Abstract
Objective
To systematically review and critically appraise the effectiveness of conservative
and surgical interventions to reduce fear in studies of people with chronic low back
pain, based on the analysis of randomized controlled trials for which fear was a primary
or secondary outcome.
Data Sources
Electronic databases PubMed, CINAHL, PsycINFO, PEDro, and CENTRAL, as well as manual
searches and grey literature were searched from inception until May 2019.
Study Selection
Randomized controlled trials analyzing the effectiveness of conservative and surgical
interventions to reduce fear were included.
Data Extraction
Two reviewers independently conducted the search strategy, study selection, data extraction,
risk of bias assessment, and quality of the evidence judgment.
Data Synthesis
Sixty-one studies (n=7201) were included. A large number of fear-related search terms
were used but only 3 fear constructs (kinesiophobia, fear-avoidance beliefs, fear
of falling) were measured in the included studies. Multidisciplinary and psychological
interventions as well as exercise reduced kinesiophobia. Fear-avoidance beliefs were
reduced by the aforementioned interventions, manual therapy, and electrotherapy. A
multidisciplinary intervention reduced the fear of falling. There was moderate evidence
of multidisciplinary interventions and exercise to reduce kinesiophobia. There was
moderate evidence of manual therapy and electrotherapy to reduce fear-avoidance beliefs.
Conclusions
The present systematic review highlights the potential effectiveness of conservative
interventions to reduce kinesiophobia and fear-avoidance beliefs in individuals with
chronic low back pain. This information can help health professionals to reduce fear
when treating patients with this condition.
Keywords
List of abbreviations:
GRADE (Grading of Recommendations Assessment, Development, and Evaluation), LBP (low back pain), MeSH (Medical Subject Headings), RCT (randomized controlled trial)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: August 29, 2019
Footnotes
Supported by the University of Málaga through a predoctoral grant (grant no. 21032017 ).
Clinical Trial Registration No.: CRD42018099774.
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
