Fear-Avoidance Beliefs Are Associated With Disability in Older American Adults With Low Back Pain

Abstract

Although fear-avoidance beliefs (FABs) have been explored in younger adults and Spanish older adults, their relationships to measures of low back pain (LBP)-related disability, overall physical health, and falling have not been investigated in older American adults. The purpose of this study was to examine the association of FABs with self-reported disability, physical health, and falling among community-dwelling older adults with LBP in the United States. This was a cross-sectional study. Ninety-three community-dwelling men and women with current LBP were included in this analysis. Participants completed the Fear-Avoidance Beliefs Questionnaire physical activity subscale (FABQ-PA). The modified Oswestry Disability Questionnaire (mOSW) and the Quebec Back Pain Disability Scale (QUE) were used to measure self-reported disability, and the Medical Outcomes Study 36-Item Short-Form Health Survey questionnaire (SF-36) physical component summary (PCS) score was used to assess physical health. Participants provided demographic information and information regarding LBP duration and intensity. Linear regression models were developed using the following dependent variables: mOSW, QUE, and SF-36 PCS scores. Logistic regression was used to determine the association between high FABs and falling. For each analysis, the FABQ-PA score independently explained 3% to 6% of the variance in the LBP-related disability score and 3% of the variance in the SF-36 PCS score. For all dependent variables, the strongest contributors to explained variance were pain intensity, assistive device use, and FABQ-PA score. High FABs were associated with falling. Future investigations might seek a more diversified sample and utilize both qualitative and quantitative measures for assessing disability and physical health. Physical activity FABs are independently associated with self-reported disability and overall physical health in older American adults with LBP. High FABs may warrant balance and falls assessment.