Cognitive factors are associated with disability and pain, but not fatigue among physiotherapy attendees with persistent pain and fatigue. — ME/CFS Atlas
E2 ModerateModerate confidencePEM not requiredCross-SectionalPeer-reviewedReviewed
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Cognitive factors are associated with disability and pain, but not fatigue among physiotherapy attendees with persistent pain and fatigue.
Thompson, Dave P, Antcliff, Deborah, Woby, Steve R · Physiotherapy · 2020 · DOI
Quick Summary
This study looked at how thoughts and beliefs affect pain, disability, and fatigue in people with long-term pain and exhaustion who were receiving physiotherapy. Researchers found that how confident people felt about managing their condition (self-efficacy) and how much they catastrophized (worried excessively) about their symptoms were linked to pain levels and disability, but surprisingly were not linked to fatigue levels.
Why It Matters
For ME/CFS patients, this study suggests that psychological interventions targeting self-efficacy and catastrophizing may help reduce disability and pain, even though fatigue appears to have different underlying mechanisms. Understanding which cognitive factors actually influence which symptoms helps tailor physiotherapy and behavioral approaches more effectively.
Observed Findings
Self-efficacy beliefs were significantly inversely associated with disability (β=-0.62) and pain (β=-0.30)
Catastrophizing was significantly positively associated with pain (β=0.24)
Cognitive factors showed no significant association with mental or physical fatigue measures
Associations between cognitive factors and pain/disability were similar in physiotherapy settings as in multidisciplinary clinical environments
166 patients with persistent pain/fatigue disorders including ME/CFS were assessed
Inferred Conclusions
Self-efficacy beliefs are particularly strong determinants of disability in persistent pain and fatigue disorders
Targeting self-efficacy through physiotherapy may be an effective method to reduce disability
The relationships between cognitive factors and symptoms are consistent across different treatment settings (physiotherapy vs. multidisciplinary environments)
Cognitive factors influence pain and disability but appear not to directly influence fatigue severity
Remaining Questions
Why do cognitive factors affect pain and disability but not fatigue—what distinct mechanisms drive fatigue in ME/CFS?
What This Study Does Not Prove
This study does not prove that changing self-efficacy or catastrophizing will cause reductions in disability or pain—it only shows these factors are correlated. The cross-sectional design cannot establish causation or directionality. Additionally, the lack of association with fatigue does not mean cognitive factors play no role in ME/CFS fatigue; it may indicate that fatigue in these conditions is driven by different biological or physiological mechanisms.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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