Identifying Patient Fear-Avoidance Beliefs by Physical Therapists Managing Patients With Low Back Pain

Calley, Darren Q; Jackson, Steven; Collins, Heather; George, Steven Z.

doi:10.2519/jospt.2010.3381

Cited by 35 publications

(24 citation statements)

References 66 publications

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“…This is despite the fact that persistent LBP is associated with altered cortical processing of painful and non-painful sensory stimuli (Wand et al, 2011), central and peripheral sensitization, and reduced pain pressure threshold, particularly in the area of symptoms (Imamura et al, 2013). The lack of group difference in anticipated and actual pain intensity in the present study may be due to the fact that the individuals with a history of LBP were asymptomatic at the time of the data collection and had relatively low levels of fear avoidance (Calley et al, 2010). Self-selected locomotor speed increased following insertion of the intramuscular electrodes.…”

Section: Discussioncontrasting

confidence: 70%

Does insertion of intramuscular electromyographic electrodes alter motor behavior during locomotion?

Smith

Kulig

2015

Journal of Electromyography and Kinesiology

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Intramuscular electromyography (EMG) is commonly used to quantify activity in the trunk musculature. However, it is unclear if the discomfort or fear of pain associated with insertion of intramuscular EMG electrodes results in altered motor behavior. This study examined whether intramuscular EMG affects locomotor speed and trunk motion, and examined the anticipated and actual pain associated with electrode insertion in healthy individuals and individuals with a history of low back pain (LBP). Before and after insertion of intramuscular electrodes into the lumbar and thoracic paraspinals, participants performed multiple repetitions of a walking turn at self-selected and controlled average speed. Low levels of anticipated and actual pain were reported in both groups. Self-selected locomotor speed was significantly increased following insertion of the electrodes. At the controlled speed, the amplitude of sagittal plane lumbo-pelvic motion decreased significantly post-insertion, but the extent of this change was the same in both groups. Lumbo-pelvic motion in the frontal and axial planes and thoraco-lumbar motion in all planes were not affected by the insertions. This study demonstrates that intramuscular EMG is an appropriate methodology to selectively quantify the activation patterns of the individual muscles in the paraspinal group, both in healthy individuals and individuals with a history of LBP.

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Section: Discussioncontrasting

confidence: 70%

Does insertion of intramuscular electromyographic electrodes alter motor behavior during locomotion?

Smith

Kulig

2015

Journal of Electromyography and Kinesiology

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“…For example, in the Leeuw et al study [29] participants were excluded if they held TSK scores <34, whereas in this study only 9 of the 14 participants had a TSK score >34. Furthermore, the FABQ median split values used in this study (FABQ-W = 12, FABQ-PA = 11.5) are well below proposed elevated cut-off values (FABQ-W >34, FABQ-PA >15) used in previous studies [34] to identify individuals with high fear-avoidance beliefs. A further issue is that the participant sample size for this initial exploratory study (n = 19) may lack sensitivity to detect smaller effects.…”

Section: Discussionmentioning

confidence: 41%

Fear of Movement Is Related to Trunk Stiffness in Low Back Pain

et al. 2013

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BackgroundPsychological features have been related to trunk muscle activation patterns in low back pain (LBP). We hypothesised higher pain-related fear would relate to changes in trunk mechanical properties, such as higher trunk stiffness.ObjectivesTo evaluate the relationship between trunk mechanical properties and psychological features in people with recurrent LBP.MethodsThe relationship between pain-related fear (Tampa Scale for Kinesiophobia, TSK; Photograph Series of Daily Activities, PHODA-SeV; Fear Avoidance Beliefs Questionnaire, FABQ; Pain Catastrophizing Scale, PCS) and trunk mechanical properties (estimated from the response of the trunk to a sudden sagittal plane forwards or backwards perturbation by unpredictable release of a load) was explored in a case-controlled study of 14 LBP participants. Regression analysis (r 2) tested the linear relationships between pain-related fear and trunk mechanical properties (trunk stiffness and damping). Mechanical properties were also compared with t-tests between groups based on stratification according to high/low scores based on median values for each psychological measure.ResultsFear of movement (TSK) was positively associated with trunk stiffness (but not damping) in response to a forward perturbation (r2 = 0.33, P = 0.03), but not backward perturbation (r2 = 0.22, P = 0.09). Other pain-related fear constructs (PHODA-SeV, FABQ, PCS) were not associated with trunk stiffness or damping. Trunk stiffness was greater for individuals with high kinesiophobia (TSK) for forward (P = 0.03) perturbations, and greater with forward perturbation for those with high fear avoidance scores (FABQ-W, P = 0.01).ConclusionsFear of movement is positively (but weakly) associated with trunk stiffness. This provides preliminary support an interaction between biological and psychological features of LBP, suggesting this condition may be best understood if these domains are not considered in isolation.

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“…Although the sample size in the present study is similar to that in previous studies [6,30], larger multi-center cohorts will be required to increase generalizability. Third, we did not investigate PT's knowledge about pain neuroscience [31], their attitude toward biopsychosocial perspectives for LBP management [24,32,33], and their adherence to clinical practice guidelines for LBP management [34].…”

Section: Limitationsmentioning

confidence: 82%

Difference between physical therapist estimation and psychological patient-reported outcome measures in patients with low back pain

Miki¹,

Kondo²,

Takebayashi³

et al. 2020

PLoS ONE

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Minimizing the number of patient-reported outcome measures (PROMs) can reduce patient burden. The primary aim of the present study was to investigate whether physical therapists (PTs) can estimate psychological PROM scores in patients with low back pain (LBP) through physical therapy evaluation. The secondary aims were; 1) to investigate whether the clinical experiences of PTs influence correlations between PT estimates and psychological PROM scores, and 2) to investigate the sensitivity and specificity of PT estimates for the psychological features detected by the PROMs. We recruited hospitalized patients owing to LBP, who underwent evaluation by PTs on the initial day of hospitalization. Patients completed PROMs, including the Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia, and Hospital Anxiety and Depression Scale immediately before the initial physical therapy session. PTs rated the magnitude of patient kinesiophobia, pain catastrophizing, anxiety, and depression using an 11-point numerical rating scale (NRS; 0 = not detected at all, 10 = very highly detected) through physical therapy evaluation immediately after the initial session. The PTs were blinded to the PROM results. We categorized PTs into two subgroups (PTs with �4 years and those with <4 years of clinical experience). Data from 78 patients (mean [SD] age = 60.5 [16.3] years) and 21 PTs were analyzed. A statistically significant but weak correlation (P = .04, Spearman's ρ = .24) was detected only in the total PCS scores and PT NRS scores in a dataset of all patients and PTs. Further, there were no statistically significant differences in correlations (all P >.05) between the two subgroups of PTs in all measures. Low sensitivity and high specificity of PT estimates for psychological features through physical therapy evaluation were identified in all PROMs when PT NRS scores were categorized into the binary score by 5 (negative: <5; positive: �5).

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Identifying Patient Fear-Avoidance Beliefs by Physical Therapists Managing Patients With Low Back Pain

Cited by 35 publications

References 66 publications

Does insertion of intramuscular electromyographic electrodes alter motor behavior during locomotion?

Does insertion of intramuscular electromyographic electrodes alter motor behavior during locomotion?

Fear of Movement Is Related to Trunk Stiffness in Low Back Pain

Difference between physical therapist estimation and psychological patient-reported outcome measures in patients with low back pain

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