A comparison of kinesiophobia, pain-activity patterns and fear-avoidance beliefs in patients with chronic low back pain

Year 2024, Volume: 10 Issue: 2, 61 - 67, 30.06.2024

Betül Ergün , Fatma Kızılay , Egemen Kızılay

https://doi.org/10.31459/turkjkin.1440542

Abstract

Chronic pain affects individuals’ activity levels. Three activity patterns are observed among individuals with chronic pain: avoidance, overdoing, and regularization. According to fear - avoidance models, kinesiophobia is related to pain severity and disability. Kinesiophobia is a psychological factor that attracts attention in people with persistent pain, is related to the severity and persistence of pain. The aim of this study was to compare demographic and clinical characteristics of individuals with chronic inflammatory low back pain (ILBP) and mechanical low back pain (MLBP), in relation to kinesiophobia, fear-avoidance beliefs, and pain/activity patterns. A total of 89 people (45 MLBP, 44 ILBP) aged 18-65 were included in this cross-sectional study. A Visual Analog Scale (VAS) was used to inquire about for the duration of axial spondylarthritis diagnosis, duration of LBP, duration of morning stiffness, general pain, pain during movement, and night pain. Patients' fear of movement due to pain was assessed with the Tampa Kinesiophobia Scale (TKS), pattern changes in daily activities were assessed with the Pain-Activity Pattern Scale (PAPS), and fear-avoidance was assessed with the Fear-Avoidance Beliefs Questionnaire (FABQ). The scores obtained were compared. There was no statistically significant difference between the MLBP and ILBP groups in terms of age (p=0.202), BMI (p=0.124), gender (0.459), education level (p=0.082) and VAS-movement (p=0.071), FABQ score (0.277), PAPSa (p=0.454), PAPSe (0.596), PAPSs (p=0.247), and TKS score (p=0167). Whereas a statistically significant difference was found between the duration of morning stiffness (p=0.001), pain duration (p=0.018), VAS resting (p=0.001), and VAS night (p=0.001) score. It was observed that high resting and night VAS scores in the ILBP group were not associated with fear-avoidance and kinesiophobia behaviors any more than in the MLBP group. The fear- avoidance and kinesiophobia behaviors of both groups were affected to a similar extent, even though the pain type was different.

Keywords

Fear-avoidance, inflammatory, kinesiophobia, low back pain, mechanical

References

• Alcaraz-Clariana, S., García-Luque, L., Garrido-Castro, J. L., Aranda-Valera, I. C., Ladehesa-Pineda, L., Puche-Larrubia, M. Á., & Alburquerque-Sendín, F. (2021). Paravertebral muscle mechanical properties in patients with axial spondyloarthritis or low back pain: a case-control study. Diagnostics (Basel), 11(10), 1898.
• Bilgin, S., Cetin, H., Karakaya, J., & Kose, N. (2019). Multivariate analysis of risk factors predisposing to kinesiophobia in persons with chronic low back and neck pain. J Manip Physiol Ther, 42, 565–571.
• Bingül, Ö. Ö., & Aslan, U. B. (2013). Adaptation, reliability and validity of the Fear-Avoidance Beliefs Questionnaire into Turkish. Physiotherapy and Rehabilitation, 24(1), 135-143.
• Bordeleau, M., Vincenot, M., Lefevre, S., Duport, A., Seggio, L., Breton, T., Lelard, T., Serra, E., Roussel, N., Neves, J. F. D., & Léonard, G. (2022). Treatments for kinesiophobia in people with chronic pain: A scoping review. Front Behav Neurosci, 16, 933483.
• Braun, A., Saracbasi, E., Grifka, J., Schnitker, J., & Braun, J. (2011). Identifying patients with axial spondyloarthritis in primary care: how useful are items indicative of inflammatory back pain? Ann Rheum Dis, 70, 1782–1787.
• Briggs, A. M., Woolf, A. D., Dreinhöfer, K., Homb, N., Hoy, D. G., Kopansky-Giles, D., & March, L. (2018). Reducing the global burden of musculoskeletal conditions. Bull World Health Organ, 96(5), 366.
• Cane, D., Nielson, W. R., McCarthy, M., & Mazmanian, D. (2013). Pain-related activity patterns: measurement, interrelationships, and associations with psychosocial functioning. Clin J Pain, 29(5), 435-442.
• Çelik, F. T., & Köçkar, Ç. (2019). Pain and fear-avoidance behaviors in patients with lumbar hernia surgery. SDU Journal of Health Science Institute, 10(1), 18-22.
• Demirci, D., Karamancıoğlu, B., Hoşbaş, B. D., Kıyıcı, M., & Altunalan, T. (2023). Investigation of stress and anxiety levels according to pain-related activity patterns in child and adolescent ski athletes. Journal of Sport and Recreation Research, 5(1), 26-37.
• Felício, D. C., Elias Filho, J., Pereira, D. S., Queiroz, B. Z. D., Leopoldino, A. A. O., Rocha, V. T. M., & Pereira, L. S. M. (2021). The effect of kinesiophobia in older people with acute low back pain: Longitudinal data from back complaints in the elders (BACE). Cad Saude Publica, 37(12), e00232920.
• Godges, J. J., Anger, M. A., Zimmerman, G., & Delitto, A. (2008). Effects of education on return to work status people with fear avoidance beliefs and acute low back pain. Phys Ther, 88(2), 231–239.
• Ishak, N. A., Zahari, Z., & Justine, M. (2017). Kinesiophobia, pain, muscle functions, and functional performances among older persons with low back pain. Pain Res Treat, 2017, 3489617.
• Larsson, C., Ekvall Hansson, E., Sundquist, K., Jakobsson, U. (2016). Kinesiophobia and its relation to pain characteristics and cognitive affective variables in older adults with chronic pain. BMC Geriatr, 16, 128.
• Ledford, C. (2017). Spine conditions: Mechanical and inflammatory low back pain. FP Essentials, 461, 15-20. Luque-Suarez, A., Martinez-Calderon, J., Navarro-Ledesma, S., Morales-Asencio, J. M, Meeus, M., & Struyf, F. (2020). Kinesiophobia is associated with pain intensity and disability in chronic shoulder pain: a cross-sectional study. J Manipulative Physiol Ther, 43(8), 791-798.
• Lüning Bergsten, C., Lundberg, M., Lindberg, P., & Elfving, B. (2012). Change in kinesiophobia and its relation to activity limitation after multidisciplinary rehabilitation in patients with chronic back pain. Disabil Rehabil, 34, 852–858.
• Navarro-Compán, V. (2019). An update on diagnosis and classification of axial spondyloarthritis. Curr Rheumatol Rep, 21(8), 39.
• Onat, A. M., & Kiraz, S. (2007). Early ankylosing spondylitis (axial undifferentiated spondyloarthritis). Turkiye Klinikleri J Int Med Sci, 3(25), 30-38.
• Pazzinatto, M. F, Rio, E. K, Crossley, K. M., Coburn, S. L., Johnston, R., Jones, D. M., & Kemp, J. L. (2022). The relationship between kinesiophobia and self-reported outcomes and physical function differs between women and men with femoroacetabular impingement syndrome. Braz J Phys Ther, 26, 100396.
• Rudwaleit, M., Feldtkeller, E., & Sieper, J. (2006). Easy assessment of axial spondyloarthritis (early ankylosing spondylitis) at the bedside. Ann Rheum Dis, 65(9), 1251.
• Silva, M. C. d. M., Tottoli, C. R., Mascarenhas, K., Marques, Y. A., Toledo, A. M., & Carregaro R. L. (2022). Is kinesiophobia associated with disturbances in dynamic balance in individuals with chronic non-specific low back pain? Br JP, 5, 47–51.
• Soysal Gündüz, Ö. (2011). The prevalence of inflammatory back pain, sacroiliitis and spondyloarthropathy in patients who underwent lumbar disc herniation surgery. Thesis in Medicine, Dokuz Eylül University, Türkiye.
• Suygun, E. T., & Celenay, S. T. (2022). Turkish translation of the patterns of activity measure-pain in patients with chronic low back and neck pain: Validity and reliability. Pain Manag Nurs, 23(2), 231-236.
• Tonga, E., Daşkapan, A., Düger, T., & Özünlü, N. (2012). Effects of different low back health trainings on fear avoidance beliefs and activity performance in chronic low back pain. Physiother Rehabil, 23, 17-25.
• Turhanoglu, A. D. (2011). Chronic low back pain. Turkiye Klinikleri J PM&R-Special Topics, 4(1), 117-122.
• Uluğ, N., Yakut, Y., Alemdaroğlu, İ., & Yılmaz, Ö. (2016). Comparison of pain, kinesiophobia and quality of life in patients with low back and neck pain. J Phys Ther Sci, 28(2), 665-670.
• Umay, E., Gürçay, E., Karaahmet, Ö., Polat, S., Umay, S., & Çakcı, A. (2014). Comparison of clinical features between the patients axial spondyloarthritis and mechanical low back pain. J PMR Sci,17, 128-133.
• Varallo, G., Scarpina, F., Giusti, E. M., Cattivelli, R., Guerrini Usubini, A., Capodaglio, P., & Castelnuovo, G. (2021). Does kinesiophobia mediate the relationship between pain intensity and disability in individuals with chronic low-back pain and obesity? Brain Sci, 11, 684.
• Vlaeyen, J. W., Kole-Snijders, A. M, Boeren, R. G., & van Eek, H. (1995). Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain, 62, 363–372.
• Waddell, G., Newton, M., Henderson, I., Somerville, D., & Main, C. J. (1993). A Fear Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low-back pain and disability. Pain, 52(2), 157–168.
• Wood, L., Bejarano, G., Csiernik, B., Miyamoto, G. C., Mansell, G., Hayden, J. A., Lewis, M., & Cashin, A. G. (2023). Pain catastrophising and kinesiophobia mediate pain and physical function improvements with Pilates exercise in chronic low back pain: a mediation analysis of a randomised controlled trial. J Physiother, 69(3), 168–174.
• Yilmaz, Ö. T., Yakut, Y., Uygur, F., Uluğ, N. (2011). Turkish version and test-retest reliability of the Tampa Kinesiophobia Scale. Physiotherapy Rehabilitation, 22(1), 44-49.