Judith Luckmann

Fear-avoidance beliefs, physical activity, and disability in elderly individuals with chronic low back pain and healthy controls.

ObjectiveResearch studies focussing on the fear-avoidance beliefs model (FABM) have expanded considerably during the last years, however, there has been very little research directed at the elderly. The objective of the present study was to investigate the validity of the FABM in older patients with chronic low back pain (CLBP). MethodIn a cross-sectional study, a group of elderly patients with CLBP (N=103) was compared with an age-matched group of pain-free individuals (N=59) to test the constructs inherent in the FABM. Constructs include fear avoidance beliefs (FABs), disability, disuse, and physical activity. In addition, the relationship of these constructs was also investigated in the patient group. CLBP-patients had an average age of 71.41 years (SD=5.2) and pain-free individuals of 71.19 years (SD=4.73). Individuals participated in a photographed series of physical activities adapted to the age group (Photograph Series of Daily Activities-German version for the elderly) for the assessment of FAB, in the Hannover Disability Questionnaire, in the Freiburg Physical Activity Questionnaire, and in an ultrasound measurement to evaluate lumbar flexion. In addition, they completed an activity diary for 1 week. Before computation, the physical activity measurements were converted into metabolic units that characterize energy expenditure. ResultsIn the patient group, FAB, pain intensity, and age predicted functional capacity, but not physical activity. Lumbar flexion was predicted by FAB and age. Patients were more fear-avoidant, reported more disability, and displayed less lumbar flexion than the pain-free individuals. No differences between the groups could be detected in regard to energy expenditure measured either by the questionnaire or by diary data. ConclusionsThe findings are consistent with results reported in the literature for younger age groups and confirm the assumption that the FABM is also valid for the elderly.

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.

Depressivität, Bewegungsangst- Kognitionen und körperliche Aktivität bei Patienten mit Rückenschmerz

Zusammenfassung. Ziel der Arbeit war die Untersuchung der Rolle von Depression und Bewegungsangst-Kognitionen (“fear-avoidance beliefs”) fur die Bereitschaft zur Aufnahme und zur Beibehaltung korperlicher Aktivitat bei Patienten mit Ruckenschmerz. In die Sekundaranalyse einer randomisierten, kontrollierten Interventionsstudie gingen Daten von N = 1378 Patienten mit vorwiegend akuten Ruckenschmerzen ein (58 % weiblich, mittleres Alter 49 Jahre). Personen mit hoher Depressivitat und gleichzeitig starken “fear-avoidance beliefs” zeigten den niedrigsten Aktivitatsumsatz zur Baseline (kcal/Woche). Bedeutsamster Pradiktor fur den Aktivitatsumsatz nach sechs bzw. 12 Monaten war neben der Baseline-Aktivitat eine hohe Selbstwirksamkeitserwartung zur Baseline; Ruckfalle in Inaktivitat wurden v.a. durch geringe Selbstwirksamkeit und geringe wahrgenommene Vorteile von Bewegung vorhergesagt. Weder Depressivitat noch Bewegungsangst erwiesen sich als bedeutsame Pradiktoren fur korperliche Aktivitat bzw. Ruckfall in Inak...