Levels Of Fear-avoidance Beliefs Research Articles

Effectiveness of Fear, Anxiety and Depression on Functional Ability in Patients with Spinal Cord Injury

Introduction: The spinal cord is the major conduit through which motor and sensory information travels between brain and body. Spinal cord injury (SCI) affects conduction of sensory and motor signals across the site of lesion19. SCI is a low- incidence, high cost disability requiring tremendous change in an individual’s life-style25. The consequence of SCI is usually permanent paralysis of voluntary muscles below the lesion, reduced mobility, impairment of social and vocational activities, with a negative impact on body systems such as respiratory, cardiovascular, urinary, gastrointestinal, reproductive and sensory.19 When a sudden-onset spinal cord injury (SCI) occurs, there are often multiple levels of trauma to address, including acute medical issues, new functional limitations, psychological reactions (e.g. anger, anxiety, depression, and denial about the permanency of the condition)that persists for months or years , distressing memories related to the traumatic event causing the SCI, and possible role changes caused by the SCI. Growing evidence suggests psychological factors such as anxiety, fear, and depression may also relate to physical function in patients with SCI. The psychological variables of fear, anxiety, and depression can be associated with each other, and therefore it may be possible that they could interact to have a greater effect on physical function.3 Objective: To study effectivness of fear, anxiety and depression on functional ability in patients with spinal cord injury Research Design: Correlational design Methodology: On the first visit, a detailed examination of subjects was done and the subjects found eligible on the basis of inclusion and exclusion criteria, were explained about the study and were requested to sign the informed consent for seeking their willingness to participate in the study.Out of 153 subjects of SCI who volunteered for this study, 100 subjects were included in the study after they met the inclusion criteria. Subjects were assessed for various psychological variants via Depression, Anxiety and Fear- avoidance beliefs. Result: Depression was the most highly associated variable for physical function in Regression model meaning that depression highly affects physical performance in Spinal Cord Injury Patient. The results also revealed significant associations between each psychological variable and all the measures of function. High levels of fear avoidance beliefs, anxiety and depression were associated with reduced self- reported measures Conclusion: An important aspect of this study is that it has specifically examined the effect of some elements of psychological variants (depression, anxiety and fear avoidance beliefs) on physical function in chronic SCI patients. Higher psychological variants are significantly and independently related to poorer physical function in bivariate correlation model. In addition, depression has been found to be the strongest factor among all the psychological variants that have a great association with performance based measure of physical function. Keywords- SCI, anxiety, depression, psychological variables, rehabilitation

Fear avoidance beliefs, anxiety, and depression in healthy individuals and persons with vestibular disorders across cultures.

In persons with vestibular disorders, disturbed vestibular input and accompanying dizziness can be associated with anxiety or depression. To avoid dizziness, persons with vestibular disorders can develop mal-adaptive fear avoidance behaviors which can negatively influence daily life functioning. The aims of this study were to (1) document different psychological factors in patients with vestibular disorders and healthy adults across cultures and (2) to assess the convergent validity of the 9-item Vestibular Activities Avoidance Instrument (VAAI), which quantifies fear avoidance beliefs. Psychological factors and disability were measured in Dutch-speaking healthy adults and English- and Dutch-speaking persons with vestibular disorders using the VAAI, the Dizziness Handicap Inventory (DHI), the Hospital Anxiety and Depression Scale (HADS) and the Activities-Specific Balance Confidence Scale (ABC). The convergent validity of the VAAI was investigated by performing correlation analyses between the VAAI, the DHI, the HADS, and the ABC. A total of 151 Dutch-speaking healthy adults, 404 English-speaking participants with vestibular disorders, and 126 Dutch-speaking participants with vestibular disorders were included. Participants with vestibular disorders presented with higher levels of fear avoidance beliefs (VAAI), perceived disability (DHI), anxiety and depression (HADS), and lower confidence during balance activities (ABC) compared to healthy adults. Regarding the convergent validity of the VAAI, there were moderate to strong correlation coefficients (r = 0.39-0.74) between fear avoidance and the DHI, HADS, and ABC in participants with vestibular disorders. Participants with vestibular disorders report a higher psychological burden compared to healthy adults. These results emphasize the importance of assessing psychological factors in persons with vestibular disorders. In addition, evidence was provided for convergent validity, supporting the VAAI as a valid outcome measure across cultures.

The Psychometric Properties of the 9-Item Vestibular Activities Avoidance Instrument.

The purpose of this study was to establish the psychometric properties of the 9-Item Vestibular Activities Avoidance Instrument (VAAI-9), a patient-reported outcome measure developed to identify fear avoidance beliefs in persons with vestibular disorders. This prospective cohort study included 100 participants 18years and older seeking care at a balance disorders clinic for dizziness. Participants completed the VAAI-9, the Dizziness Handicap Inventory (DHI), and other patient-reported outcomes at the initial visit and the 3-month follow-up. To measure test-retest reliability, the VAAI-9 was completed again 5days after the initial visit and was analyzed using a 2-way mixed ICC for absolute agreement. Internal consistency was determined using the Cronbach alpha. The Spearman correlation coefficient was used to assess convergent validity of the VAAI-9 with other outcomes. Receiver operating characteristic curves were used to identify baseline VAAI-9 cutoff scores for those who reported mild (DHI ≤ 30) or moderate or severe (DHI > 30) perceived disability at the 3-month follow-up. The mean age of the study cohort was 49 (SD = 16) years; 73 (73%) were women. Seventy-one participants completed the 5-day follow-up, and 68 completed the 3-month follow-up. The VAAI-9 demonstrated excellent internal consistency (α = 0.91) and test-retest reliability (ICC = 0.90). Baseline VAAI-9 scores had moderate to strong associations with other outcome measures at baseline and 3months. A baseline VAAI-9 score of 26 or higher had a sensitivity of 80.6% and a specificity of 78.4% for identifying a DHI score of >30 at 3months (area under the curve = 0.86). The results provide evidence of excellent reliability and validity for the 9-item VAAI in persons with vestibular disorders. A baseline VAAI-9 score of ≥26 identified individuals at risk of persistent moderate to severe disability due to dizziness. Initial levels of fear avoidance beliefs measured using the VAAI-9 provided important prognostic information about outcomes for persons with vestibular symptoms.

A further Rasch analysis of the Fear-Avoidance Beliefs Questionnaire in adults with chronic low back pain suggests the revision of its rating scale.

Low-back pain (LBP) is a common health problem and one of the leading causes of activity limitation and work absence. LBP determines high societal burdens, as it is the most common cause of medically certified sick leave and early retirement, with economic impacts similar to other high-cost conditions such as cancer, cardiovascular and autoimmune diseases. The aim of this study was to examine the psychometric properties of the Fear-Avoidance Beliefs Questionnaire (FABQ) and its two subscales, in subjects with chronic low back pain (LBP). Methodological research based on a cross-sectional observational study. Outpatients consecutively admitted to our Rehabilitation Unit were enrolled between January and August 2015, before the beginning of an 8-week program of multidisciplinary rehabilitation. A convenience sample of 155 Italian subjects with chronic LBP (57% men; mean age: 43±11 years; mean pain duration: 23±32 months) completed the FABQ. Rasch analysis was used to investigate dimensionality of the entire scale and key psychometric properties of its two subscales. The FABQ-Physical Activity (FABQ-PA) and FABQ-Work (FABQ-W) subscales showed two distinct unidimensional structures. Their 7-option rating categories were malfunctioning, but after collapsing problematic categories and omitting the central one ("unsure") the new 4 categories (completely disagree; disagree; agree; completely agree) functioned as intended. After that and accommodation of local response dependency between two items in a testlet solution, each of the two subscales presented acceptable fit to the Rasch model (just one FABQ-W items was slightly underfitting). Person separation reliability was acceptable, but not high (0.69 for FABQ-PA, and 0.79 for FABQ-W). FABQ-PA and FABQ-W have adequate unidimensionality. A simplification of the response options of both subscales is strongly recommended to improve the technical quality of the scale. The reliability indexes suggest FABQ-PA and FABQ-W can be used for group judgements about level of fear-avoidance beliefs, but not for clinical decision-making in individuals. The selection of their items is acceptable, although if future studies corroborate our results - there is room for some refinements to improve the general measurement quality. Fear-avoidance beliefs are associated with reduction of physical activity, and development of disability and deconditioning. This study examined the measurement properties of the two FABQ subscales, showing their essential unidimensionality, recommending the simplification of the rating categories, and discussing strengths and weaknesses of item selection. Our results extend the evidence for FABQ as a satisfactory (but improvable) measure of fear-avoidance beliefs in chronic LBP.

Using Massage to Combat Fear-Avoidance and the Pain Tension Cycle

Massage is a common therapeutic modality utilized by clinicians in a variety of settings to help treat injuries, reduce pain, and return function to patients. Massage benefits the patients both psychologically and physiologically, as patients report less pain and anxiety along with better mood and even decreased blood pressure following massage. Additionally, on the cellular level, massage has the ability to modulate the damaging inflammatory process and, in some cases, influence protein synthesis. Although massage has not been linked to a rehabilitation theory to date, this paper will propose how massage may influence fear-avoidance beliefs, or the patient’s inability to cope with pain that then leads to a pain tension cycle. Pain will often result in use avoidance, which creates muscle tension that further exacerbates the pain. Massage can affect the Fear-Avoidance Model because the beneficial effects of massage can break the cycle by either relieving the patient’s pain or eliminating the muscle tension. A modified Fear-Avoidance Model is presented that conceptualizes how pain and fear-avoidance lead to tension and muscle dysfunction. Massage has been incorporated into the model to demonstrate its potential for breaking the pain tension cycle. This model has the potential to be applied in clinical settings and provides an alternate treatment to patients with chronic pain who present with increased levels of fear-avoidance beliefs.

Health Literacy and Fear Avoidance Beliefs Among Women with Chronic Low Back Pain

Purpose Low back pain is considered a major health issue universally. LBP patients may avoid certain activities due to their fear avoidance behavior. Health literacy has a huge influence on the health programs and service delivery models mainly in managing chronic low back pain. The aim of this study was to examine the relation between low back pain disability, fear avoidance beliefs’ and health literacy. Materials and Methods 227 female low back pain patients of age between 20 and 55 years were analyzed. Disability, fear avoidance, and health literacy were subjectively assessed using the Oswestry Disability Index (ODI), the Fear Avoidance Beliefs’ Questionnaire (FABQ), and the Newest Vital Sign (NVS), respectively. Pearson correlation was used to determine the association between Disability, fear avoidance beliefs’ and health literacy. Results The high disability group had significantly poor beliefs related to physical activity (FAB-PA) as well as work (FAB-W). Low disability group had adequate literacy compared to those with the high disability. Greater disability was associated with higher levels of fear avoidance beliefs related to physical activity(r=0.4; p−0.00) and work (r=0.3; p−0.00) and was negatively correlated with health literacy (r=− 0.4; p≤0.01). Conclusion The study findings showed that moderate relationship exists between disability and elevated fear-avoidance beliefs and patients with limited health literacy may have difficulty in self-management of back pain further leading to chronic disability. A multidisciplinary approach focusing on these aspects while assessing disability due to low back pain is needed.

Resilience and Vulnerability Factors When Pain is Acute as Predictors of Disability: Findings From a Two-Year Longitudinal Study.

To investigate the predictive power of resilience and vulnerability factors in relation to pain-related disability. A two-year prospective study investigated whether back pain-related disability was predicted by the following variables, measured when pain was acute: 1) pain-related disability, 2) pain intensity, 3) depression, 4) fear avoidance beliefs, 5) anxiety sensitivity, and 6) resilience. Two hundred thirty-two patients treated in five primary care centers participated in this study. They were assessed at baseline during an acute back pain episode and at six, 12, 18, and 24 months. Ninety-nine patients completed all the assessment sessions. Linear mixed models were used to examine the trajectory of disability across the measurement occasions and its association with the predictors. Individuals who had higher scores of disability and pain intensity when pain was acute also had higher scores of disability six months later; moreover, the increase in disability was greater over time in comparison with individuals with lower scores in disability and pain intensity when pain was acute. Individuals who had reported greater levels of fear avoidance beliefs when pain was acute also reported greater scores of disability six months later; however, no differences were found in the rate of change in disability. No associations were found between initial disability or rate of change and resilience, anxiety sensitivity, or depression. Patients with acute back pain who show high levels of pain-related disability, pain intensity, and fear avoidance beliefs are at risk of developing back pain-related disability and should be the target of a preventive intervention.

Is there an association between fear avoidance beliefs, and pain and disability in patients with orofacial pain?

Numerous psychosocial factors have been shown to contribute to the development and perpetuation of orofacial pain. One well-recognized model for explaining the link between psychosocial factors and chronic pain is the fear avoidance model. To date, this proposed link has not been studied in subjects with orofacial pain. During the initial evaluation of subjects with orofacial pain, we collected data on fear avoidance beliefs using the Fear Avoidance Beliefs Questionnaire, and disability and pain. At between 6 and 8weeks follow-up, we re-collected these data, as well as data addressing subjects' perceived change in their condition. Data were analyzed using correlation coefficients and linear regression. Fear avoidance beliefs at intake were inversely correlated with intake disability, There were no significant associations between fear avoidance beliefs at initial evaluation or in changes in fear avoidance beliefs during the 6-8weeks follow-up period; and changes in disability, pain or perceived change in condition at 6-8weeks follow-up. Of note, fear avoidance beliefs increased over the follow-up period, despite improvements in all outcome measures. There was insufficient evidence to suggest that high levels of fear avoidance beliefs at initial evaluation are associated with higher levels of disability or pain at intake, or with change in disability, pain or perceived change in condition at 6-8weeks follow-up. Similarly, there was insufficient evidence to suggest that changes in fear avoidance beliefs during treatment are associated with any of these outcome measures.

Low back pain beliefs are associated to age, location of work, education and pain-related disability in Chinese healthcare professionals working in China: a cross sectional survey.

BackgroundLow back pain (LBP) is the leading cause of disability worldwide. Evidence pointing towards a more efficacious model of care using a biopsychosocial approach for LBP management highlights the need to understand the pain-related beliefs of patients and those who treat them. The beliefs held by healthcare professionals (HCPs) are known to influence the treatment advice given to patients and consequently management outcomes. Back pain beliefs are known to be influenced by factors such as culture, education, health literacy, place of work, personal experience of LBP and the sequelae of LBP such as disability. There is currently a knowledge gap among these relationships in non-western countries. The aim of this study was to examine the associations between LBP-related beliefs among Chinese HCPs and characteristics of these HCPs.MethodsA convenience sample of 432 HCPs working in various health settings in Shanghai, China, completed a series of questionnaires assessing their demographic characteristics, LBP status, pain-related disability and their beliefs about their own LBP experience, using the Back beliefs Questionnaire (BBQ) and the Fear Avoidance Beliefs Questionnaire (FABQ).ResultsYounger Chinese HCPs (20–29 years) held more negative beliefs and attitudes related to LBP compared to older HCPs (>40years; BBQ mean difference [95% CI]: 2.4 [0.9 - 3.9], p = 0.001). HCPs working outside tertiary hospitals had poorer beliefs concerning the inevitable consequences of LBP (BBQ mean difference [95% CI]: −2.4 [−3.8 - −1.0], p = 0.001). HCPs who experienced LBP had higher level of fear avoidance beliefs when experiencing high LBP-related disability (FABQ-physical mean difference [95% CI]: 2.8 [1.5 - 4.1], p < 0.001; FABQ-work mean difference [95% CI]: 6.2 [4.0 - 8.4], p < 0.001)) and had lower level of fear avoidance beliefs if they had completed postgraduate study (FABQ-physical mean difference [95% CI]: 2.9 [−5.8 - 0.0], p = 0.049).ConclusionThis study suggests that LBP-related beliefs and attitudes among Chinese HCPs are influenced by age, location of work, level of LBP-related disability and education level. Understanding back pain beliefs of Chinese HCPs forms an important foundation for future studies into the condition and its management in China.

Low levels of physical activity in back pain patients are associated with high levels of fear‐avoidance beliefs and pain catastrophizing

Fear-avoidance beliefs are important determinants for disability in patients with non-specific low-back pain (LBP). The association with self-reported level of physical activity is less known. The aim of the present study was to describe the level of physical activity in patients with chronic non-specific LBP and its relation to fear-avoidance beliefs and pain catastrophizing. A cross-sectional study on 64 patients with chronic non-specific LBP in primary healthcare. The variables measured and the questionnaires used were: level of physical activity (six-graded scale); activity limitations (Roland Morris Disability Questionnare (RDQ)); fear-avoidance beliefs (Tampa Scale of Kinesiophobia (TSK) 13-item and sub-scales 'activity avoidance' and 'somatic focus'); and pain catastrophizing (Pain Catastrophizing Scale (PCS)). The level of physical activity was dichotomised into low and high physical activity. Individual median scores on the TSKandPCSscales were used to group the patients into different levels offear-avoidance beliefs and pain catastrophizing. Univariate logistic regressions were used to calculate odds ratios for having low physical activity. Patients with low physical activity had significantly higher scores in fear-avoidance beliefs and pain catastrophizing (p < 0.05). Odds ratios for low level of physical activity were between 4 and 8 (p < 0.05) for patients with high fear-avoidance beliefs or medium/high pain catastrophizing. This study indicates that it seems important for physiotherapists in primary care to measure levels of fear-avoidance beliefs or pain catastrophizing. In particular, the two subscales of the TSK could be of real value for clinicians when making treatment decisions concerning physical exercise therapy for patients with chronic LBP.

Fear-avoidance beliefs about back pain in patients with subacute low back pain

The fear-avoidance beliefs of patients with subacute low back pain (LBP) considered at risk for chronic disabling LBP are not well known. The objectives of this cross-sectional descriptive survey, conducted in secondary care practice, were to assess fear-avoidance beliefs about back pain in patients with subacute LBP and to seek an association between physician or patient characteristics and level of fear-avoidance beliefs. A total of 286 rheumatologists completed a self-administered questionnaire assessing physicians’ demographic, professional data, personal history of back pain, and back pain fear-avoidance beliefs (on the Fear-Avoidance Belief Questionnaire [FABQ]) and 443 patients with sLBP completed one on pain, perceived handicap and disability (Quebec Back Pain Disability Scale), anxiety and depression (Hospital Anxiety Depression questionnaire), and back pain beliefs (FABQ). Mean FABQ scores for rheumatologists for physical activities (FABQ Phys) and occupational activities (FABQ Work) were 9.2 ± 4.4 (range 0–21) and 16.7 ± 6.9 (range 2–37), respectively, and patient scores were 16.7 ± 5.2 and 19.3 ± 12.4, respectively. A total of 68% of patients and 10% of physicians had a high rating on the FABQ Phys (>14). Patients’ fear-avoidance beliefs about physical activity were associated with low level of education (odds ratio [OR] 4.19; 95% confidence interval [CI] 1.83–9.57), patients’ perceived disability (OR 1.05; CI 1.03–1.07), and physicians’ high FABQ Phys score (OR 5.92; CI 1.31–26.32). Here we show that fear-avoidance beliefs about back pain were high in patients with subacute LBP and their rheumatologists.