Physical Therapy Utilization of Graded Exposure for Patients With Low Back Pain

Abstract

sychological factors are commonly used to explain the development and maintenance of chronic low back pain (LBP). 38,39 In fact, individual studies suggest that psychological factors are stronger than physical and demographic factors for predicting LBP outcomes. 8,20 This clinical commentary focuses on the fear-avoidance model of musculoskeletal pain (FAM), which was reviewed by 29 Briefly, the FAM proposes that the primary affective and cognitive components influencing pain perception are anxiety, pain-related fear (including fear of movement and reinjury), physical (limitations in physical performance and disuse syndrome), and societal (chronic disability) consequences. 6,27,32,48 The FAM was selected as the focus of this manuscript, because the model appears to have clinical relevance for patients with LBP. Specifically, previous studies suggest that questionnaires based on the FAM accurately identify poor prognosis for patients with LBP.

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

“…There is evidence that identifying patients with elevated fearavoidance beliefs and managing them accordingly may reduce fear and improve outcomes. [3][4][5][10][11][12][13][14][15][16][17][18][19][20]36,40,41,56,68 The purpose of this study was to determine the effect of adding a single-item screening variable that classified patients with elevated versus not elevated fearavoidance beliefs of physical activities on a model that predicts risk-adjusted FS outcomes.…”

A Psychometric Investigation of Fear-Avoidance Model Measures in Patients With Chronic Low Back Pain

“…2,12,14,44,46,52 Furthermore, effective FAM treatment strategies have been reported, including patient education, 3,5 graded exercise, 13,36 and graded exposure. 6,20,21,37,58,59 While portions of the FAM are well supported in the literature, there are unresolved questions and issues affecting its application in clinical settings. …”

“…6,20,21,37,58,59 While portions of the FAM are well supported in the literature, there are unresolved questions and issues affecting its application in clinical settings. 33 One unresolved issue is related to measurement of FAM constructs in outpatient physical therapy settings, which is the focus of this particular study.…”

Patient Education Based on Principles of Cognitive Behavioral Therapy for a Patient With Persistent Low Back Pain: A Case Report

“…Additionally, how to best implement cognitive and behavioral interventions during physical therapist management of low back pain (LBP) to obtain superior results compared to traditional physical therapy interventions alone remains unclear. 19 This raises the need for case studies and conceptual work to demonstrate the use of CBT-based patient education in physical therapist practice. The purpose of this case report is to demonstrate the application and clinical outcomes associated with CBT-based patient education provided by a physical therapist during the care of a patient with persistent LBP.…”

“…19,39,54,56,59 Indeed, physical therapists appear to be ideal candidates to utilize CBT-based patient education. The structure of CBT, as a process, closely mirrors the examination and evaluation process in which physical therapists engage, and the Guide to Physical Therapist Practice 1 suggests, the importance of identifying and addressing patient educational deficits that may contribute to disablement.…”