Investigation of Elevated Fear-Avoidance Beliefs for Patients With Low Back Pain: A Secondary Analysis Involving Patients Enrolled in Physical Therapy Clinical Trials

Abstract Objective The Fear-Avoidance Model of chronic pain (FAM) posits that pain catastrophizing and fear-avoidance beliefs are prognostic for disability and chronicity. In acute low-back pain, early physical therapy (PT) is effective in reducing disability in some patients. How early PT impacts short- and long-term changes in disability for patients with acute pain is unknown. Based on the FAM, we hypothesized that early reductions in pain catastrophizing and fear-avoidance beliefs would mediate early PT’s effect on changes in disability (primary outcome) and pain intensity (secondary outcome) over 3 months and 1 year. Subjects Participants were 204 patients with low-back pain of < 16 days duration, who enrolled in a clinical trial (NCT01726803) comparing early PT sessions or usual care provided over 4 weeks. Methods Patients completed the Pain Catastrophizing Scale (PCS), Fear-Avoidance Beliefs Questionnaire (FABQ work and physical activity scales) and outcomes (Oswestry Disability Index and Numeric Pain Rating Scale) at baseline, 4 weeks, 3 months, and 1 year. We applied longitudinal mediation analysis with single and multiple mediators. Results Early PT led to improvements in disability and pain over 3 months, but not 1 year. In the single mediator model, four-week reductions in pain catastrophizing mediated early PT’s effects on 3-month disability and pain intensity improvements, explaining 16% and 22% of the association, respectively, but the effects were small. Pain catastrophizing and fear-avoidance beliefs did not jointly mediate these associations. Conclusions In acute low-back pain, early PT may improve disability and pain outcomes at least partly through reducing patients’ catastrophizing.

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Predictive validity of initial fear avoidance beliefs in patients with low back pain receiving physical therapy: is the FABQ a useful screening tool for identifying patients at risk for a poor recovery?

European Spine Journal ◽

10.1007/s00586-007-0511-y ◽

2007 ◽

Vol 17 (1) ◽

pp. 70-79 ◽

Cited By ~ 35

Author(s):

Joshua A. Cleland ◽

Julie M. Fritz ◽

Gerard P. Brennan

Keyword(s):

At Risk ◽

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Predictive Validity ◽

Screening Tool ◽

Low Back ◽

Fear Avoidance ◽

Fear Avoidance Beliefs ◽

Patients At Risk

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Physical Therapist Management of a Patient With Acute Low Back Pain and Elevated Fear-Avoidance Beliefs

Physical Therapy ◽

10.1093/ptj/84.6.538 ◽

2004 ◽

Vol 84 (6) ◽

pp. 538-549 ◽

Cited By ~ 22

Author(s):

Steven Z George ◽

Joel E Bialosky ◽

Julie M Fritz

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Physical Therapist ◽

Previous History ◽

Sales Manager ◽

Low Back ◽

Fear Avoidance ◽

Fear Avoidance Beliefs ◽

Acute Low Back Pain

Abstract Background and Purpose. Elevated fear-avoidance beliefs are believed to be a precursor of chronic disability, yet effective intervention options have not been described in the literature. The purpose of this case report is to describe physical therapist management of a patient with acute low back pain and elevated fear-avoidance beliefs. Case Description. The patient was a 42-year-old sales manager with acute low back pain. The patient had no previous history of activity-limiting low back pain and initially had limitations in straight leg raising, limitations in lumbar movement, and elevated fear-avoidance beliefs. Intervention. Treatment-based classification and graded exercise were used. Outcome. Disability, fear-avoidance beliefs, and pain decreased 4 weeks after starting physical therapy. Six months later, disability and fear-avoidance beliefs had increased, but were still improved when compared with the initial measurements. Discussion. Disability and fear-avoidance beliefs improved following a fear-avoidance-based physical therapy intervention. Research is warranted to investigate the effectiveness of this approach.

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What Characterizes People Who Have an Unclear Classification Using a Treatment-Based Classification Algorithm for Low Back Pain? A Cross-Sectional Study

Physical Therapy ◽

10.2522/ptj.20120263 ◽

2013 ◽

Vol 93 (3) ◽

pp. 345-355 ◽

Cited By ~ 10

Author(s):

Tasha R. Stanton ◽

Mark J. Hancock ◽

Adri T. Apeldoorn ◽

Benedict M. Wand ◽

Julie M. Fritz

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Secondary Analysis ◽

Cross Sectional Study ◽

Classification Algorithm ◽

Clinical Settings ◽

Low Back ◽

Fear Avoidance ◽

Cross Sectional ◽

Fear Avoidance Beliefs

Background A treatment-based classification algorithm for low back pain (LBP) was created to help clinicians select treatments to which people are most likely to respond. To allow the algorithm to classify all people with LBP, additional criteria can help therapists make decisions for people who do not clearly fit into a subgroup (ie, unclear classifications). Recent studies indicated that classifications are unclear for approximately 34% of people with LBP. Objective To guide improvements in the algorithm, it is imperative to determine whether people with unclear classifications are different from those with clear classifications. Design This study was a secondary analysis of data from 3 previous studies investigating the algorithm. Methods Baseline data from 529 people who had LBP were used (3 discrete cohorts). The primary outcome was type of classification, that is, clear or unclear. Univariate logistic regression was used to determine which participant variables were related to having an unclear classification. Results People with unclear classifications had greater odds of being older (odds ratio [OR]=1.01, 95% confidence interval [CI]=1.003–1.033), having a longer duration of LBP (OR=1.001, 95% CI=1.000–1.001), having had a previous episode(s) of LBP (OR=1.61, 95% CI=1.04–2.49), having fewer fear-avoidance beliefs related to both work (OR=0.98, 95% CI=0.96–0.99) and physical activity (OR=0.98, 95% CI=0.96–0.996), and having less LBP-related disability (OR=0.98, 95% CI=0.96–0.99) than people with clear classifications. Limitations Studies from which participant data were drawn had different inclusion criteria and clinical settings. Conclusions People with unclear classifications appeared to be less affected by LBP (less disability and fewer fear avoidance beliefs), despite typically having a longer duration of LBP. Future studies should investigate whether modifying the algorithm to exclude such people or provide them with different interventions improves outcomes.

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Avaliação de Medos, Crenças e Comportamentos de Evitação em Policiais Militares de Minas Gerais Portadores de Dor Lombar Crônica/Fear-Avoidance Assessment in Minas Gerais Military Police Agents With Low Back Pain

REVISTA CIÊNCIAS EM SAÚDE ◽

10.21876/rcsfmit.v5i3.383 ◽

1970 ◽

Vol 5 (3) ◽

pp. 18-26

Author(s):

Marcelo von Sperling de Souza ◽

Maximiliano Ferreira Torres de Carvalho ◽

Anna Florence Alves Paulino Souza ◽

Flávia Corrêa Assumpção

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Sick Leave ◽

Minas Gerais ◽

Low Back ◽

Fear Avoidance ◽

Invasive Procedures ◽

Military Police ◽

Fear Avoidance Beliefs ◽

Fear Avoidance Beliefs Questionnaire

RESUMO Objetivo: descrever os índices de medos, crenças e evitação em policiais militares portadores de dor lombar crônica, acompanhados pelo Grupo de Coluna Vertebral do Hospital da Polícia Militar de Minas Gerais (PMMG). Materiais e métodos: durante um período de três anos, estas variáveis foram medidas pelo Fear-avoidance beliefs questionnaire (FABQ) versão português-brasileira, preenchido por autorrelato. As demais variáveis utilizadas para classificação da amostra em subgrupos e comparação destes quanto aos seus escores no FABQ foram idade, sexo, histórico de procedimento invasivo de coluna, presença de radiculopatia e encaminhamento pela Junta Central de Saúde (JCS), órgão oficial de perícias médicas na PMMG. Resultados: 248 militares preencheram o questionário satisfatoriamente e foram incluídos no estudo. A média de pontuação do FABQ-Work foi de 23,18 ± 10,79, enquanto a média de pontuação do FABQ-Phys foi de 18,10 ± 6,09. Não foram encontradas diferenças significativas nos escores dos subgrupos divididos por sexo, histórico de procedimento invasivo ou presença de radiculopatia. Indivíduos com idade superior a 40 anos apresentaram maiores índices de medo e evitação para atividades físicas (FABQ-Phys). Indivíduos que se encontravam em afastamento prolongado do trabalho (encaminhados pela JCS) apresentaram maior medo e evitação tanto para atividades físicas quanto atividades de trabalho. Conclusão: estes resultados permitiram identificar características dos policias militares em risco de incapacidade prolongada, ressaltando a necessidade de medidas educativas focadas na correção de crenças errôneas sobre dor lombar crônica para um melhor prognóstico na sua reabilitação.Palavras-chave: Dor lombar, Polícia, Medo, Questionários ABSTRACTObjectives: the purpose of this study was to describe fear-avoidance levels in military police agents with chronic low back pain followed by the Spine Group of the Military Police Hospital. Materials and Methods: The Brazilian Portuguese version of the Fear-avoidance Beliefs Questionnaire (FABQ) was applied during a three-year period. Secondary variables (age, sex, history of spinal invasive procedures, presence of radiculopathy, referral from medical experts due to prolonged sick-leave) were used for subgroup analysis and FABQ mean scores comparison. Results: 248 patients filled out FABQ correctly and were included in the study. FABQ-work and FABQ-Phys means were 23.18±10.79 and 18.10±6.09, respectively. There were no differences in FABQ scores between subgroups divided by sex, invasive procedures or radiculopathy. Age subgroup comparisons revealed that older individuals (> 40-years old) showed higher FABQ-Phys scores. Individuals with prolonged sick-leave showed higher scores at both FABQ-Phys and FABQ-Work subscales. Conclusion: Our results allowed identification of variables possibly related to long-time disability in military police agents and put emphasis on the need of educational interventions in which fear-avoidance beliefs are addressed in order to improve their rehabilitation prognosis.Keywords: Low back pain, Police, Fear, Questionnaires.

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A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability

Pain ◽

10.1016/0304-3959(93)90127-b ◽

1993 ◽

Vol 52 (2) ◽

pp. 157-168 ◽

Cited By ~ 1857

Author(s):

Gordon Waddell ◽

Mary Newton ◽

Iain Henderson ◽

Douglas Somerville ◽

Chris J. Main

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Low Back ◽

Fear Avoidance ◽

Fear Avoidance Beliefs ◽

Fear Avoidance Beliefs Questionnaire

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The relationship between disability, quality of life and fear- avoidance beliefs in patients with chronic low back pain

Turkish Neurosurgery ◽

10.5137/1019-5149.jtn.6156-12.1 ◽

2012 ◽

Cited By ~ 2

Author(s):

Dogan Gucluhan Guclu ◽

Oya Guclu ◽

Aysel Ozaner ◽

Omer Senormanci ◽

Ramazan Konkan

Keyword(s):

Quality Of Life ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Low Back ◽

Fear Avoidance ◽

Fear Avoidance Beliefs ◽

The Relationship

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The Prediction of Chronicity in Patients with Acute and Sub-Acute Non-Specific Low Back Pain and Associated Risk Factors: A Case-Control Study

10.21203/rs.3.rs-971261/v1 ◽

2021 ◽

Author(s):

Mohsen Sadeghi-Yarandi ◽

Mohammad Ghasemi ◽

Ali Ghanjal ◽

Mojtaba Sepandi ◽

Ahmad Soltanzadeh

Keyword(s):

Risk Factors ◽

Low Back Pain ◽

Back Pain ◽

Sleep Quality ◽

Case Control Study ◽

Case Control ◽

Low Back ◽

Fear Avoidance ◽

Fear Avoidance Beliefs ◽

Control Study

Abstract Background: Chronic low back pain is one of the most common musculoskeletal disorders in different countries that people of any age can experience many times. This study aimed to predict the chronicity of non-specific acute and sub-acute LBP and related risk factors among cases referred to physiotherapy clinics.Methods: This case-control study was performed among 420 patients suffered from acute, sub-acute and chronic LBP referred to two physiotherapy centers in Tehran-Iran in 2020. Data were obtained using the Fear-Avoidance Beliefs Questionnaire (FABQ), Patient Health Questionnaire (PHQ-9), Pain Catastrophic Scale (PCS-13), Tampa Scale for Kinesiophobia (TSK-11), Pittsburgh Sleep Quality Index (PSQI), Walker's Health-Promoting Lifestyle Questionnaire, Roland Morris Disability Questionnaire (RMDQ) and Numerical Pain Rating Scale (NPRS). Data analysis was performed by applying independent sample t-test, chi-square, and multiple logistic regression in SPSS software version 25. IBM Amos version 22 was employed for path analysis.Results: The mean age and body mass index in all patients were 43.94 ± 6.72 years and 25.69 ± 3.54 kg.m-2, respectively. It was found that some demographic parameters (i.e. weight, BMI, job, type of occupational task performance, history of low back pain, work shift, underlying diseases and income), some cognitive parameters ( i.e. fear-avoidance beliefs, kinesiophobia, catastrophic pain, and depression), some lifestyle parameters (i.e. health responsibility, physical activity and interpersonal relationships), sleep quality and pain related disability were among the most critical risk factors in the chronicity of acute and sub-acute LBP (P < 0.05).Conclusion: Personal, psychological, and psychosocial parameters can be among the most critical predictors in the chronicity of acute and sub-acute non-specific LBP. Hence, paying attention to all the mentioned factors at the beginning of patients' treatment to create a targeted treatment algorithm and prevent the conversion of acute and sub-acute into chronic LBP has particular importance.

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