Fear-avoidance Beliefs Research Articles

Fear-avoidance beliefs, anxiety and depression are associated with motor control and dynamics parameters in patients with chronic low back pain

PurposeTo evaluate the influence of fear-avoidance beliefs, anxiety and depression on dynamic and motor control parameters before and after Functional Restoration Program. MethodsPatients were divided into three groups depending on clinical scores scores. Dynamic and motor control parameters were extracted from gait analysis. ResultsPatients showed different ways based on preferred walking speed, capacity benefit, peaks of propulsion and gait stability in function of clinical scores. ConclusionFear-avoidance beliefs associated to anxiety and depression influence biomechanics on overground walking. We depicted different ways to adapt their gait in function of biopsychosocial scores. Functional Restoration Program influence these ways.

Asynchronous and Tailored Digital Rehabilitation of Chronic Shoulder Pain: A Prospective Longitudinal Cohort Study.

BackgroundChronic shoulder pain (SP) is responsible for significant morbidity, decreased quality of life and impaired work ability, resulting in high socioeconomic burden. Successful SP management is dependent on adherence and compliance with effective evidence-based interventions. Digital solutions may improve accessibility to such treatments, increasing convenience, while reducing healthcare-related costs.PurposePresent the results of a fully remote digital care program (DCP) for chronic SP.Patients and MethodsInterventional, single-arm, cohort study of individuals with chronic SP applying for a digital care program. Primary outcome was the mean change between baseline and 12 weeks on the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Secondary outcomes were change in pain (NPRS), analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement.ResultsFrom 296 patients at program start, 234 (79.1%) completed the intervention. Changes in QuickDASH between baseline and end-of-program were both statistically (p < 0.001) and clinically significant, with a mean reduction of 51.6% (mean −13.45 points, 95% CI: 11.99; 14.92). Marked reductions were also observed in all secondary outcomes: 54.8% in NPRS, 44.1% ceased analgesics consumption, 55.5% in surgery intent, 37.7% in FABQ-PA, 50.3% in anxiety, 63.6% in depression and 66.5% in WPAI overall. Higher engagement was associated with higher improvements in disability. Mean patient satisfaction score was 8.7/10.0 (SD 1.6).ConclusionThis is the first real-world cohort study reporting the results of a multimodal remote digital approach for chronic SP rehabilitation. High completion and engagement rates were observed, which were associated with clinically significant improvement in all health-related outcomes, as well as marked productivity recovery. These promising results support the potential of digital modalities to address the global burden of chronic musculoskeletal pain.

Influence of fear-avoidance beliefs and catastrophizing in the result of facet radiofrequency denervation in patients with chronic low back pain

Influence of fear-avoidance beliefs and catastrophizing in the result of facet radiofrequency denervation in patients with chronic low back pain

Kinesiophobia and its association with balance and mobility in knee osteoarthritis patients in Rawalpindi &amp; Islamabad

Objective:&#x0D; The purpose of this study was to evaluate the relationship of fear avoidance belief or kinesiophobia with balance and mobility in knee osteoarthritis patients.&#x0D; Materials and methods:&#x0D; This cross-sectional correlational study was conducted in Fauji Foundation Hospital, Benazir Bhutto Hospital and Holy Family Hospital, Rawalpindi/Islamabad from January 2019 to June 2019. A total of 64 knee osteoarthritis patients (both male and female) between the ages of 40- 60 years were included in this study. They were selected using the Kallgren Lawrence Classification system (Grade I, II and III) and American College of Rheumatology criteria. Fear avoidance belief questionnaire was used to identify fear avoidance belief/kinesiophobia, Step-up test and Functional Reach test were used to measure balance and timed up and go test was used to measure mobility. Statistical analysis was carried out using SPSS version 21. Kolmogorov-Smirnov test was applied to find out the normal distribution. The relationship between fear avoidance belief and balance and mobility was examined using Spearman’s test of correlation.&#x0D; Results:&#x0D; Results showed a weak negative correlation between fear avoidance belief and functional reach test (r= -0.259, P= 0.039), and a weak positive correlation between fear avoidance belief and timed up and go test (r= 0.26, P= 0.841).&#x0D; Conclusion:&#x0D; Balance and mobility are negatively affected by fear avoidance beliefs in knee osteoarthritic patients. Thus, fear avoidance belief is an important psychological construct to be considered in the assessment and treatment of knee osteoarthritic patients to prevent balance impairments and fall risk.&#x0D;

Belief, Knowledge and Perception of Causes of Low Back Pain among Rural and Urban Dwellers in a Nigerian City

The study examined the belief, knowledge and perception of causes of low back pain among rural and urban dwellers in Nigeria. One hundred and ninety-two (192) participants (99 from rural and 93 from urban community) were recruited for this study. A modified questionnaire from a previous similar study from India was administered to each of the participants to complete. The completed questionnaire was collected immediately. Data was analyzed using descriptive and inferential statistics, alpha level, was set at 0.05. Result showed that one hundred and thirty-three (71 urban and 62 rural) participants (133, 69.3%) perceived that pile was very important as a cause of low back pain. Considering the fear avoidance belief, 149 (69 urban and 80 rural) 77.6% agreed that low back pain get progressively worse in life. With regard to the knowledge of participants, 72 (45%) participants were able to answer two or three questions correctly and so were termed partially knowledgeable. Nature of work has significant association with each of the following perception, pile (X²=203.38) and poor mattresses (X²=237.830) as major cause of low back pain. This study concluded that many residents in Ile-Ife are not adequately knowledgeable about LBP and had negative perception and beliefs regarding low back pain (LBP).

Exploratory factor analysis of the fear-avoidance beliefs questionnaire in patients with chronic ankle instability

PurposeTo perform an exploratory factor analysis of the Fear-Avoidance Beliefs Questionnaire in patients with chronic ankle instability. MethodsA cross-sectional survey study was utilized. The Fear-Avoidance Beliefs Questionnaire was administered to patients with chronic ankle instability who met the inclusion criteria. Both an unrestricted and restricted factor analysis with varimax rotation were utilized to explore the factor structure of the instrument. Kaiser-Meyer-Olkin values were used to determine sampling adequacy. Bartlett’s test of sphericity was used to justify that the correlations were suitable for the principal component analysis. ResultsThe restricted two-factor analysis resulted in two factors with acceptable internal consistency values. The Keiser-Meyer-Olkin value was acceptable (0.81), and Bartlett’s test of sphericity was significant (χ2 (55) = 515.59, p < 0.001). ConclusionThe ankle-specific Fear-Avoidance Beliefs Questionnaire consists of two stable factors and should be used to further examine fear-avoidance beliefs in people with chronic ankle instability.

Psychological Approaches for the Integrative Care of Chronic Low Back Pain: A Systematic Review and Metanalysis.

Chronic low back pain (CLBP) is the most common cause of disability worldwide, affecting about 12% to 30% of the adult population. Psychological factors play an important role in the experience of pain, and may be predictive of pain persistence, disability, and long-term sick leave. The aim of this meta-analysis was to identify and to describe the most common psychological approaches used to treat patients who suffer from CLBP. A systematic search was performed on PubMed/MEDLINE and Cochrane Central. Overall, 16 studies with a total of 1058 patients were included in the analysis. Our results suggest that cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) interventions are both associated with an improvement in terms of pain intensity and quality of life when singularly compared to usual care. Disability also improved in both groups when compared to usual care. Significant differences in fear-avoidance beliefs were noted in the CBT group compared to usual care. Therefore, psychological factors are related to and influence CLBP. It is crucial to develop curative approaches that take these variables into account. Our findings suggest that CBT and MBSR modify pain-related outcomes and that they could be implemented in clinical practice.

Individuals progressive tension protocol in the application of elastic bandage in nonspecific chronic low back pain: a case study

Introduction: Low back pain is a disorder of musculoskeletal origin of multifactorial character, which can become chronic when it persists for more than 3 months. It is expected that 80% of the world's population will present with low back pain at some stage of life, characterizing it as a serious public health condition that requires specific interventions for treatment. Given the context, elastic banding arises, a resource that can be useful to these patients, however, its effectiveness requires that the bandage be of quality that the therapist has experience and that its application is standardized, the latter being scarce in the current literature. Thus, the present study sought to observe what would be the application of a progressive tension protocol with elastic bandage in an individual with nonspecific chronic low back pain. Methods: A 47-year-old female, caregiver of the elderly and diagnosed with nonspecific chronic low back pain participated in the study. The treatment protocol lasted 10 weeks, where the elastic bandage was applied to the participant and in the first and last session, in addition to the report of the level of pain obtained through the Numerical Pain Scale (END), the following questionnaires were used to evaluate: Oswestry Disability Index (ODI), Survey of Pain Attitude (SOPA-B) and Fear Avoidance Beliefs Questionnaire (FABQ). Conclusion: The findings suggest that the application of elastic bandage following the progressive tension protocol promoted a reduction in disability index, pain and fear of movement, such outcomes can be considered clinically relevant, given the constant search for therapeutic techniques that provide improvement in the quality of life of patients with chronic low back pain.&#x0D;

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

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 &lt; 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.

Fear as a barrier to physical activity in young adults with obesity: a qualitative study

ABSTRACT Obesity continues to be a growing public health problem worldwide. In adults with obesity, physical activity has health benefits beyond those directly attributable to weight loss. However, adults with obesity encounter various barriers to physical activity. Some barriers including fear, have received little academic attention, particularly in adults under 45 years. The aim of this qualitative study was to explore how fears about physical activity are experienced by, and impact on, adults with obesity aged 18 to 45 years. Semi-structured interviews were undertaken in a sample of 10 participants with a body mass index greater than 30 kg/m2. Analysis was conducted using the six phases of thematic analysis from the guidelines of Braun and Clarke. Participants gave detailed accounts of their experiences of fear and how it impacted on physical activity. Three themes were extracted: (1) fear as a barrier to physical activity; (2) threats, concerns and worries about weight underpinning fear(s) of activity; and (3) the consequences of fear(s). The findings suggest that the emotion of fear, particularly pain-related fear(s), were a frequent and important barrier to physical activity among younger adults with obesity. This is an important finding because of the risk it poses to health behaviour change. The findings provide some evidence that younger adults experience fear avoidance beliefs aligned to the conceptual principles of the Fear Avoidance Model. Further research is needed to further explore this relationship in a larger sample of younger adults with obesity, and explore its implications for promoting behaviour change in this group.

The Level of Kinesiophobia and Its Relationship with Physical Activity in People with a History of Ankle Sprain

Introduction: Kinesiophobia is one of the leading clinical factors in recovery from injury. The stressful situation of an ankle joint injury can cause severe withdrawal and fear of the patient to undertake physical activity, resulting in hypokinesia. Aims: The aim of the study was to demonstrate the relationship between the level of daily physical activity reported by the respondent after an ankle sprain and severity of the kinesiophobia phenomenon. Material and methods: The study comprised 78 people (mean age 23.1 years ± 3.3) with a history of ankle sprain injury. This population was divided into 2 groups, taking the given level of physical activity into account. GR1 consisted of 34 patients with an activity level of 0-3 hours a week of sports activity, GR2 was made up of 44 individuals reporting a level of physical activity &gt; 3 hours a week. In order to obtain the necessary results, the respondents filled in their own personal data sheet; and 3 standardised questionnaires translated into Polish: Foot and Ankle Ability Measure (FAAM); Fear-Avoidance Beliefs Questionnaire (FABQ); Tampa Scale of Kinesiophobia (TSK-17). Results: A high level of physical activity helps to avoid limitations in ankle and foot functioning. A relationship was found between functional limitations and the intensity of fear regarding movement according to the FABQ questionnaire. The limitations of the foot function translate into higher results for the FABQ questionnaire. No other statistically significant relationships were found. Conclusions: Kinesiophobia is a protective factor in the acute disease/injury phase. Physiologically, its level should decrease as functional abilities are regained. If the functional limitations remain high, the fear of movement also increases. Regular, high-level physical activity significantly improves the functioning of the ankle and foot, and reduces the level of kinesiophobia.

STarT MSK tool: Translation, adaptation and validation in Hebrew.

The Keele STarT MSK Tool divides musculoskeletal patients into three prognostic groups for risk-stratified care. It has shown good predictive and discriminative ability in development and validation samples. This study aimed to translate and validate the STarT MSK in a Hebrew version, among Israeli people living with musculoskeletal (MSK) pain. A cross-sectional study, with nested prospective sub-sample. The STarT MSK was translated into Hebrew using published guidelines. A total of 153 adults (18+) who reported living with MSK pain were administered the STarT MSK. Clinical measures included for validity testing included the 12-Item Short-Form Health Survey (SF-12), the Hospital Anxiety and Depression Scale (HADS), the Fear-Avoidance Beliefs Questionnaire (FABQ) and a numerical pain rating scale (NPRS). The STarT MSK was forward and backward translated, with minor changes to ensure cultural adaptation. The test-retest reliability of the STarT MSK total score was excellent (intraclass correlation coefficient 0.92). Internal consistency for the MSK scale was (α=0.612). The Spearman's correlation coefficients between STarT MSK total score and the validation measures confirmed the hypotheses and were significant. The Israeli translation and validation of the STarT MSK suggest that it is a valid and reliable instrument. The STarT MSK discriminated low-, medium- and high-risk groups.

Pain knowledge and fear-avoidance beliefs of French osteopathy students and educators towards chronic low back pain: An osteopathic educational institution-based cross-sectional survey

BackgroundPractitioners’ fear-avoidance beliefs can influence positively or negatively therapeutic outcomes in their patients. This study reports pain knowledge and fear-avoidance beliefs of French osteopathy students and educators towards the management of chronic low back pain (cLBP). MethodsAn online cross-sectional survey was proposed to educators and students. It included sociodemographic characteristics and two questionnaires: the FABQ-HC to assess beliefs on the effects of physical and work activities for people with cLBP, and the NPQ to assess participants' knowledge of pain. ResultsParticipants (N = 172) had mean FABQ-HC subscale scores of 11.02 ± 4.44 (Physical activity) and 24.37 ± 11.78 (Work). The mean NPQ total score was 11.90 ± 2.05. There were no significant score differences between students and educators (p > 0.05). Results showed that Year 4 students (N = 65) had a significantly better score (p < 0.05) at the FABQ-HC Physical Activity than Year 5 students (N = 71). Educators (N = 36) having less than 10 years of practice in osteopathy had better scores than other educators (p < 0.01) at the FABQ-HC Work. Educators and students in the study show similar scores to other French HCPs and international osteopaths on the FABQ-HC Physical activity. In contrast, they scored lower on the FABQ-HC Work. ConclusionsThe main finding was that educators and students belonging to the same OEI have no significantly different beliefs about cLBP and no significantly differing knowledge of pain. There is potential to improve pain education especially concerning the beliefs around cLBP concerning work activity.

Measurement properties of the Brazilian versions of Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in individuals with shoulder pain

PurposeTo verify the measurement properties of the Brazilian versions of Fear-avoidance Beliefs Questionnaire (FABQ) and Tampa Scale of Kinesiophobia (TSK) in individuals with shoulder pain.MethodsIndividuals with shoulder pain (>18 years) were included in this study. Structural validity was verified by exploratory factor analysis, which was used to identify dimensionality of the FABQ and TSK. Test-retest reliability was assessed with intraclass correlation coefficient(3,1) and internal consistency with Cronbach’s alpha. Floor or ceiling effects were also investigated. Responsiveness was verified by effect sizes and area under the receiver operating characteristic curve (AUC).ResultsExploratory factor analysis identified two and one factor in the FABQ and TSK, respectively. FABQ and TSK presented moderate to good reliability and adequate internal consistency (Cronbach’s alpha > 0.70). The floor effect was present in one factor of the FABQ. The FABQ and TSK showed small to moderate effect sizes and did not show adequate AUC.ConclusionFABQ and TSK are multidimensional and unidimensional instruments, respectively. Those instruments presented moderate to good reliability and the responsiveness was considered to be suboptimal in individuals with shoulder pain.

Development of the Prevent for Work Questionnaire (P4Wq) for the assessment of musculoskeletal risk factors in the workplace: part 2—pilot study for questionnaire development and validation

ObjectiveThe aim of this study was to develop a multifactorial, self-report questionnaire: Prevent for Work Questionnaire (P4Wq). The questionnaire is intended for screening for risk factors in work-related musculoskeletal disorders...

Musculoskeletal disorders and associated factors among office workers in an activity-based work environment

ABSTRACT Objectives. This study aimed to evaluate the prevalence of musculoskeletal disorders (MSDs) and associated factors among office workers working in the activity-based workplace (ABW). Methods. Forty-two office workers with an ABW and 68 office workers as controls participated. The Nordic musculoskeletal questionnaire, the Baecke physical activity questionnaire, the Copenhagen psychosocial questionnaire III and the fear-avoidance beliefs questionnaire were used and the pain pressure threshold (PPT) was measured. Results. There were no significant differences in the prevalence of MSDs in most body areas between the ABW and control groups. The ABW group experienced significantly (p < 0.05) more right wrist, hand and finger (WHF) pain in the past 6 months when compared with the control group. The ABW group demonstrated significantly (p < 0.05) more work-related physical activity and daily time spent standing. There were no significant differences in other pain-related factors measured. Conclusions. Office workers with an ABW had a similar prevalence of MSDs to office workers with a designated workplace and no differences in associated factors.

Comparison of chronic widespread pain prevalence with different criteria in two cohorts of rheumatoid arthritis

ObjectiveThis study aims to investigate chronic widespread pain with the 1990 (CWP1990) and 2019 (CWP2019) definitions 6 years after the onset of rheumatoid arthritis (RA), in one patient cohort with tight controls and one conventional cohort, and factors associated with reporting CWP1990 and CWP2019, respectively.MethodsA cohort of 80 RA patients with monthly visits to the physician the first 6 months was compared to a cohort of 101 patients from the same clinic with conventional follow-up. Both cohorts had early RA (< 13 months). The prevalence of CWP1990 and the more stringent CWP2019 were in a 6-year follow-up investigated with a questionnaire, including a pain mannequin and a fear-avoidance beliefs questionnaire.ResultsIn the tight control cohort, 10% reported CWP2019 after 6 years compared to 23% in the conventional cohort (p = 0.026). There was no difference when using the CWP1990 definition (27% vs 31%, p = 0.546). When adjusted for important baseline data, the odds ratio for having CWP2019 was 2.57 (95% CI 1.02–6.50), in the conventional group compared to the tight control group (p = 0.046). A high level of fear-avoidance behaviour towards physical activity was associated with CWP2019, OR 10.66 (95% CI 1.01–112.14), but not with CWP1990 in the tight control cohort.ConclusionA more stringent definition of CWP identifies patients with a more serious pain condition, which potentially could be prevented by an initial tight control management. Besides tight control, caregivers should pay attention to fear-avoidance behaviour and tailor treatment.Key Points• CWP2019 is a more stringent definition of chronic widespread pain and identifies patients with a more serious pain condition.• Patients with a serious pain condition could be helped by frequent follow-ups.• This study suggests that a special attention of fear-avoidance behaviour towards physical activity in patients with RA is needed.

When Treating Coexisting Low Back Pain and Hip Impairments, Focus on the Back: Adding Specific Hip Treatment Does Not Yield Additional Benefits-A Randomized Controlled Trial.

To determine whether adding hip treatment to usual care for low back pain (LBP) improved disability and pain in individuals with LBP and a concurrent hip impairment. Randomized controlled trial. Seventy-six participants (age, 18 years or older; Oswestry Disability Index, 20% or greater; numeric pain-rating scale, 2 or more points) with LBP and a concurrent hip impairment were randomly assigned to a group that received treatment to the lumbar spine only (LBO group) (n = 39) or to one that received both lumbar spine and hip treatments (LBH group) (n = 37). The individual treating clinicians decided which specific low back treatments to administer to the LBO group. Treatments aimed at the hip (LBH group) included manual therapy, exercise, and education, selected by the therapist from a predetermined set of treatments. Primary outcomes were disability and pain, measured by the Oswestry Disability Index and the numeric pain-rating scale, respectively, at baseline, 2 weeks, discharge, 6 months, and 12 months. The secondary outcomes were fear-avoidance beliefs (work and physical activity subscales of the Fear-Avoidance Beliefs Questionnaire), global rating of change, the Patient Acceptable Symptom State, and physical activity level. We used mixed-model 2-by-3 analyses of variance to examine group-by-time interaction effects (intention-to-treat analysis). Data were available for 68 patients at discharge (LBH group, n = 33; LBO group, n = 35) and 48 at 12 months (n = 24 for both groups). There were no between-group differences in disability at discharge (-5.0; 95% confidence interval [CI]: -10.9, 0.89; P = .09), 12 months (-1.0; 95% CI: -4.44, 2.35; P = .54), and all other time points. There were no between-group differences in pain at discharge (-0.2; 95% CI: -1.03, 0.53; P = .53), 12 months (0.1; 95% CI: -0.53, 0.72; P = .76), and all other time points. There were no between-group differences in secondary outcomes, except for higher Fear-Avoidance Beliefs Questionnaire (work subscale) scores in the LBH group at 2 weeks (-3.35; 95% CI: -6.58, -0.11; P = .04) and discharge (-3.45; 95% CI: - 6.30, -0.61; P = .02). Adding treatments aimed at the hip to usual low back physical therapy did not provide additional short- or long-term benefits in reducing disability and pain in individuals with LBP and a concurrent hip impairment. Clinicians may not need to include hip treatments to achieve reductions in low back disability and pain in individuals with LBP and a concurrent hip impairment. J Orthop Sports Phys Ther 2021;51(12):581-601. Epub 16 Nov 2021. 2021. doi:10.2519/jospt.2021.10593.

Effects of attentional bias modification on chronic low back pain in older outpatients: A randomized crossover trial (pilot study).

In the present study, the effect of attentional bias modification (ABM) on older outpatients, with chronic low back pain, was examined. This was a single-center, randomized, single-blinded, crossover trial and patients were randomly divided in a 1:1 allocation ratio into two groups: an ABM Leading group and an ABM Trailing group. Forty-three outpatients with chronic low back pain participated. Patients were evaluated four times and the treatments were ABM + Normal intervention or Normal intervention only. Outcome measures included pain intensity on the Numerical Rating Scale, the Pain Catastrophizing Scale, Fear-Avoidance Beliefs Questionnaire, Hospital Anxiety and Depression Scale, Somatic Symptom Scale-8, and EuroQol 5 Dimension-3 levels questionnaire. In addition, we performed the 30-second Chair-Stand test and the Timed Up & Go test for physical function evaluations. There was no change in pain intensity due to ABM. However, the total Pain Catastrophizing Scale score was significantly decreased, and the EuroQol 5 Dimension-3 levels questionnaire and 30-second chair-stand test were significantly improved (P <.05). The Health Science Ethics Committee, Graduate School of Biomedical Sciences, Nagasaki University (permit number: 17060861), and the clinical trial was registered with UMIN (UMIN000029424).

Turning away from sound: The role of fear avoidance in noise sensitivity following mild traumatic brain injury

BackgroundNoise sensitivity (NS) following mild traumatic brain injury (mTBI) is common impacts functioning and outcomes. Recent research suggests psychological factors may have a significant role in the development of NS after mTBI. Psychological interventions have been advocated for to reduce this experience. To be effective, these interventions must aim to target the psychological processes that contribute to this relationship. Fear avoidance holds promise in this regard. The current study aimed to explore the role of fear avoidance in NS and examine its role in mediating the relationship between psychological distress and NS. MethodAdults (n = 234) diagnosed with mTBI were recruited from outpatient mTBI clinics throughout New Zealand. Participants completed self-report measures of pre-injury mental health status, as well as current post-concussion symptoms, psychological distress (anxiety, stress, depression, fear avoidance and post-traumatic stress symptoms) and functional status upon entry to an mTBI outpatient clinic (M = 8.9, SD = 9.2, post injury). ResultsA pre-injury mental health diagnosis was associated with NS after mTBI, as were symptoms of anxiety, stress, depression, and post-traumatic stress. Regression analyses revealed that fear avoidance (β = 0.45, p = .01), as well as stress (β = 0.07, p = .01) and PTSD symptoms (β = 0.02, p = .01), made a significant and unique contribution to NS. A series of mediation analyses found that fear avoidance had a significant indirect effect on the relationships between psychological distress and NS. ConclusionsFear avoidance is related to NS following mTBI. Targeting fear avoidance behaviours and beliefs may represent a treatment target for reducing NS after mTBI.