference and (2) expectations of recovery, using Bayesian networks (BNs) analyses. This study also explored the potential mediating pathways (if any) between different psychosocial factors.

METHODS: This was a cross-sectional study conducted on a sample of 173 participants with acute/subacute WAD. Pain intensity, pain interference, pessimism, expectations of recovery, pain catastrophizing, and self-efficacy beliefs were assessed. BN analyses were conducted to analyse the mediating effects of psychological factors on the association between pain intensity and pain-related outcomes.

RESULTS: The results revealed that self-efficacy beliefs partially mediated the association between pain intensity and pain interference. Kinesiophobia partially mediated the association between self-efficacy and pain catastrophizing. Psychological factors did not mediate the association between pain intensity and expectations of recovery.

CONCLUSION: These results indicate that individuals with acute/subacute WAD may present with lesser pain interference associated with a determined pain intensity value when they show greater self-efficacy beliefs. As the cross-sectional nature of this study limits firm conclusions on the causal impact, researchers are encouraged to investigate the role that patient's self-efficacy beliefs play in the transition to chronic WAD via longitudinal study designs.

Bibliographic note

Funding Information: Dr. Javier Martinez-Calderon is supported by the Universidad de Malaga through a postdoctoral grant. All authors state that they have no conflicts of interest to declare. Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.


Original languageEnglish
JournalEuropean Spine Journal
Early online date27 Jan 2021
Publication statusE-pub ahead of print - 27 Jan 2021


  • Acute, Neck pain, Observational study, Psychological factors, Whiplash