Fear Avoidance Beliefs Predict Disability in Older Adults With Chronic Low Back Pain

Abstract

Objectives To determine whether fear avoidance beliefs (FAB) in older adults with chronic low back pain (CLBP) is significantly associated with gait speed and/or self-report (Roland Morris Questionnaire, RMQ) Design Cross-sectional analysis Setting Academic Medical Center (single site) Participants Two-hundred English-speaking participants aged 65 and older with CLBP every day or almost every day of ≥ moderate intensity for ≥3 months. Measurements The physical activity portion of the FAB questionnaire assessed fear avoidance beliefs. Disability was measured with gait speed and the RMQ. Covariates measured included age, gender, BMI, chronic disease (Cumulative Illness Rating Scale-CIRS), depression (Geriatric Depression Scale-GDS), and pain (McGill Pain Questionnaire short form-MPQ.) Results Fear avoidance beliefs were significantly associated with the RMQ (p<.0001) and gait speed (p=.002) after controlling for all covariates. Conclusion Fear avoidance beliefs related to physical activity in older adults with CLBP were significantly associated with both self-reported and performance-based disability after controlling for known confounders. Previous studies have reported similar associations between self-reported measures of disabling back pain and fear avoidance beliefs. Ours is the first study to examine the relationship between FAB and gait speed, a powerful predictor of morbidity and mortality. Future work should examine whether targeting fear avoidance in addition to other psychosocial measures in older adults with CLBP improves gait speed and functional independence.

Problem areas identified as important to older adults with lumbar spinal stenosis

“…Pain appears to be more important than other symptoms such as weakness, numbness, and tingling in the legs. These results are consistent with the studies on the role of fearavoidance beliefs in functional impairment [36] and disability [37,38] among people with chronic low back pain. In other words, fear of pain, in addition to pain itself, can lead to functional impairment and disability.…”

Is there a relationship between pain and psychological concerns related to falling in community dwelling older adults? A systematic review

“…Interestingly, although Hadjistavropoulos et al [34] established falls efficacy and balance confidence were able to predict future falls, the authors established that the SAFFE was not able to predict future falls. Activity avoidance due to pain is known to occur [16] and it seems plausible that pain may be an important factor that mediates this relationship. A recent meta-analysis [20] established that older adults with chronic musculoskeletal pain are less active than those without pain, and activity avoidance due to a FOF could possibly contribute to this observed reduction in physical activity and warrants investigation.…”

“…However, one potential risk factor that appears to have received minimal consideration is pain. This is surprising since other fear related behaviours, such as the avoidance of physical activity in older adults experiencing pain (although not in relation to FOF) have been the focus of research in recent years [15][16][17]. Pain is a common and pervasive problem in community dwelling older adults and it is frequently underdiagnosed [18].…”

Einstellungen und Überzeugungen von Behandlern bei älteren Patienten mit Rückenschmerzen

“…AngstVermeidungs-Überzeugungen hatten in einer Studie von Basler et al einen prä-diktiven Wert bezüglich der Funktionskapazität [3]. Eine weitere Studie zeigte signifikante Assoziationen zwischen AngstVermeidungs-Überzeugungen und dem Behinderungsgrad sowie der Gehgeschwindigkeit [5]. Es gilt jedoch zu bedenken, dass auch Sturzangst bei dieser Population zur Bewegungsvermeidung führen kann [18].…”