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Fear of Movement Is Not Associated With Objective and Subjective Physical Activity Levels in Chronic Nonspecific Low Back Pain

Published:October 03, 2016DOI:https://doi.org/10.1016/j.apmr.2016.09.115

      Abstract

      Objectives

      To assess the association of physical activity measures, derived with an accelerometer and a self-reported questionnaire, with fear of movement in patients with chronic nonspecific low back pain (LBP) and to investigate the association between disability and fear of movement in this population.

      Design

      Cross-sectional study.

      Setting

      Outpatient physical therapy university clinics.

      Participants

      Patients (N=119) presenting with nonspecific LBP of >3 months' duration.

      Interventions

      Not applicable.

      Main Outcome Measures

      Physical activity levels measured objectively with an accelerometer (ie, counts per minute, time spent in moderate-to-vigorous and light physical activity per day, number of steps per day, and number of 10-minute bouts of moderate-to-vigorous physical activity per day) and subjectively with a self-reported questionnaire (Baecke Physical Activity Questionnaire); fear of movement (Tampa Scale of Kinesiophobia); pain (11-point numerical rating scale); disability (Roland Morris Disability Questionnaire); and depression (Beck Depression Inventory). The associations were examined with correlational, univariate, and multivariable linear regression analyses.

      Results

      None of the objective physical activity measures were associated with fear of movement. The apparent association of self-reported physical activity levels with fear of movement (correlational analyses: r=−.18; P<.05; univariate regression analyses: β=−.04; 95% confidence interval [CI], −.07 to −.01; P=.04) was not confirmed in multivariable analyses. Fear of movement was consistently associated with disability in both correlational (r=.42; P<.01) and multivariable (β=.21; 95% CI, .11–.31; P<.001) analyses.

      Conclusions

      Our data support one aspect of the fear-avoidance model—that higher fear of movement is associated with more disability—but not the aspect of the model linking fear of movement with inactivity.

      Keywords

      List of abbreviations:

      BMI (body mass index), CI (confidence interval), IQR (interquartile range), LBP (low back pain), MVPA (moderate-to-vigorous physical activity), RMDQ (Roland Morris Disability Questionnaire), TSK (Tampa Scale of Kinesiophobia), V⋅o2max (maximal oxygen consumption)
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      References

        • Keefe F.J.
        • Dunsmoret J.
        Pain behavior concepts and controversies.
        Am Pain Soc J. 1992; 1: 92-100
        • Turk D.C.
        • Rudy T.E.
        Cognitive factors and persistent pain: a glimpse into Pandora’s box.
        Cognit Ther Res. 1992; 16: 99-122
        • Vlaeyen J.W.
        • Crombez G.
        Fear of movement/(re)injury, avoidance and pain disability in chronic low back pain patients.
        Man Ther. 1999; 4: 187-195
        • Maher C.G.
        • Williams C.
        • Lin C.
        • Latimer J.
        Managing low back pain in primary care.
        Aust Prescr. 2011; 34: 128-132
        • da C Menezes Costa L.
        • Maher C.G.
        • Hancock M.J.
        • McAuley J.H.
        • Herbert R.D.
        • Costa L.O.
        The prognosis of acute and persistent low-back pain: a meta-analysis.
        CMAJ. 2012; 184: E613-E624
        • Vlaeyen J.W.
        • Linton S.J.
        Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art.
        Pain. 2000; 85: 317-332
        • Vlaeyen J.W.
        • Kole-Snijders A.M.
        • Boeren R.G.
        • van Eek H.
        Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain.
        . 1995; 62: 363-372
        • Costa Lda C.
        • Maher C.G.
        • McAuley J.H.
        • Hancock M.J.
        • Smeets R.J.
        Self-efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain.
        Eur J Pain. 2011; 15: 213-219
        • Crombez G.
        • Vlaeyen J.W.
        • Heuts P.H.
        • Lysens R.
        Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability.
        Pain. 1999; 80: 329-339
        • Verbunt J.A.
        • Seelen H.A.
        • Vlaeyen J.W.
        • van der Heijden G.J.
        • Knottnerus J.A.
        Fear of injury and physical deconditioning in patients with chronic low back pain.
        Arch Phys Med Rehabil. 2003; 84: 1227-1232
        • Vlaeyen J.W.
        • Kole-Snijders A.M.
        • Rotteveel A.M.
        • Ruesink R.
        • Heuts P.H.
        The role of fear of movement/(re)injury in pain disability.
        J Occup Rehabil. 1995; 5: 235-252
        • Vincent H.K.
        • Seay A.N.
        • Montero C.
        • Conrad B.P.
        • Hurley R.W.
        • Vincent K.R.
        Kinesiophobia and fear-avoidance beliefs in overweight older adults with chronic low-back pain: relationship to walking endurance—part II.
        Am J Phys Med Rehabil. 2013; 92: 439-445
        • French D.J.
        • France C.R.
        • Vigneau F.
        • French J.A.
        • Evans R.T.
        Fear of movement/(re)injury in chronic pain: a psychometric assessment of the original English version of the Tampa Scale for Kinesiophobia (TSK).
        Pain. 2007; 127: 42-51
        • Roelofs J.
        • Goubert L.
        • Peters M.L.
        • Vlaeyen J.W.
        • Crombez G.
        The Tampa Scale for Kinesiophobia: further examination of psychometric properties in patients with chronic low back pain and fibromyalgia.
        Eur J Pain. 2004; 8: 495-502
        • Gheldof E.L.
        • Vinck J.
        • Vlaeyen J.W.
        • Hidding A.
        • Crombez G.
        The differential role of pain, work characteristics and pain-related fear in explaining back pain and sick leave in occupational settings.
        Pain. 2005; 113: 71-81
        • Helmhout P.H.
        • Staal J.B.
        • Heymans M.W.
        • Harts C.C.
        • Hendriks E.J.
        • de Bie R.A.
        Prognostic factors for perceived recovery or functional improvement in non-specific low back pain: secondary analyses of three randomized clinical trials.
        Eur Spine J. 2010; 19: 650-659
        • Picavet H.S.
        • Vlaeyen J.W.
        • Schouten J.S.
        Pain catastrophizing and kinesiophobia: predictors of chronic low back pain.
        Am J Epidemiol. 2002; 156: 1028-1034
        • Swinkels-Meewisse I.E.
        • Roelofs J.
        • Schouten E.G.
        • Verbeek A.L.
        • Oostendorp R.A.
        • Vlaeyen J.W.
        Fear of movement/(re)injury predicting chronic disabling low back pain: a prospective inception cohort study.
        Spine (Phila Pa 1976). 2006; 31: 658-664
        • Smeets R.J.
        • van Geel K.D.
        • Verbunt J.A.
        Is the fear avoidance model associated with the reduced level of aerobic fitness in patients with chronic low back pain?.
        Arch Phys Med Rehabil. 2009; 90: 109-117
        • Elfving B.
        • Andersson T.
        • Grooten W.J.
        Low levels of physical activity in back pain patients are associated with high levels of fear-avoidance beliefs and pain catastrophizing.
        Physiother Res Int. 2007; 12: 14-24
        • Verbunt J.A.
        • Huijnen I.P.
        • Koke A.
        Assessment of physical activity in daily life in patients with musculoskeletal pain.
        Eur J Pain. 2009; 13: 231-242
        • van Weering M.G.
        • Vollenbroek-Hutten M.M.
        • Hermens H.J.
        The relationship between objectively and subjectively measured activity levels in people with chronic low back pain.
        Clin Rehabil. 2011; 25: 256-263
        • Trost S.G.
        • O’Neil M.
        Clinical use of objective measures of physical activity.
        Br J Sports Med. 2014; 48: 178-181
        • Ciconelli R.M.
        • Ferraz M.B.
        • Santos W.
        • Meinão I.
        • Quaresma M.R.
        Brazilian-Portuguese version of the SF-36: a reliable and valid quality of life outcome measure.
        Rev Bras Reumatol. 1999; 39: 143-150
        • Nusbaum L.
        • Natour J.
        • Ferraz M.B.
        • Goldenberg J.
        Translation, adaptation and validation of the Roland-Morris questionnaire—Brazil Roland-Morris.
        Braz J Med Biol Res. 2001; 34: 203-210
        • Roland M.
        • Morris R.
        A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain.
        Spine (Phila Pa 1976). 1983; 8: 141-144
        • Ross R.L.P.
        Clinical assessment of pain.
        in: van Dieen J.H. Assessment in occupational therapy and physical therapy. WB Saunders, Philadelphia1997: 123-133
        • Siqueira F.B.
        • Teixeira-Salmela L.F.
        • Magalhães L.C.
        Analysis of the psychometric properties of the Brazilian version of the tampa scale for kinesiophobia [Portuguese].
        Acta Ortop Bras. 2007; 15: 19-24
        • de Souza F.S.
        • Marinho Cda S.
        • Siqueira F.B.
        • Maher C.G.
        • Costa L.O.
        Psychometric testing confirms that the Brazilian-Portuguese adaptations, the original versions of the Fear-Avoidance Beliefs Questionnaire, and the Tampa Scale of Kinesiophobia have similar measurement properties.
        Spine (Phila Pa 1976). 2008; 33: 1028-1033
        • Beck A.T.
        • Ward C.H.
        • Mendelson M.
        • Mock J.
        • Erbaugh J.
        An inventory for measuring depression.
        Arch Gen Psychiatry. 1961; 4: 561-571
        • Gorenstein C.
        • Andrade L.
        Validation of a Portuguese version of the Beck Depression Inventory and the State-Trait Anxiety Inventory in Brazilian subjects.
        Braz J Med Biol Res. 1996; 29: 453-457
        • Baecke J.A.
        • Burema J.
        • Frijters J.E.
        A short questionnaire for the measurement of habitual physical activity in epidemiological studies.
        Am J Clin Nutr. 1982; 36: 936-942
        • Sardinha A.
        • Levitan M.N.
        • Lopes F.L.
        • et al.
        Translation and cross-cultural adaptation of the Habitual Physical Activity Questionnaire [Portuguese].
        Arch Clin Psychiatry (São Paulo). 2010; 37: 16-22
        • Troiano R.P.
        • Berrigan D.
        • Dodd K.W.
        • Masse L.C.
        • Tilert T.
        • McDowell M.
        Physical activity in the United States measured by accelerometer.
        Med Sci Sports Exerc. 2008; 40: 181-188
        • Trost S.G.
        • McIver K.L.
        • Pate R.R.
        Conducting accelerometer-based activity assessments in field-based research.
        Med Sci Sports Exerc. 2005; 37: S531-S543
        • Matthews C.E.
        • Chen K.Y.
        • Freedson P.S.
        • et al.
        Amount of time spent in sedentary behaviors in the United States, 2003-2004.
        Am J Epidemiol. 2008; 167: 875-881
        • Portney L.G.
        • Watkins M.P.
        Foundations of clinical research: applications to practice.
        2nd ed. Prentice Hall, Upper Saddle River2000
        • Smeets R.J.
        • Wade D.
        • Hidding A.
        • Van Leeuwen P.J.
        • Vlaeyen J.W.
        • Knottnerus J.A.
        The association of physical deconditioning and chronic low back pain: a hypothesis-oriented systematic review.
        Disabil Rehabil. 2006; 28: 673-693
        • Verbunt J.A.
        • Smeets R.J.
        • Wittink H.M.
        Cause or effect? Deconditioning and chronic low back pain.
        Pain. 2010; 149: 428-430
        • Hagstromer M.
        • Troiano R.P.
        • Sjostrom M.
        • Berrigan D.
        Levels and patterns of objectively assessed physical activity—a comparison between Sweden and the United States.
        Am J Epidemiol. 2010; 171: 1055-1064
        • Herbolsheimer F.
        • Schaap L.A.
        • Edwards M.H.
        • et al.
        Physical activity patterns among older adults with and without knee osteoarthritis in six European countries.
        Arthritis Care Res (Hoboken). 2016; 68: 228-236
        • Wideman T.H.
        • Asmundson G.G.
        • Smeets R.J.
        • et al.
        Rethinking the fear avoidance model: toward a multidimensional framework of pain-related disability.
        Pain. 2013; 154: 2262-2265
        • Westman A.E.
        • Boersma K.
        • Leppert J.
        • Linton S.J.
        Fear-avoidance beliefs, catastrophizing, and distress: a longitudinal subgroup analysis on patients with musculoskeletal pain.
        Clin J Pain. 2011; 27: 567-577
        • Wideman T.H.
        • Sullivan M.J.
        Development of a cumulative psychosocial factor index for problematic recovery following work-related musculoskeletal injuries.
        Phys Ther. 2012; 92: 58-68
        • Hasenbring M.I.
        • Verbunt J.A.
        Fear-avoidance and endurance-related responses to pain: new models of behavior and their consequences for clinical practice.
        Clin J Pain. 2010; 26: 747-753
        • Bunzli S.
        • Smith A.
        • Schutze R.
        • O’Sullivan P.
        Beliefs underlying pain-related fear and how they evolve: a qualitative investigation in people with chronic back pain and high pain-related fear.
        BMJ Open. 2015; 5: e008847