Original research| Volume 98, ISSUE 1, P96-104, January 2017

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

Published:October 03, 2016DOI:



      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.


      Cross-sectional study.


      Outpatient physical therapy university clinics.


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


      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.


      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.


      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.


      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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