The Influence of Self-Efficacy, Fear-Avoidance Belief, and Coping Styles on Quality of Life for Chinese Patients with Chronic Nonspecific Low Back Pain: A Multisite Cross-Sectional Study.

BACKGROUND: As a bio-psycho-social issue, chronic low back pain (CLBP) has been a significant topic in health management, and patients' quality of life (QOL) is gaining extensive attention. Self-efficacy, pain fear-avoidance belief (FAB), and coping styles play important roles in the QOL of CLBP patients. However, it remains unclear how self-efficacy and FAB influence QOL through specific coping styles. This study aimed to explore the influencing paths of self-efficacy, FAB, and coping styles on the QOL of patients with CLBP. METHODS: This study relies on a multisite, cross-sectional design involving 221 CLBP patients. Stepwise multiple regression and structural equation modeling were employed. RESULTS: CLBP patients lived with a poor global QOL. Self-efficacy played a direct, positive role in predicting QOL for patients with CLBP (ß = 0.35), and it also played an indirect, positive role in predicting QOL (ß = 0.19) through active coping styles (ß = 0.31). FAB played a direct, negative role in predicting QOL (ß = -0.33), and it also played an indirect, negative role in predicting QOL (ß = -0.32) through passive coping styles (ß = 0.32). CONCLUSIONS: Self-efficacy and FAB are both directly and indirectly related to global QOL, and coping styles are important mediating variables. Self-efficacy and active coping are protective factors for the QOL of CLBP patients, while FAB and passive coping are risk factors. Health education strategies are recommended by medical personnel to enhance CLBP patients' pain self-efficacy, decrease pain FAB, and modify pain coping styles, so that their global QOL can be improved.

Fear-avoidance beliefs are independently associated with the prevalence of chronic pain in Japanese workers.

PURPOSE: Pain is a global public health problem with implications for both personal and social heath. Fear-avoidance beliefs (FABs) have been demonstrated to negatively impact and prolong pain in many Western countries, but little is known about the association between FABs and chronic pain (CP) in Asian countries, including Japan. We examined the relationship between FABs and CP in Japanese white-collar workers, a growing population with a high prevalence of CP. METHODS: Questionnaires and company records were used to gather data from 433 Japanese white-collar workers. Data were related to experience of pain, participant sociodemographic/health/lifestyle characteristics, fear-avoidance beliefs [Tampa Scale for Kinesiophobia (TSK)], work-related psychosocial factors (Brief Job Stress Questionnaire), and depressive illness [Psychological Distress Scale (K6)]. Analysis of covariance and multilevel logistic regression modeling were used to analyze associations between the data while controlling for factors known to influence CP prevalence. RESULTS: Prevalence rate of CP was 11.1% (48 of 433 persons). Adjusted odds ratios for participants with CP significantly increased in participants with high TSK scores, even after adjusting for factors known to influence CP prevalence. CONCLUSION: We found a significant association between high TSK scores and CP in Japanese white-collar workers when controlling for other known factors that influence CP such as work-related psychosocial characteristics and depressive conditions. This finding suggests that FABs are independently associated with prevalence of CP.

A single session of education for a patient with negative beliefs about low back pain: A case report of 16-month follow-up.

The effectiveness of education in patients with low back pain (LBP) remains controversial and inconclusive. This case report describes the long-term effects of a single educational session on the rehabilitation of a patient with chronic LBP (CLBP). A 57-year-old woman presented with the main complaint of LBP and inability to prostrate for several years. The intervention consisted of a single session of patient-specific education that targeted negative cognitive beliefs. This education included instructions about the obtained findings, spinal anatomy, patient reassurance, the relationship between imaging findings and patient symptoms, proposed treatment, and a home exercise program. The patient was able to independently complete the prostration task immediately after the session without pain. This improvement was maintained for at least 16 months, as demonstrated by the Numeric Pain Rate Scale, Patient-Specific Functional Scale, Fear Avoidance Belief Questionnaire, and the Keele STarT Back Screening Tool. In conclusion, a single session of patient-specific education was effective, both immediately and over the long term, in addressing pain and function in patients with CLBP.

Fear-Avoidance Beliefs, Kinesiophobia, and Disability Risk Among Indians with Spine Pain.

Purpose: To determine the burden of fear-avoidance beliefs (FAB), kinesiophobia, and risk of persistent disability among Indians with spine pain. Methods: Demographic and clinical data collected from 139 patients who attended a spine rehabilitation clinic for assessment and treatment of their spine pain were analyzed. Fear-avoidance beliefs, kinesiophobia, and risk of persistent disability were measured using the Fear-avoidance Beliefs Questionnaire (FABQ), Tampa Scale for Kinesiophobia (TSK), and the STarT Back Tool (SBT). A multivariate analysis was performed to determine the effect of pain, disability, age, gender, BMI, lifestyle, pain duration, and pain location on FAB, TSK, and SBT scores. Results: A majority of patients had medium to high-risk FAB-physical activities (FAB-P) (50.5%) and SBT (54%) scores. The percentage of patients with medium or high-risk FAB-P (p = 0.03), FAB-work (FAB-W) (p = 0.03), and SBT (p = 0.03) scores were significantly higher in patients with pain score > 7, and the percentage of patients with medium or high-risk with FAB-P (p < 0.0001), TSK (p = 0.0003), and SBT (p < 0.0001) scores were significantly higher in patients with severe, crippled or bed-ridden disability. Disability was the only significant predictor for FAB-W, FAB-P, and SBT scores. Conclusion: The prevalence of fear-avoidance beliefs and risk of persistent disability was significant among Indians and should be taken into account while planning treatment for their spine pain.

Fear-avoidance beliefs, anxiety and depression are associated with motor control and dynamics parameters in patients with chronic low back pain.

PURPOSE: To evaluate the influence of fear-avoidance beliefs, anxiety and depression on dynamic and motor control parameters before and after Functional Restoration Program. METHODS: Patients were divided into three groups depending on clinical scores scores. Dynamic and motor control parameters were extracted from gait analysis. RESULTS: Patients showed different ways based on preferred walking speed, capacity benefit, peaks of propulsion and gait stability in function of clinical scores. CONCLUSION: Fear-avoidance beliefs associated to anxiety and depression influence biomechanics on overground walking. We depicted different ways to adapt their gait in function of biopsychosocial scores. Functional Restoration Program influence these ways.

A cross-sectional study on fear-avoidance beliefs and chronic low back pain in fighter pilots.

BACKGROUND: Chronic low back pain (CLBP) is considered a serious complaint among fighter pilots because the vertebrae of these pilots are exposed to high compression forces from prolonged sitting on a hard ejection seat and frequent sudden fighter aircraft maneuvers. It is yet unknown whether a correlation exists between CLBP and psychosocial/behavioral performance of fighter pilots. METHODS: This was a cross-sectional study of 66 fighter pilots with nonspecific CLBP voluntarily participated in this study. Self-efficacy was measured based on the degree of physical activity and work performance using the fear-avoidance beliefs questionnaire (FABQ). RESULTS: A significant inverse correlation was found between the work subscale of the FABQ (FABQw) (mean score: 27.4 ± 8.4) and both age (mean: 35 ± 4.9 years) and flying experience (mean: 13.2 ± 4.4 years) among fighter pilots with nonspecific CLBP. In contrast, there was no significant correlation between physical activity subscale of the FABQ (mean score: 12.3 ± 6.4) and both age and flying experience. CONCLUSIONS: An inverse correlation was observed between FABQw and both age and flying experience among fighter pilots with nonspecific CLBP. It is important for rehabilitation specialists to understand the role of cognitive/affective components of a pain from tissue injury and nociception to prevent occupational disability and enhance occupational performance.

Development, validation and evaluation of a novel self-instructional module in patients with chronic non-specific low back pain.

BACKGROUND: Low back pain (LBP) is ranked highest in terms of disability-adjusted life-years lived. Patient education and self-management have shown to play a crucial role in the overall pain management. However, the literature on the same with respect to Indian context is still lacking. The study was aimed to develop, validate and assess the acceptability and effectiveness of self-instructional educational module among Indian chronic LBP (CLBP) patients. METHODS: A prospective single-arm open-label study was conducted in a pain clinic of a tertiary care public hospital in North India with 'Backcare booklet-self-instructional module (SIM)' as an intervention in patients with CLBP. SIM was developed with the intent to provide up-to-date evidence-based information in an easy understanding way to patients with CLBP. 132 patients were administered SIM with a single session of verbal explanation. Pain intensity (numeric rating scale [NRS]), disability, fear-avoidance belief Questionnaire (FABQ), quality of life (EQ5D) and knowledge level were assessed at baseline and after 3 months of intervention. Student's paired t-test and Chi-square test were used. Data were analysed using SPSS version 15.0. RESULTS: 120 patients successfully completed the 3 months' follow-up. Significant reductions were observed in pain intensity (76[12] vs 55 [15, P < 0.01); disability (51[14] vs 43 [10], P < 0.01); FABQ (46[12] vs 41 [10], P < 0.01); EQ5D (0.35 [0.27] vs 0.18 [0.26], P < 0.01). CONCLUSION: Backcare booklet as an intervention, along with usual pharmacological care is a cost-effective educational medium to promote self-management of CLBP in the clinical outpatient settings.

The experience of patients with fear-avoidance belief hospitalised for low back pain - a qualitative study.

PURPOSE: Severe pain, anxiety, depression, and fear-avoidance belief (FAB) are widespread among patients hospitalised for acute low back pain (LBP). Research shows that these psychological factors impact negatively on rehabilitation. This study aimed to investigate and develop an understanding of pain in patients with fear avoidance belief hospitalised for LBP. METHOD: Semi-structured interviews were conducted with nine patients selected by an FAB questionnaire: averaged FAB - physical activity score was 21 and FAB - work score was 30. All participants were recruited from a rheumatology ward. Analyses were based on the content analysis. RESULTS: The analysis revealed two main categories: (1) back history until the pain became dominant, demonstrating the importance of the LBP histories before admission to hospital. (2) Being in a universe of pain verified, the severe pain expressed through metaphors and a need to be involved in the rehabilitation. During interviews, the participants did not indicate high FAB behaviour. CONCLUSIONS: Despite high scores, the FAB questionnaire might not be sufficient to detect FAB in patients hospitalised for acute LBP. It is important to include the deeper meaning of metaphors and the personal story behind the expression of pain as a way of understanding each individual with LBP. Implications for Rehabilitation FAB questionnaire is not sufficient either to detect fear avoidance in LBP patients hospitalised with acute conditions or to catch the complexities of individual pain experiences. It seems essential for health care professionals (HCP) to involve the patient in their treatment and development of a rehabilitation plan based on their individual histories and concerns about the future. The metaphors expressed are a way for HCPs to gain insight into the psychological aspect of pain for the individual patient.

Influence of fear-avoidance belief on orthopedic nurses′ work engagement who had occupational low back pain / 中国实用护理杂志

Objective:To explore the status of occupational low back pain among orthopedic nurses, and to investigate the influence of fear-avoidance belief on their work engagement.Methods:A convenient sample of 325 orthopedic nurses were recruited from one tertiary grade orthopedic hospital in Tianjin City. The data collection tools included a demographic questionnaire, which assessed nurses′ demographic information and their general condition of low back pain, the Chinese version of Fear-avoidance Beliefs Questionnaire, and the Chinese version of Utrecht Work Engagement Scale.Results:91.7%(298/325) of orthopedic nurses reported that they had occupational low back pain, and the mean score of fear-avoidance belief was 59.18±14.55, and the mean score of Utrecht work engagement was 40.40±17.49. Nearly 89.3% (266/298) of nurses with low back pain had low or moderate level of work engagement. There was a statistically significant relationship between fear-avoidance belief and work engagement ( r=-0.306, P<0.001). Hierarchical Regression Analysis showed that variables, including higher education, salary per month, sick-leave, quitting job and fear-avoidance belief influenced orthopedic nurses′ work engagement. Specifically, fear-avoidance belief independently can explain 23.6% variation of work engagement. Conclusions:Orthopedic nurses′ occupational low back pain is very common, and the level of work engagement of this population is moderate, and fear-avoidance belief can predict work engagement. This revealed that nursing managers are supposed to pay attention to orthopedic nurses′ occupational low back pain, adopting appropriate nursing interventions to reduce these nurses′ pain, to decrease their fear-avoidance belief, which then in turn strengthen the nurses′ work engagement.

The study of the variability of anticipatory postural adjustments in patients with recurrent non-specific low back pain.

BACKGROUND AND OBJECTIVES: Intrinsic variability is present in all actions, including repetitive tasks. The aim of this study was to evaluate the variability of anticipatory postural adjustments (APAs) of trunk muscles in participants with low back pain (LBP). MATERIAL AND METHOD: The study included 21 participants with recurrent non-specific LBP (15 men, 6 women) and 21 healthy volunteers. Standard deviation of electromyographic activity of the external oblique (EO), transverse abdominis/internal oblique (TrA/IO), and erector spinae (ES) muscles onset relative to deltoid muscle onset was recorded in 75 rapid arm flexions, and the correlation with the participants' avoidance belief (the FABQ score) and disability (the Roland-Morris Questionnaire score) was statistically analyzed. RESULTS: participants with LBP exhibited less variability in timing of APAs of the TrA/IO muscle compared with the control group (P=0.047). The timing of APAs of the TrA/IO muscle was significantly correlated with the FABQ score (P=0.006). There was no significant correlation between this variable and disability (P=0.09). Decrease in variability of the timing of APA of the EO (P=0.45) and ES (P=0.6) muscles was not significant. CONCLUSION: The variability of the postural responses of participants with LBP decreased. Restoring variability in postural control responses might be a goal in rehabilitating these patients.

Validation of the Persian version of the fear avoidance belief questionnaire in patients with low back pain.

OBJECTIVES: Fear of pain or re-injury and avoidance attitudes have a great impact on maintenance of chronic low back pain (CLBP) and disability. Fear-Avoidance Beliefs Questionnaire (FABQ) is developed to assess these psychosocial factors. The aim of this study was to provide a translated and validated version of the FABQ for Persian speaking population. METHODS: Forward and backward translation techniques were carried out for translation and cultural adaptation of the questionnaire into Persian. Internal consistency and test-retest reliability were used to assess the reliability of the Persian questionnaire. Construct validity of the scale was assessed by divergent validity (using Spearman correlation coefficient) and exploratory factor analysis. Principle component analysis with varimax rotation method was applied for assessment of factor analysis. RESULTS: The test-retest reliability was excellent with the Intra-class Correlation (ICC) value of 0.802 and 0.808 for the physical activity and work subscales of the questionnaire, respectively. The Chronbach's alpha coefficient value of 0.89, demonstrated adequate internal consistency of the questionnaire. Factor analysis revealed two factors which could explain 57.9% of the total variance. Items 7, 10 and 11 of the questionnaire were used in both major factors of the final Persian version. Regarding the divergent validity of the questionnaire, data demonstrated no correlation (r< 0.3) between factor 2 (which is about physical activity) and measured clinical variables (pain intensity and level of dysfunction), while factor 1 (which is about work) was fairly correlated with both pain intensity and disability level of the subjects. CONCLUSION: The provided Persian version of FABQ is a reliable and valid measurement and further research into its use as a diagnostic and prognostic tool is warranted. Development of this questionnaire will be useful for comparability between Persian and English language studies and facilitates an international collaboration in this field.

Are fear-avoidance beliefs in low back pain patients a risk factor for low physical activity or vice versa? A cross-lagged panel analysis.

OBJECTIVE: The assumption that low back pain (LBP) patients suffer from "disuse" as a consequence of high fear-avoidance beliefs is currently under debate. A secondary analysis served to investigate whether fear-avoidance beliefs are associated cross-sectionally and longitudinally with the physical activity level (PAL) in LBP patients. METHODS: A total of 787 individuals (57% acute and 43% chronic LBP) were followed up over a period of one year with measurements of fear-avoidance beliefs and physical activity level. Fear-avoidance beliefs concerning physical activity were measured by the physical-activity subscale of the FABQ (Fear-Avoidance Beliefs Questionnaire), the physical activity level was assessed in weighted metabolic equivalents (MET) hours/week with a German self-report questionnaire. Data were investigated by structural equation modelling in a cross-lagged panel design for the whole sample and separately for acute and chronic LBP. RESULTS: The acute and chronic sub sample increased their total physical activity level significantly after one year. The structural equation modelling results did not support the disuse-aspect inherent in the fear-avoidance belief model. Cross-lagged path coefficients were low (.04 and .05 respectively) and, therefore, did not allow to predict final physical activity by initial fear-avoidance beliefs or vice versa. DISCUSSION: Consequently, due to missing links between fear-avoidance beliefs and physical activity in a longitudinal design, the assumptions of the fear-avoidance belief model have to be questioned. These findings are in line with other investigations published recently. Most probably, "fear-avoidance belief" represents a cognitive scheme that does not limit activity per se, but only is directed to the avoidance of specific movements.

The reliability and validity of the Chinese version of the fear-avoidance beliefs questionnaire for evaluating patients with lower back pain / 中华物理医学与康复杂志

Objective To translate a fear-avoidance belief questionnaire and explore the reliability, validity and responsiveness of the Chinese version for evaluating patients with lower back pain. Method The original questionnaire translated into Chinese (the FABQ-CHI) was administered to inpatients and outpatients who also completed a medical outcomes 36-item short-form health survey (SF-36), the Chinese version of Oswestry's disability index (CODI), and an 11-point pain numerical rating scale (NRS). Two days later, the outpatients were asked to complete the questionnaire again. About one to two weeks later, the inpatients were evaluated again. Results The FABQ-CHI had very good content validity, split-half reliability and test-retest reliability, with intraclass correlation coefficients of 0.809 and 0.696 and a Cronbach's alpha of 0. 857. Spearman's correlation coefficients between the FABQ-CHI and the NRS, the CODI, the SF-36 (physical) and the SF-36 (mental) were 0.303, 0. 488, -0. 350 and -0. 308 respectively. Factor analysis yielded three factors which accounted for 61.2% of the total response variance. Conclusions The FABQ-CHI is a valid and reliable evaluating tool for patients with lower back pain. It has been shown to demonstrate very good content validity, a high degree of test-retest reliability and internal consistency,and good construct validity.