Fear-Avoidance Beliefs Questionnaire Scores Research Articles

Effects of Fu’s subcutaneous needling on clinical efficacy and psychological cognitive characteristics in patients with chronic non-specific low back pain: A randomized controlled trial

Background and purposeLow back pain (LBP) is a major global public health problem. Evidence shows that LBP is also related to cognitive, psychological, and lifestyle factors. Fu’s subcutaneous needling (FSN) has been used for the treatment of musculoskeletal problems for many years. This prospective randomized controlled trial aimed to evaluate the clinical efficacy and fear avoidance beliefs of FSN in the treatment of patients with chronic non-specific LBP. Material and methodsNinety participants with chronic non-specific LBP were randomly divided into the FSN and the traditional acupuncture (TA) groups (n = 45) and received either FSN or TA treatment for three consecutive days from December 2021 to March 2023. The primary outcome was pain intensity measured by the visual analogue scale (VAS). Secondary outcomes were trunk extensor endurance (TEE), lumbar range of motion (ROM), and the Fear Avoidance Beliefs Questionnaire (FABQ). Outcome measurements were made before the first treatment and after each treatment. Follow-up assessments of VAS and FABQ scores were conducted one month after treatment. ResultsThe FSN group had significantly lower VAS and FABQ scores at each time point after intervention compared to the TA group (P < 0.01). The scores of TEE and lumbar ROM were higher in the FSN group than those in the TA group (P < 0.01). Repeated measures analysis of variance (ANOVA) showed significant time effects, group effects, and interaction effects for VAS, TEE, lumbar ROM, and FABQ in both groups (P < 0.01). One month after treatment, the FSN group had significantly lower VAS and FABQ scores compared to the TA group (P < 0.05). ConclusionThis study suggested that FSN was superior to TA in terms of clinical efficacy and fear-avoidance beliefs in the treatment of chronic non-specific LBP. FSN could be used as an effective clinical treatment.

DETERMINATION OF EMOTIONAL AND BEHAVIORAL FACTORS ASSOCIATED WITH PAIN SEVERITY IN PATIENTS WITH CHRONIC LOW BACK PAIN

OBJECTIVE: The primary aim of the study was to determine which emotional and behavioral factors affect the pain severity and to what extent in patients with chronic low back pain (LBP). MATERIAL AND METHODS: One hundred and seventy-eight patients with LBP participated in the cross-sectional study. The primary outcome was the Visual Analog Scale (VAS) evaluated the pain severity during rest (VASrest) and activity (VASact). Secondary outcomes included the Pain Beliefs Questionnaire (PBQ), The Pain Coping Questionnaire (PCQ) and The Fear-Avoidance Beliefs Questionnaire (FABQ). RESULTS: While PBQ scores increased, VASrest and VASact scores decreased significantly (p&amp;lt; 0.05). There was a positive and significant correlation between VASrest and only Medical Remedies Subparameter of PCQ(p=0.008), and between VASactivity and only Helpless Subparameter of PCQ (p&amp;lt;0.05). VASrest and VASact had positive and significant associations with FABQ scores (p&amp;lt; 0.05). The results of the regression analysis showed that pain-related psychologic beliefs are the main determinants of VASrest(p=0.014) and VASact (p=0.006). Pain related organic beliefs had a significant but lower effect on VASrest (p=0.019) and VASact (p=0.031). It was observed that seeking a medical remedy for pain at rest had a significant effect on reducing the VAS scores(p=0.024). CONCLUSIONS: Inadequacies in the management of negative beliefs associated with pain contribute to the exacerbation of pain even at rest. However, neither fear avoidance behavior nor coping strategies except medical remedies developed for pain at rest do not reduce pain severity.

Kinesiophobia and fear avoidance behaviors in collegiate female athletes during menstruation

Background and Study Aim. The menstrual cycle can be a factor affecting performance in female athletes if accompanied by pain. In this study, authors aimed to examine how menstruation pain affects kinesiophobia and fear avoidance behavior in female athletes. Material and Methods. Study included a total of 50 female athletes aged 18-35 years. The athletes were divided into 3 groups as Group 1 (With Pain), Group 2 (No Pain) and Group 3 (Intermittent Pain) according to their pain experience during menstruation. The groups were compared in terms of kinesiophobia and fear avoidance behaviors. Kinesiophobia was evaluated with the Tampa Kinesiophobia Scale (TKS), fear avoidance behaviors were evaluated by using Fear Avoidance Beliefs Questionnaire (FABQ). Results. There was a significant difference between the 3 groups in terms of both TKS and FABQ scores (p&lt;0.05). In terms of TKS, there was no significant difference between Group 1 and Group 3 (p&gt;0.05), there was a significant difference between Group 1 and Group 2 and between Group 2 and Group 3 (p&lt;0.05). There was a significant difference in favor of Group 1 in all pairwise comparisons in terms of FABQ scores (p&lt;0.05). Pain intensity was associated with TKS and FABQ. Conclusions. A significant majority of female athletes experienced pain during menstruation, exhibited kinesiophobia and fear avoidance behavior due to pain. Since kinesiophobia and fear avoidance behavior can be a limiting factor for the athlete's optimum performance, female athletes should be supported in order for them to develop coping methods.

227. Continued improvement in functional gait and balance parameters to one year following decompression surgery for cervical spondylotic myelopathy

<h3>BACKGROUND CONTEXT</h3> Cervical spondylotic myelopathy (CSM) tends to produce a progressive decline in function characterized by gait disturbance, worsening balance and loss of upper extremity dexterity. Traditionally, the goal of decompressive surgery for CSM was to arrest neurological deterioration and prevent further disability rather than to provide functional recovery. In recent years, studies utilizing functional outcome measurements (FOMs) have demonstrated objective improvements in gait and balance dysfunction out to three months after surgery for CSM, but 1-year follow-up has yet to be reported. <h3>PURPOSE</h3> To determine whether the trends in improvements in gait, balance, pain levels, and psychological profiles observed at three months after cervical decompression for CSM continue out to one year postoperatively. <h3>STUDY DESIGN/SETTING</h3> Prospective, concurrent control cohort study. <h3>PATIENT SAMPLE</h3> The study included 22 symptomatic CSM patients, 20 age-matched healthy control volunteers (C). <h3>OUTCOME MEASURES</h3> Gait and balance parameters, neck disability index (NDI), Visual analog scale (VAS) neck, and psychological measures – Tampa Scale for Kinesiophobia (TSK) and Fear Avoidance Beliefs Questionnaire (FABQ). <h3>METHODS</h3> Patients performed gait and balance evaluations prior to surgery (Pre) and at 3 months (Post3) and 12 months (Post12) postoperatively. Functional data were recorded and analyzed using human motion capture and dynamic surface EMG. Patients also completed outcomes questionaries at the same time points. Repeated measurements and one-way analysis of variance (ANOVA) were used to analyze data. <h3>RESULTS</h3> Continued improvement in multiple gait parameters was observed out to one year postoperatively: faster walking speed (Post3: 0.92 vs Post12: 0.99 m/s, p=0.048; C: 1.02 m/s, p>0.050), shorter step time (Post3: 0.44 vs Post12: 0.42 s, p=0.041; C: 0.42 s, p>0.050), and longer step length (Post3: 0.52 vs Post12: 0.55, p=0.048; C: 0.57, p>0.050). Additional gains in balance occurred between 3 and 12 months: head total sway (Post3: 57.70 vs Post12: 51.35 cm, p=0.045 cm; C: 46.42, p>0.050) as well as cone of economy (CoE) dimensions in the coronal plane for both the head (Post3: 3.14 vs Post12: 2.55 cm, p=0.037 cm; C: 2.19, p>0.050) and center of mass (Post3: 2.11 vs Post12: 1.85 cm, p=0.034 cm; C: 1.64, p>0.050). There were significant improvements in all PROMs after surgery: VAS neck (Pre: 5.4, Post3, 2.1, Post12 1.3, p<0.021) and NDI (Pre: 44.6, Post3: 28.5, Post12 20.1, p=0.032). Progressive improvements were observed in TSK and FABQ scores (p<0.050). <h3>CONCLUSIONS</h3> This study reports objective functional measures and psychological outcomes in addition to standard patient-reported outcome measures for CSM patients out to one year postoperatively, thereby providing a comprehensive global assessment of their recovery. Select measures of gait and balance improved at all time points postoperatively and ultimately resembled those of the healthy controls at one year. These results provide important insight regarding the continued recovery that occurs between 3 and 12 months after surgical decompression for CSM. In turn, this information enriches the discussion surgeons can have with patients before and after surgery. FOMs provide both clinicians and patients with a more detailed and sensitive assessment of overall treatment outcomes and the timeframe of functional recovery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

223. The psychological burden of disease among patients undergoing cervical spine surgery: are we underestimating our patients’ inherent disability?

<h3>BACKGROUND CONTEXT</h3> Recent studies have suggested that for patients with chronic neck pain, both psychological and psychosomatic symptoms need to be addressed as psychological distress is associated with poor outcomes in these patients. The fear avoidance model has been used to explain how maladaptive thoughts and behaviors contribute to chronicity and disability. Certain mental health scores have been previously analyzed in patients with pathologies in different spinal regions. However, these rates have yet to be assessed against patients undergoing cervical spine surgery. <h3>PURPOSE</h3> Identify the psychological burden among patients undergoing surgical treatment for their symptomatic cervical degenerative disease. <h3>STUDY DESIGN/SETTING</h3> Single-center prospective double-blinded, randomized control trial that consists of patients undergoing surgical arthrodesis for 3 single- or multilevel cervical disease, resulting in cervical radiculopathy. <h3>PATIENT SAMPLE</h3> This study included 47 symptomatic cervical degenerative disorders patients. <h3>OUTCOME MEASURES</h3> Fear Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS). Neck Disability Index (NDI), EuroQol Five Dimensions (EQ5D). <h3>METHODS</h3> A total of 47 patients age >18 with symptomatic cervical degenerative disease were included and those with active depression or history of major depression were excluded from the study. Basic demographics and baseline HRQLs (NDI, EQ5D, PCS, FABQ) were assessed via descriptive analyses. Patient psychosomatic scores that measure preoperative pain catastrophe and fear avoidance of procedure (PCS, FABQ) were compared to previously published benchmarks in a lumbar spine population. These mental health components and disability were further stratified by their severity as previously published (PCS >30; FABQ >34). Correlations assessed the relationship between these mental health components and severity of disability described by NDI (Not Disabled=0-4, Mild=5-14, Moderate=15-24, Severe=25-34, Complete=34+). Furthermore, logistic regressions were analyzed to determine whether NDI was an independent predictor of psychological burden described by PCS and FABQ. <h3>RESULTS</h3> Forty-seven patients were enrolled (age 53.6 years, BMI 29.4 kg/m2). 32% of these patients were diagnosed with radiculopathy, 26% with myelopathy, and 42% with concomitant imaging diagnosis (hnp, ddd, spondylosis all with or without central stenosis). These patients were all scheduled to undergo spinal fusions with decompression and had failed at least 3 months of conservative treatment. The average number of levels fused was 2.27±1.4. At baseline, the average PCS was 27.4 and FABQ: 40. By overall health metrics, the patient population had an average EQ5D score of 9.3 and an NDI of 25.6. 57.1% of patients had a severe FABQ, 40.8% had a severe PCS, and 27.7% had a severe NDI score. As compared to historical controls of lumbar patients, the patients in this study had greater levels of psychosomatic pathology measured by FABQ (40 vs 17.55; p<0.001) and PCS (27.4 vs 19.25; p<0.001). PCS was positively correlated with FABQ scores (r=0.55; p<0.001). Increasing neck disability was correlated with greater PCS measured disability (Overall r=0.7, Complete r=0.58; p<0.05). Being completely disabled was also identified to have a significant relationship with having a severe PCS score independent of levels fused and diagnosis (OR=11.7[1.5-90.5]; p=0.019). This trend was similarly identified for FABQ (Overall r=0.5, Complete r=0.4; all p<0.05). Age was also not a significant predictor for baseline severe PCS and FABQ nor were diagnosis and presence of stenosis. <h3>CONCLUSIONS</h3> Cervical spine patients have an overall great amount of mental health pathology; however, a large portion of these patients also have high fear avoidance beliefs and pain catastrophizing at baseline. These rates were identified to be higher than previously identified benchmarks of lumbar spine patients. Because this study excluded patients with an official diagnosis of depression or other psychological condition, it is reasonable to say that the mental health pathology of patients undergoing cervical surgery is greatly underestimated and should warrant preoperative treatment to help mitigate these mental health scores at baseline. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Investigation of the relationship between physical activity, kinesiophobia and fear of falling in older adults with chronic pain

Aims This study aims to investigate the relationship between physical activity, fear of movement and fear of falling in older adults with chronic pain. Materials and methods The study includes 163 older adults aged 65 years and over, who live in a private nursing home. The cognitive functions of the individuals who participated in the study were evaluated with the mini-mental examination scale (MMES), fears of movement with the Tampa Scale of Kinesiophobia (TSK), fear-avoidance behaviour with the Fear-avoidance Beliefs Questionnaire (FABQ), physical activity levels with the Physical Activity Scale for Older (PASE), and the fears of falling were assessed with Tinetti’s Falls Efficacy Scale (FES). Results In the correlation analysis, there was a weak correlation between age and fall risk (r = 0.349, p < 0.001), and PASETotal score (r = –0.020, p = 0.011). There was a weak positive correlation between Tinetti FES and FABQ scores (r = 0.349, p < 0.001), and kinesiophobia value (r = 0.259, p < 0.001), there was a weak negative correlation between Tinetti FES and PASETotal (r = –0.241, p = 0.002). A positive mid correlation was determined between kinesiophobia and the FABQ scores (r = 0.41, p < 0.001). The established regression model was found to be significant (F = 12.175; p < 0.001). Among the independent variables included in the model, FABQTotal (t = 3.589; p < 0.0001) and PASETotal (t = –3.325; p < 0.0001) significantly affected the fear of falling. Conclusion The presence of chronic pain in older adults who have problems related to physical activity, fear of falling, and kinesiophobia due to advancing age may affect social participation, functional level, and quality of life significantly. Therefore, pain should be addressed in older adults and should be considered as an important issue in rehabilitation programs.

Fear Avoidance Beliefs and Outcome After Surgery for Degenerative Lumbar Spine.

This was a prospective cohort study. The aim of this study is to question the influence of fear avoidance beliefs on functional outcome following surgery for degenerative lumbar spine. Fear avoidance beliefs are well-studied modifiers of low back pain. Nonetheless, the influence of fear avoidance beliefs on the outcome of spinal surgery remains controversial. We conducted a prospective cohort study including patients undergoing surgery for degenerative lumbar discopathy, spondylolisthesis, and stenosis. Patients completed a preoperative questionnaire including the Fear Avoidance Beliefs Questionnaire (FABQ) as well as Visual Analog Scales for radicular and lumbar pain (VAS-R/L), Oswestry Disability Index (ODI), and Short-Form 36 health survey (SF36). Functional outcome was measured at least 6 months after surgery using ODI. Sixty-three patients with a mean follow-up of 254 days (8.5 mo, minimum=179 d, maximum=534 d) were included in the study. Women showed stronger work-related fear avoidance beliefs but there was no other difference in baseline characteristics and functional outcome between patients with low or high (>75th percentile) baseline FABQ-P or FABQ-W scores. Individual variables associated with whether patients reached minimal clinically important difference for ODI were: working status [odds ratio (OR)=0.13; 95% confidence interval (95% CI), 0.03-0.62; P =0.01], American Society of Anesthesiologists classification score (OR=0.32; 95% CI, 0.11-0.92; P =0.03), preoperative duration of symptoms (OR=0.94; 95% CI, 0.89-0.99; P =0.03), and preoperative ODI (OR=1.03; 95% CI, 1.00-1.07; P =0.05). Neither physical nor work-related preoperative FABQ scores were predictors of functional results. In our study, the FABQ was not associated with functional outcome following surgery for degenerative lumbar spine. Other psychological patient-reported measures are needed to refine selection of patients undergoing spine surgery in order to ensure better outcomes.

Investigating the effects of myofascial induction therapy techniques on pain, function and quality of life in patients with chronic low back pain

IntroductionLow back pain (LBP) is well documented as a common health problem; it is the leading cause of activity limitation and work absence throughout much of the world, and it causes an enormous economic burden on individuals, families, communities, industry, and governments. The aim of this study was to comparatively investigate the effects of myofascial induction therapy (MIT) against pain neuroscience education (PNE) on pain and function in patients with chronic low back pain (CLBP). MethodForty patients with CLBP were included and randomly divided into two groups according to the treatment program (40 min/session, 2 sessions/week during 8-week), as follows: the MIT and the PNE groups. The outcome measures were the fear-avoidance beliefs questionnaire (FABQ), Roland Morris disability questionnaire, McGill pain questionnaire, finger floor test, SF-36 quality-of-life questionnaire, and thoracolumbar fascia ultrasound imaging results. Patients were evaluated before and after treatment. ResultsWithin both groups, all outcome scores showed a significant improvement (p < 0.05). After 8-week, SF-36 physical function, physical role and mental health scores significantly improved in MIT group compared with PNE group, finger floor test score significantly decreased in MIT group compared with PNE group, and FABQ score significantly decreased in PNE group compared with MIT group (p < 0.05). ConclusionsAlthough both MIT and PNE were found to be effective on pain and function in patients with CLBP, MIT techniques were substantially better in improving the mobility of trunk flexion and quality of life in these patients.

Verbal Encouragement Improves Star Excursion Balance Test Performance In Patients With Chronic Ankle Instability

PURPOSE:The Star Excursion Balance Test (SEBT) is a common dynamic balance test. Functional limitations on the SEBT are associated with CAI, but psychological constraints such as kinesiophobia or a lack of confidence may affect performance. The purpose of this study was to investigate the effects of verbal encouragement (VE) on maximum reach distance performance between CAI and healthy participants on the SEBT and to explore the role of kinesiophobia with this functional. METHODS:Thirty-four individuals: 17 CAI (10 F/7 M; age= 21.06±3.19yr; height=171.2±11.9 cm; weight=67.7±10.8 kg) and 17 healthy controls (10 F/7 M; age=19.41 ±1.23yr; height=169.35±6.36 cm; weight=64.89±8.76kg) volunteered. Independent variables included condition (VE vs No VE) and group (CAI vs Healthy). The Fear Avoidance Beliefs Questionnaire (FABQ) was administered. Participants completed 3 SEBT trials per condition, starting with No VE followed by VE to eliminate the effect of heightened motivation with a randomized order. Analysis of Variance (ANOVA) examined group differences and whether VE affected performance for Anterior (ANT), Posteromedial (PM), and Posterolateral (PL) reach distances. FABQ was compared between the CAI and Healthy groups using a t-test; all alpha levels were <.05 a priori. RESULTS:With No VE, a significant group-by-condition interaction was observed in both the ANT (CAI: 66.90 ± 5.50 vs Healthy:70.65 ± 4.52) and PM (CAI: 77.60 ± 7.70 vs Healthy: 81.89 ± 8.25 reach directions, which diminished with VE: ANT (CAI: 70.43 ± 4.52 vs Healthy: 71.77 ± 5.10) and PM (CAI: 85.41 ± 7.19 vs Healthy: 86.45 ± 8.71), showing that the two groups behaved similarly with VE. There was no statistically significant interaction (p=0.48) for the PL reach direction without VE (CAI: 73.60 ± 7.84 vs Healthy: 75.16 ±11.72) or with VE (CAI: 80.18 ±9.79 vs Healthy: 80.06 ± 11.93). The CAI group had significantly higher FABQ scores (10.53 ±9.45) than the healthy group (0.41 ± 1.70) (p<.001). CONCLUSIONS: The CAI group had lower performance on the SEBT without VE, but with VE, the scores were comparable to healthy controls. Clinicians and researchers should acknowledge the impact that motivation and psychological stresses have on functional performance in patients with pathologies such as CAI.

The Relationship Between Injury-Related Fear and Visuomotor Reaction Time in Individuals With a History of Anterior Cruciate Ligament Reconstruction.

Deficits in reaction time, decreased self-reported knee function, and elevated levels of injury-related fear have been observed in individuals who sustain anterior cruciate ligament injury. Understanding the relationship between these variables may provide the impetus to further investigate effective intervention strategies to address these deficits in individuals after anterior cruciate ligament reconstruction (ACLR). To examine the relationship between injury-related fear and lower-extremity visuomotor reaction time (VMRT) in individuals with a history of ACLR. A secondary purpose was to determine the relationship between self-reported knee function and lower-extremity VMRT in individuals with a history of ACLR. Cross-sectional study. Laboratory. Twenty participants between the ages of 18-35years, with history of unilateral ACLR within the last 10 years, who injured their knee playing or training for organized or recreational sports. Scores on the athlete fear avoidance questionnaire, the fear-avoidance beliefs questionnaire (FABQ), the knee injury and osteoarthritis outcome score, and reaction time (in seconds) on the lower-extremity VMRT task using the FitLight Trainer™, bilaterally. Spearman Rho correlations examined the relationship between the dependent variables. There was a moderate positive correlation between VMRT and FABQ-total (r = .62, P < .01), FABQ-sport (r = .56, P = .01), and FABQ-physical activity (r = .64, P < .01) for the injured limb. Correlations between FABQ scores and VMRT for the uninjured limb were weak positive correlations (r = .36-.41, P > .05). Weak correlations between the osteoarthritis outcome score subscales, athlete fear avoidance questionnaire, and VMRT were observed for the injured limb (P > .05). Individuals with a history of ACLR who exhibited elevated levels of injury-related fear demonstrated slower VMRT. There were no relationships between self-reported knee function and VMRT. Future research should explore interventions to address injury-related fear and VMRT in individuals after ACLR.

Relationship between sarcopenia and pain catastrophizing in patients with lumbar spinal stenosis: A cross-sectional study

ObjectivesThe purpose of this study is to clarify the psychological factors related to sarcopenia in patients with lumbar spinal stenosis (LSS). MethodsThis cross-sectional study included 72 patients with LSS (38 males and 34 females; mean age, 70.4 ± 6.9 years). Demographic data, lower extremity pain, back pain, Japanese Orthopaedic Association score, Pain Catastrophizing Scale (PCS) score, Hospital Anxiety and Depression Scale (HADS) score, Fear-Avoidance Beliefs Questionnaire score, walking velocity, grip strength, walking distance, and appendicular muscle mass were assessed. Muscle mass was measured using bioelectrical impedance analysis. Patients were grouped based on sarcopenia status according to skeletal muscle mass index. ResultsThe prevalence of sarcopenia was 13.9% (10 of 72 patients). Sarcopenia was significantly more common in females. The incidence of dyslipidemia and cardiovascular disease were significantly higher in the sarcopenia group. The sarcopenia group had lower body weight, body mass index, grip strength, and walking distance than the control group. The sarcopenia group had higher PCS scores and HADS-anxiety scores. Multivariate analysis identified body weight, dyslipidemia, walking distance, and PCS score as significantly related to sarcopenia. ConclusionsPain catastrophizing might be the most relevant psychological factor in sarcopenia. Evaluation of both physical function and pain catastrophizing is needed when investigating sarcopenia in LSS.

Developing a clinical prediction rule to identify patients with lumbar disc herniation who demonstrate short-term improvement with mechanical lumbar traction.

To develop a clinical prediction rule (CPR) that predicts treatment responses to mechanical lumbar traction (MLT) among patients with lumbar disc herniation (LDH). This study was an uncontrolled prospective cohort study. The subjects included 103 patients diagnosed with LDH for which they underwent conservative therapy. The subjects received MLT for 2 weeks, and the application of any other medication was left at the discretion of the attending physician. The initial evaluation was performed prior to the initiation of treatment. The independent variables from the initial evaluation were imaging diagnosis, Oswestry Disability Index (ODI), Fear-Avoidance Beliefs Questionnaire score, visual analog scale, medical interview, physical examination. The patients whose ODI after 2 weeks of treatment improved by ≥50% of that at the initial evaluation were defined as responders. Of the 103 subjects, 24 were responders, and the five predictors selected for the CPR were limited lumbar extension range of motion, low-level fear-avoidance beliefs regarding work, no segmental hypomobility in the lumbar spine, short duration of symptoms, and sudden onset of symptoms. For the patients with at least three of the five predictors, the probability of their ODI greatly improving increased from 23.3% to 48.7% compared with the patients without these predictors (positive likelihood ratio, 3.13). Five factors were selected for the CPR to predict whether patients with LDH would demonstrate short-term improvement following conservative therapy with MLT.

Changes in fear-avoidance beliefs and work participation after occupational rehabilitation for musculoskeletal- and common mental disorders: secondary outcomes of two randomized clinical trials.

To assess: (i) whether changes in the Fear-Avoidance Beliefs Questionnaire (FABQ) were greater for multicomponent inpatient rehabilitation vs outpatient cognitive behavioural therapy, and (ii) whether baseline scores and changes (pre- to post-intervention) in FABQ were associated with future work-participation. Individuals sick-listed for 2-12 months were randomized to inpatient multicomponent rehabilitation (3.5 weeks or 4+4 days) or outpatient cognitive behavioural therapy (6 sessions/6 weeks). A total of 334 subjects were included. There were no significant differences on FABQ between the in- and out-patient programmes during follow-up. Participants with consistently low scores on the work subscale had more work-participation days, followed by those who reduced their scores. Participants who increased, or had consistently high scores had the least workdays. For the physical activity subscale, the associations were weaker. FABQ-work scores at baseline were associated with number of work-participation days for both musculoskeletal and psychological diagnoses, and more strongly for the latter group. This study suggests that FABQ could be a useful prognostic tool for individuals on sick leave due to musculoskeletal or psychological disorders. There was no evidence that inpatient occupational rehabilitation reduces FABQ scores more than outpatient cognitive behavioural therapy.

Validity of an Alternate Hand Behind Back Shoulder Range of Motion Measurement in Patients With Shoulder Pain and Movement Dysfunction

ObjectivesThe purpose of this study was to determine the criterion-related validity of a novel method of measuring hand behind back (HBB) shoulder range of motion (ROM) for evaluating pain and disability in people with shoulder pain and movement impairment. MethodsThis cross-sectional study design evaluated shoulder ROM, pain, fear-avoidance beliefs, and disability in 60 people (aged 35-70 years, 31 male) with chronic unilateral shoulder dysfunction (mean duration 15.73 weeks). Shoulder HBB ROM was measured with a bubble inclinometer in a manner that did not require the patient to disrobe. Correlations were sought between HBB ROM and other shoulder movements, as well as scores recorded on the Shoulder Pain and Disability Index (SPADI), visual analogue scale for pain, Fear Avoidance Beliefs Questionnaire (FABQ), and duration of symptoms. ResultsRestriction of HBB movement was significantly correlated with SPADI total disability score (r = 0.39, P < .01), flexion ROM (r = 0.30, P < .05), abduction ROM (r = 0.39, P < .01), and external rotation ROM (r = 0.60, P < .01). Other variables were not significantly correlated with HBB ROM. Multiple linear regression analysis indicated that the variance in HBB ROM was explained by the SPADI disability subscore (P = .01) but not by visual analogue scale score (P = .05), FABQ score (P = .65), or duration of symptoms (P = .73). The FABQ score was not explained by limitation in HBB ROM and shoulder movements. ConclusionThese findings suggest that this novel method of measuring HBB ROM could be used as a functional outcome measure in the evaluation of patients with shoulder disorders. This method could be considered as an additional or alternative where there are challenges in measuring HBB because of restrictions in undressing a patient, such as for cultural reasons.

The Impact of Injury on Health-Related Quality of Life in College Athletes.

Health-related quality of life (HRQOL) is a broad term for the impact of injury or illness on physical, psychological, and social health dimensions. Injury has been associated with decreased HRQOL in athletes. However, the influence of injury history, participation status, time since last injury, and injury severity on HRQOL remains unclear. To compare HRQOL in collegiate athletes based on injury history, participation status, time since last injury, and injury severity and to examine relationships between HRQOL outcomes. Cross-sectional. 3 National Collegiate Athletic Association (NCAA) institutions. 467 collegiate athletes (199 males, 268 females; 19.5 ± 1.3 y, 173.9 ± 10.5 cm, 71.9 ± 13.6 kg) were recruited from NCAA Division I (n = 299) and Division III (n = 168) institutions. Athletes were included regardless of participation status, which created a diverse sample of current and past injury histories. During a single session, participants completed an injury history form, the Disablement in the Physically Active Scale (DPA), and the Fear-Avoidance Beliefs Questionnaire (FABQ). Dependent variables included DPA-Physical Summary Component (DPA-PSC), DPA-Mental Summary Component (DPA-MSC), and FABQ Scores. HRQOL differences were detected between groups based on injury history, participation status, and time since last injury. No differences were detected for injury severity. A moderate correlation was identified between the DPA-PSC and FABQ (rs = 0.503, P < .001) and a weak relationship was identified between the DPA-MSC and FABQ (rs = 0.266, P < .001). Injury negatively influenced HRQOL in athletes with a current injury. While those individuals participating injured reported better HRQOL than the athletes sidelined due to injury, deficits were still present and should be monitored to ensure a complete recovery. Identifying the patient's perception of impairment will help facilitate evidencebased treatment and rehabilitation strategies that target the physical and psychosocial aspects of health.

College Athletes With Ankle Sprain History Exhibit Greater Fear-Avoidance Beliefs.

Postinjury, college athletes have reported elevated levels of fear. However, it is unclear how a history of ankle sprain impacts injury-related fear. The aim of this study was to determine if Fear-Avoidance Beliefs Questionnaire (FABQ) scores differ between college athletes with a history of a single ankle sprain, those with recurrent ankle sprains, and healthy controls. Cross-sectional design. National Collegiate Athletic Association institutions. From a large database of college athletes, 75 participants with a history of a single ankle sprain, 44 with a history of recurrent ankle sprains (≥2), and 28 controls with no injury history were included. Participants completed an injury history questionnaire and the FABQ. On the injury history form, the participants were asked to indicate if they had ever sustained an ankle sprain and, if yes, to describe how many. FABQ scores ranged from 0 to 66 with higher scores representing greater fear. Athletes with a history of recurrent ankle sprains (median, 28.00; interquartile range, 18.25-38.00) reported higher levels of fear than those with a history of a single ankle sprain (21.00; 8.00-31.00; P = .03; effect size = 0.199) and healthy controls (5.50; 0.00-25.00; P < .001; effect size = 0.431). Athletes with a history of a single sprain reported greater fear than healthy controls (P = .01, effect size = 0.267). Athletes with a history of a single sprain reported greater fear than healthy controls (P = .02, effect size = 0.23). College athletes with a history of ankle sprain exhibited greater levels of fear on the FABQ than healthy controls. These findings suggest that ankle sprains in general may increase injury-related fear and that those with a history of recurrent sprains are more vulnerable.

Task-related and person-related variables influence the effect of low back pain on anticipatory postural adjustments

BackgroundPeople with low back pain exhibit altered postural coordination that has been suggested as a target for treatment, but heterogeneous presentation has rendered it difficult to identify appropriate candidates and protocols for such treatments. This study evaluated the associations of task-related and person-related factors with the effect of low back pain on anticipatory postural adjustments. MethodsThirteen subjects with and 13 without low back pain performed seated, rapid arm flexion in self-initiated and cued conditions. Mixed-model ANOVA were used to evaluate group and condition effects on APA onset latencies of trunk muscles, arm-raise velocity, and pre-movement cortical potentials. These measures were evaluated for correlation with pain ratings, Fear Avoidance Beliefs Questionnaire scores, and Modified Oswestry Questionnaire scores. FindingsDelayed postural adjustments of subjects with low back pain were greater in the cued condition than in the self-initiated condition. The group with low back pain exhibited larger-amplitude cortical potentials than the group without pain, but also significantly slower arm-raise velocities. With arm-raise velocity as a covariate, the effect of low back pain remained significant for the latencies of postural adjustments but not for cortical potentials. Latencies of the postural adjustments significantly correlated with Oswestry and Fear Avoidance Beliefs scores. InterpretationDelayed postural adjustments with low back pain appear to be influenced by cueing of movement, pain-related disability and fear of activity. These results highlight the importance of subject characteristics, task condition, and task performance when comparing across studies or when developing treatment of people with low back pain.

Effects of Myofascial Release in Nonspecific Chronic Low Back Pain: A Randomized Clinical Trial.

Double-blind, randomized parallel sham-controlled trial with concealed allocation and intention-to treat analysis. To investigate the effects of an isolate myofascial release (MFR) protocol on pain, disability, and fear-avoidance beliefs in patients with chronic low back pain (CLBP). MFR is a form of manual medicine widely used by physiotherapists in the management of different musculoskeletal pathologies. Up to this moment, no previous studies have reported the effects of an isolated MFR treatment in patients with CLBP. Fifty-four participants, with nonspecific CLBP, were randomized to MFR group (n = 27) receiving four sessions of myofascial treatment, each lasting 40 minutes, and to control group (n = 27) receiving a sham MFR. Variables studied were pain measured by means Short Form McGill Pain Questionnaire (SF-MPQ) and visual analog scale (VAS), disability measured with Roland Morris Questionnaire, and fear-avoidance beliefs measured with Fear-Avoidance Beliefs Questionnaire. Subjects receiving MFR displayed significant improvements in pain (SF-MPQ) (mean difference -7.8; 95% confidence interval [CI]: -14.5 to -1.1, P = 0.023) and sensory SF-MPQ subscale (mean difference -6.1; 95% CI: -10.8 to -1.5, P = 0.011) compared to the sham group, but no differences were found in VAS between groups. Disability and the Fear-Avoidance Beliefs Questionnaire score also displayed a significant decrease in the MFR group (P < 0.05) as compared to sham MFR. MFR therapy produced a significant improvement in both pain and disability. Because the minimal clinically important differences in pain and disability are, however, included in the 95% CI, we cannot know whether this improvement is clinically relevant. 2.

Lumbar Kinematics, Functional Disability and Fear Avoidance Beliefs Among Adults with Nonspecific Chronic Low Back Pain.

This study aimed to examine correlations between lumbar kinematics, functional disability and fear avoidance beliefs among adults with nonspecific chronic low back pain (LBP). This cross-sectional study was conducted between March and December 2014. A total of 32 adults diagnosed with nonspecific chronic LBP were recruited from outpatients attending either an orthopaedic clinic at a university hospital or a private physiotherapy clinic in Malaysia. Lumbar kinematics were measured using sensors attached at the first lumbar (L1) and second sacral (S2) vertebrae levels. The Oswestry Disability Index (ODI) and Fear-Avoidance Beliefs Questionnaire (FABQ) were used to assess degree of functional disability and fear avoidance beliefs, respectively. For maximum range of motion, positive correlations were observed between ODI scores and right lateral flexion and right rotation (P = 0.01 each), although there was a negative correlation with left rotation (P = 0.03). With maximum angular velocity, ODI scores were positively correlated with right and left lateral flexion L1 (P = 0.01 and <0.01, respectively) but negatively correlated with left lateral flexion L2 (P = 0.04). Regarding minimum angular velocity, ODI scores were positively correlated with left lateral flexion S2 (P <0.01) but negatively correlated with right and left lateral flexion L1 (P = 0.02 each), right rotation L1 (P = 0.02) and left rotation S2 (P = 0.01). No significant correlations were found between lumbar kinematics and FABQ scores. These findings suggest that certain lumbar kinematic parameters are correlated with functional disability, but not with fear avoidance beliefs.

Feasibility of a Smartphone-Based Exercise Program for Office Workers With Neck Pain: An Individualized Approach Using a Self-Classification Algorithm

ObjectiveTo explore the feasibility of a newly developed smartphone-based exercise program with an embedded self-classification algorithm for office workers with neck pain, by examining its effect on the pain intensity, functional disability, quality of life, fear avoidance, and cervical range of motion (ROM). DesignSingle-group, repeated-measures design. SettingThe laboratory and participants' home and work environments. ParticipantsOffices workers with neck pain (N=23; mean age ± SD, 28.13±2.97y; 13 men). InterventionParticipants were classified as having 1 of 4 types of neck pain through a self-classification algorithm implemented as a smartphone application, and conducted corresponding exercise programs for 10 to 12min/d, 3d/wk, for 8 weeks. Main Outcome MeasuresThe visual analog scale (VAS), Neck Disability Index (NDI), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Fear-Avoidance Beliefs Questionnaire (FABQ), and cervical ROM were measured at baseline and postintervention. ResultsThe VAS (P<.001) and NDI score (P<.001) indicated significant improvements in pain intensity and functional disability. Quality of life showed significant improvements in the physical functioning (P=.007), bodily pain (P=.018), general health (P=.022), vitality (P=.046), and physical component scores (P=.002) of the SF-36. The FABQ, cervical ROM, and mental component score of the SF-36 showed no significant improvements. ConclusionsThe smartphone-based exercise program with an embedded self-classification algorithm improves the pain intensity and perceived physical health of office workers with neck pain, although not enough to affect their mental and emotional states.