scholarly journals Effects of Education on Return-to-Work Status for People With Fear-Avoidance Beliefs and Acute Low Back Pain

2008 ◽  
Vol 88 (2) ◽  
pp. 231-239 ◽  
Author(s):  
Joseph J Godges ◽  
Marie A Anger ◽  
Grenith Zimmerman ◽  
Anthony Delitto
Keyword(s):  
Physical Activity ◽  
Low Back Pain ◽  
Back Pain ◽  
Pain Management ◽  
Low Back ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Acute Low Back Pain ◽  
Education Group ◽  
Physical Activity And Exercise

Background and PurposePeople with acute low back injury and fear-avoidance beliefs are at risk for remaining off work for an extended period of time. However, the effectiveness of intervention strategies for improving return-to-work status in people with acute low back pain and fear-avoidance beliefs has not been reported. The objective of this study was to determine whether education and counseling on pain management, physical activity, and exercise could significantly decrease the number of days that people with low back injury are off work.SubjectsThirty-four people who were unable to return to work following a work-related episode of low back pain and who exhibited fear-avoidance beliefs participated in this study.MethodsParticipants who scored 50 points or higher on the Fear-Avoidance Beliefs Questionnaire were alternately assigned to an education group or a comparison group. Both groups received conventional physical therapy intervention. Participants in the education group were given education and counseling on pain management tactics and the value of physical activity and exercise. The effectiveness of the interventions was measured by the number of days before people returned to work without restrictions.ResultsAll participants in the education group returned to regular work duties within 45 days. One third of the participants in the comparison group remained off work at 45 days. There was a statistically significant difference between the groups with regard to the number of days before returning to work.Discussion and ConclusionEducation and counseling regarding pain management, physical activity, and exercise can reduce the number of days off work in people with fear-avoidance beliefs and acute low back pain.

Changes in Pain Catastrophizing and Fear-Avoidance Beliefs as Mediators of Early Physical Therapy on Disability and Pain in Acute Low-Back Pain: A Secondary Analysis of a Clinical Trial

Pain Medicine ◽  
2021 ◽  
Author(s):  
Brittany L Sisco-Taylor ◽  
John S Magel ◽  
Molly McFadden ◽  
Tom Greene ◽  
Jincheng Shen ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapy ◽  
Pain Catastrophizing ◽  
Low Back ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Acute Low Back Pain ◽  
Early Physical Therapy

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.

scholarly journals Association between high fear-avoidance beliefs about physical activity and chronic disabling low back pain in nurses in Japan

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Tomoko Fujii ◽  
Hiroyuki Oka ◽  
Kenichiro Takano ◽  
Fuminari Asada ◽  
Takuo Nomura ◽  
...  
Keyword(s):  
Physical Activity ◽  
Low Back Pain ◽  
Psychological Distress ◽  
Back Pain ◽  
Low Back ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Work Related ◽  
The Past ◽  
Absence From Work

Abstract Background High prevalence of low back pain (LBP) in nurses has been reported globally. Ergonomic factors and work-related psychosocial factors have been focused on as risk factors. However, evidence on the role of fear-avoidance beliefs (FABs) concerning LBP in nurses is lacking. This study examined LBP prevalence and the association between FABs and chronic disabling LBP that interfered with work and lasted ≥ 3 months. Methods Female nurses (N = 3066; mean age = 35.8 ± 10.6 years) from 12 hospitals in Japan participated. A self-reported questionnaire was used to collect information on sociodemographics, LBP, work-related factors, and psychological distress. FABs about physical activity were assessed using a subscale from the FAB Questionnaire (score range = 0–24). The participants were asked to choose one of four statements regarding their LBP in the past 4 weeks: 1) I did not have LBP, 2) I had LBP without work difficulty, 3) I had LBP with work difficulty but without requiring absence from work, and 4) I had LBP requiring absence from work. If the participant had LBP in the past 4 weeks, it was also inquired if the LBP had lasted for ≥ 3 months. Chronic disabling LBP was defined as experiencing LBP with work difficulty in the past 4 weeks which had lasted for ≥ 3 months. In the nurses who had experienced any LBP in the past 4 weeks, we examined the association between FABs and experiencing chronic disabling LBP using multiple logistic regression models adjusting for pain intensity, age, body mass index, smoking status, psychological distress, hospital department, weekly work hours, night shift work, and the12 hospitals where the participants worked. Results Four-week and one-year LBP prevalence were 58.7 and 75.9%, respectively. High FABs (≥ 15) were associated with chronic disabling LBP (adjusted odds ratio = 1.76, 95% confidence interval [1.21–2.57], p = 0.003). Conclusions LBP is common among nurses in Japan. FABs about physical activity might be a potential target for LBP management in nurses. Trial registration UMIN-CTR UMIN000018087. Registered: June 25, 2015.

scholarly journals Identifying Psychosocial Variables in Patients With Acute Work-Related Low Back Pain: The Importance of Fear-Avoidance Beliefs

2002 ◽  
Vol 82 (10) ◽  
pp. 973-983 ◽  
Author(s):  
Julie M Fritz ◽  
Steven Z George
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Likelihood Ratio ◽  
Work Status ◽  
Low Back ◽  
Psychosocial Variables ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Work Related ◽  
Acute Low Back Pain

Abstract Background and Purpose. Psychosocial factors are known to affect recovery from acute low back pain. The factors with the greatest influence and the optimal methods of measurement and interpretation have not been established. The purpose of this study was to examine baseline psychosocial variables and their ability to predict prolonged work restrictions. Subjects. The subjects were 78 people with work-related low back pain who were participating in a clinical trial (mean age=37.4 years, SD=10.4, range=18–58; mean duration of pain=5.5 days, SD=4.6, range=0–19). Methods. A baseline examination including measures of impairment, disability, and psychosocial variables was performed. All subjects had physical therapy interventions. Work status was assessed after 4 weeks. Sensitivity, specificity, and likelihood ratios were calculated for the prediction of work status by the use of psychosocial variables. Receiver operator characteristic curves and logistic regression were used to identify the variables that were most predictive of work status. Results. Twenty-two subjects (29%) had persistent work restrictions. The work subscale of the Fear-Avoidance Beliefs Questionnaire was the strongest predictor of work status (negative likelihood ratio of 0.08 for scores less than 30, positive likelihood ratio of 3.33 for scores greater than 34). Discussion and Conclusion. Fear-avoidance beliefs about work was the psychosocial factor that could best be used to predict return to work in patients with acute work-related low back pain. Examination of fear-avoidance beliefs may serve as a useful screening tool for identifying patients who are at risk for prolonged work restrictions.

Fear-Avoidance Beliefs, Disability, and Participation in Workers and Nonworkers With Acute Low Back Pain

2006 ◽  
Vol 22 (1) ◽  
pp. 45-54 ◽  
Author(s):  
Ilse E. J Swinkels-Meewisse ◽  
Jeffrey Roelofs ◽  
Andr?? L. M Verbeek ◽  
Rob A. B Oostendorp ◽  
Johan W. S Vlaeyen
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Low Back ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Acute Low Back Pain

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

2004 ◽  
Vol 84 (6) ◽  
pp. 538-549 ◽  
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.

Attitudes of nurses, physiotherapy assistants and masseurs towards low back pain treatment

2021 ◽  
pp. 1-10
Author(s):  
Eszter Simoncsics ◽  
Adrienne Stauder
Keyword(s):  
Physical Activity ◽  
Health Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Treatment Modalities ◽  
Low Back ◽  
Care Providers ◽  
Fear Avoidance ◽  
Professional Background ◽  
Fear Avoidance Beliefs

PURPOSE: We evaluated the attitudes of nurses compared to physiotherapy assistants and medical masseurs (PAMs) regarding various treatment modalities used in the treatment of low-back pain (LBP) as their opinions might influence the patients’ attitudes to therapy. DESIGN: Cross sectional self-reported questionnaire survey. METHODS: 175 Hungarian health care providers completed questionnaires evaluating their opinions on the importance of various therapeutic interventions and the need for initiation of LBP treatment. Their personal LBP history and fear-avoidance beliefs (FABQ) were also investigated. FINDINGS: The importance of exercise therapy (p = 0.024) and massage (p <  0.01) was evaluated higher by the PAMs, while medication (p = 0.04) was scored higher by the nurses. Those who experienced moderate or severe LBP were more positive about pain medication than to those with mild pain (p = 0.048). Years in health care work had only a weak association with opinions. The nurses reported more fear-avoidance beliefs than the PAMs about both physical activity (p = 0.024) and work (p = 0.021). Those who experienced moderate or severe LBP had higher FABQ scores (p = 0,076), however the difference was significant only for FABQ activity (p = 0.035). CONCLUSIONS: Our study confirmed that professional background and years of experience can influence the attitudes towards the importance of certain therapies, although these differences were small. Experiencing moderate or severe LBP increased the fear-avoidance beliefs about work and physical activity independently of the professional background. CLINICAL RELEVANCE: Our study draws the attention to the importance of standardization of the information to be passed to the patients and to the need of discussing personal experiences and beliefs during professional training.

Convergent and known group validity of the STarT Back Tool in a Nigerian population with chronic low back pain

physioscience ◽  
2021 ◽  
Author(s):  
Chidozie Emmanuel Mbada ◽  
Joshua Oluwafunmibi Ojo ◽  
Opeyemi Ayodiipo Idowu ◽  
Taofik Oluwasegun Afolabi ◽  
Aanuoluwapo Deborah Afolabi ◽  
...  
Keyword(s):  
Physical Activity ◽  
Low Back Pain ◽  
Back Pain ◽  
Physical Disability ◽  
Pain Catastrophizing ◽  
Low Back ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Group Validity ◽  
Nigerian Population

Abstract Background The STarT Back Tool (SBT) was developed to aid the stratification of patients with low-back pain (LBP), based on future risks for physical disability. Objective Investigation of the convergent and known group validity of the SBT in a Nigerian population with chronic LBP using disability-related psychosocial outcomes. Method Cross-sectional study involved 30 consenting patients with chronic LBP in an outpatient physiotherapy clinic of a tertiary health institution in Nigeria. Future risk of disability was assessed using the SBT. Psychosocial variables of pain catastrophizing, fear-avoidance beliefs (FAB), and kinesiophobia were assessed using the Pain Catastrophizing Scale, the Fear-Avoidance Beliefs Questionnaire and the Tampa Scale of Kinesiophobia, respectively. Data was analysed using percentages and Spearman correlation. Results Based on the SBT, there were rates of 43.3 % and 23.3 % for low and high future risks of physical disability. The median score of pain catastrophizing was 13.5, that of FAB came in at 16.5 related to physical activity and 14.0 related to work, and the score for kinesiophobia amounted to 39. The SBT total scores moderately correlated with the FAB related to work (rho = 0.45 (95 % CI 0.09–0.700). FAB related to physical activity (p = 0.040) significantly differed across the SBT subgroups. Conclusion The SBT and the other psychosocial instruments used in this study did not correlate to a sufficient degree. In addition, patients exhibiting catastrophizing, fear-avoidance beliefs, or kinesiophobia could not be differentiated based on SBT risk groups. The results should be interpreted with caution until findings from additional studies with sufficient sample sizes are at hand.

scholarly journals Fear-avoidance beliefs are associated with exercise compliance: Secondary analysis of a randomised controlled trial among female healthcare workers with recurrent low back pain

2019 ◽  
Author(s):  
Annika Taulaniemi ◽  
Markku Kankaanpää ◽  
Marjo Rinne ◽  
Kari Tokola ◽  
Jari Parkkari ◽  
...  
Keyword(s):  
Physical Activity ◽  
Low Back Pain ◽  
Back Pain ◽  
Healthcare Workers ◽  
Exercise Programme ◽  
Low Back ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Low Education ◽  
Exercise Compliance

Abstract Background Exercise is recommended for the treatment and management of low back pain (LBP) and the prevention of chronicity. Compliance with exercise has proved to be only modest in intervention studies among people with musculoskeletal pain. Fear-avoidance beliefs (FABs) are known to affect exercise adherence.The purpose of the study was twofold: to examine which bio-psycho-social factors contributed to exercise compliance during a 6-month neuromuscular exercise intervention among female healthcare workers with recurrent LBP, and to investigate how exercising affects FABs at 6 and 12 months’ follow-up.Methods A total of 219 healthcare workers aged 30–55 years with mild-to-moderate re-current non-specific LBP were originally allocated to four groups (exercise, counselling, combined exercise and counselling, control). In the present study, the exercise groups (exercise only and exercise + counselling) and non-exercise groups (counselling only and control) were merged. Baseline factors of the exercise compliers (exercising ≥24 times over 24 weeks; n=58) were compared to those of the non-compliers (exercising <1 time/week, 0–23 times; n=52). The effects of the exercise programme on FABs were analysed by a generalised linear mixed model according to the intention-to-treat principle (exercisers; n= 110 vs non-exercisers; n=109) at three measurement points (baseline, 6, and 12 months). A per-protocol analysis compared the more exercised to the less exercised and non-exercisers.Results A low education level (p=0.026), shift work (p=0.023), low aerobic (p=0.048) and musculoskeletal (p=0.043) fitness level, and high FABs related to physical activity (p=0.019) at the baseline contributed to lower exercise compliance. The exercise programme reduced levels of both physical activity- and work-related FABs, and there was a dose response: FABs reduced more in persons with better exercise compliance.Conclusion Healthcare workers who had lower education and fitness levels, worked shifts, and had high physical activity-related FABs had a lower compliance to the 6-month neuromuscular exercise programme. Exercising with good compliance reduced levels of FABs, which are known to be linked with prolonged LBP. In exercise interventions, motivational strategies should be targeted at persons with low education and fitness levels and high FABs in order to achieve better exercise compliance.

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