Sabine Quint

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.

TTM-based counselling in physiotherapy does not contribute to an increase of adherence to activity recommendations in older adults with chronic low back pain--a randomised controlled trial.

Background The present study examines the outcome of counselling in physiotherapy based on the Transtheoretical Model (TTM) in a sample of elderly individuals with chronic low back pain.

Fear Avoidance Beliefs und Funktion bei älteren Personen mit chronischem Rückenschmerz

ZusammenfassungEs wird untersucht, in welcher Weise sich Fear Avoidance Beliefs (FABs) auf subjektive und objektive Funktionsparameter sowie auf den Schmerz bei älteren Erwachsenen auswirken. FABs werden operationalisiert über eine Fünf-Item-Skala gleichen Namens, die über eine interne Konsistenz von α=0,74 verfügt. Einbezogen wurden 152 ältere Patienten mit Schmerzen im Rücken, die fast in der Hälfte der Fälle auf eine Spondylose zurückgeführt wurden. Das Durchschnittsalter betrug 70,1 Jahre (SD=4,1; Spanne 65–84). Alle Patienten nahmen an einem standardisierten physiotherapeutischen Programm mit zehn halbstündigen Sitzungen teil. Datenerhebungen fanden vor (t1), unmittelbar nach (t2) und sechs Monate nach (t3) Abschluss der physiotherapeutischen Behandlung statt. Primäres Outcome-Kriterium ist die Funktion, die zum einen als subjektives Maß durch den Funktionsfragebogen Hannover und zum anderen als objektives Maß durch die mit der Ultraschalltopometrie gemessene Anteflexion bestimmt wurde. Sekundäre Outcome-Kriterien sind Schmerzparameter. Zum Messzeitpunkt t1 wurden die Patienten in drei Gruppen mit stark, mittel oder gering ausgeprägten FABs eingeteilt. Zweifaktorielle Varianzanalysen mit Post-hoc-Tests zeigen in beiden Funktionsparametern für die Gruppe mit hohen FABs zu allen Messzeitpunkten ungünstigere Werte. Ein Einfluss der FABs auf die Schmerzparameter ist allerdings nicht festzustellen. Es ist zu erwarten, dass die Effektivität der Physiotherapie verbessert werden kann, wenn die FABs der Patienten bei der Therapieplanung berücksichtigt werden.AbstractFear Avoidance Beliefs and physical function in elderly individuals with chronic low back pain This analysis assessed how fear avoidance beliefs (FABs) affected subjective and objective functional parameters as well as pain in elderly individuals. The study comprised 152 elderly patients with low back pain, which was attributed to spondylosis in almost half of the cases. Their average age was 70.1 years (SD=4.3, range 65–84). All of the patients participated in a physiotherapeutic program including data acquisition before treatment (t1), immediately after its completion (t2), and 6 months later (t3). FABs were assessed by a five-item scale with satisfying psychometric properties. The primary outcome criterion was function, which was evaluated as a subjective measure using the Hannover functional disability scale and as an objective measure based on the anteflexion determined by ultrasound topometry. Secondary outcome criteria were pain parameters. At the time o the first measurement (t1), the patients were classified into three groups with strong, intermediate, or weak FABs. Analyses of variance reveal an improvement of subjective functional capacity in every FAB group between t1 and t2. At t3, there is a decline of these values only in the group of the high fear avoiders. High fear avoiders also show lower values in the objective measure at all three measurement points. No influence of the FABs on the pain parameters could be determined. It would be expected that the efficacy of physiotherapy could be improved if the patients’ FABs are taken into consideration when planning the treatment regimen.

Fear Avoidance Beliefs and physical function in elderly individuals with chronic low back pain

ZusammenfassungEs wird untersucht, in welcher Weise sich Fear Avoidance Beliefs (FABs) auf subjektive und objektive Funktionsparameter sowie auf den Schmerz bei älteren Erwachsenen auswirken. FABs werden operationalisiert über eine Fünf-Item-Skala gleichen Namens, die über eine interne Konsistenz von α=0,74 verfügt. Einbezogen wurden 152 ältere Patienten mit Schmerzen im Rücken, die fast in der Hälfte der Fälle auf eine Spondylose zurückgeführt wurden. Das Durchschnittsalter betrug 70,1 Jahre (SD=4,1; Spanne 65–84). Alle Patienten nahmen an einem standardisierten physiotherapeutischen Programm mit zehn halbstündigen Sitzungen teil. Datenerhebungen fanden vor (t1), unmittelbar nach (t2) und sechs Monate nach (t3) Abschluss der physiotherapeutischen Behandlung statt. Primäres Outcome-Kriterium ist die Funktion, die zum einen als subjektives Maß durch den Funktionsfragebogen Hannover und zum anderen als objektives Maß durch die mit der Ultraschalltopometrie gemessene Anteflexion bestimmt wurde. Sekundäre Outcome-Kriterien sind Schmerzparameter. Zum Messzeitpunkt t1 wurden die Patienten in drei Gruppen mit stark, mittel oder gering ausgeprägten FABs eingeteilt. Zweifaktorielle Varianzanalysen mit Post-hoc-Tests zeigen in beiden Funktionsparametern für die Gruppe mit hohen FABs zu allen Messzeitpunkten ungünstigere Werte. Ein Einfluss der FABs auf die Schmerzparameter ist allerdings nicht festzustellen. Es ist zu erwarten, dass die Effektivität der Physiotherapie verbessert werden kann, wenn die FABs der Patienten bei der Therapieplanung berücksichtigt werden.AbstractFear Avoidance Beliefs and physical function in elderly individuals with chronic low back pain This analysis assessed how fear avoidance beliefs (FABs) affected subjective and objective functional parameters as well as pain in elderly individuals. The study comprised 152 elderly patients with low back pain, which was attributed to spondylosis in almost half of the cases. Their average age was 70.1 years (SD=4.3, range 65–84). All of the patients participated in a physiotherapeutic program including data acquisition before treatment (t1), immediately after its completion (t2), and 6 months later (t3). FABs were assessed by a five-item scale with satisfying psychometric properties. The primary outcome criterion was function, which was evaluated as a subjective measure using the Hannover functional disability scale and as an objective measure based on the anteflexion determined by ultrasound topometry. Secondary outcome criteria were pain parameters. At the time o the first measurement (t1), the patients were classified into three groups with strong, intermediate, or weak FABs. Analyses of variance reveal an improvement of subjective functional capacity in every FAB group between t1 and t2. At t3, there is a decline of these values only in the group of the high fear avoiders. High fear avoiders also show lower values in the objective measure at all three measurement points. No influence of the FABs on the pain parameters could be determined. It would be expected that the efficacy of physiotherapy could be improved if the patients’ FABs are taken into consideration when planning the treatment regimen.

Graded Exposure for Chronic Low Back Pain in Older Adults: A Pilot Study.

Background and Purpose: Fear-avoidance beliefs in older adults with chronic low back pain (CLBP) can lead to disability. Graded exposure-based active physical therapy could be an option to enhance physical ability in older patients with CLBP. The purpose of this study was to develop a standardized graded exposure treatment according to the fear-avoidance model of musculoskeletal pain for older patients with CLBP and to examine its effectiveness and feasibility in the German health care system. Methods: The study represents a phase I/phase II trial of a complex intervention. Taking a first step into the hierarchy of growing empirical evidence, a prospective 1-factor observational study was conducted with repeated measurements 1 week before and within 2 weeks after the intervention. Three physical therapists, who completed an introductory workshop, provided the treatment in the form of individual therapies. Sixteen participants 65 years or older with CLBP and perceived physical limitations were recruited. Four patient-reported outcome measures and semistructured interviews were conducted. The primary outcome was physical ability measured with the Hanover Functional Ability Questionnaire. Secondary outcomes were the numerical pain rating scale, and an age-specific and adapted 11-item short-form of the Patient Anxiety Symptom Scale, the KVS-D 65+, which quantified catastrophizing and avoidance beliefs. Fear of falling was measured with the Falls Efficacy Scale-International. For the analysis, Wilcoxon signed-rank test for paired samples and an &agr; level of .05 were chosen. For the qualitative evaluation, semistructured interviews were conducted with the patients and physical therapists explored indicators of feasibility such as demands, acceptability, satisfaction, adaptation needs, and implementation. For content analysis, codes were primarily derived deductively and complemented by inductively derived new themes. Results: A significant increase in physical ability after the treatment was observed with an effect size (ES) of 0.95 (P = .008). With regard to secondary outcomes, there was a statistically significant decrease in pain intensity (P = .029) and a reduction in catastrophizing (ES = 0.91; P = .021) and avoidance beliefs (ES = 1.37; P = .001). The interviews revealed good acceptance and satisfaction of the treatment by the patients and physical therapists. Conclusion: On the whole, the treatment appears effective and feasible. Apart from the benefits achieved by the participants, the study provides a basis for designing future studies at a higher level of evidence.

Graded Activity for Older Adults with Chronic Low Back Pain: Program Development and Mixed Methods Feasibility Cohort Study

BACKGROUND Persistent pain is highly prevalent in older adults and can lead to functional limitations in activities of daily living, and to psychosocial distress. There is a lack of established active therapy programs, especially for older adults with chronic pain. OBJECTIVES To develop a graded activity program and to evaluate its feasibility within a pilot study. DESIGN Phase I/phase II trial of a complex intervention. A mixed methods design was chosen to evaluate the feasibility, acceptability, and preliminary evidence of effectiveness. SUBJECTS AND SETTING Several experts participated in the program development. Sixteen community-dwelling older adults (73.9 ± 5.9 years on average) with chronic low back pain and three primary care physical therapists attempted the program. METHODS Guided semi-structured interviews were conducted with all patients and therapists and used a content-analytic approach. Measurements of self-rated functional status (HFAQ), average pain (NRS), falls self-efficacy (FES-I), and catastrophizing and avoidance beliefs (CAS-D 65+) were applied at baseline and after the intervention. RESULTS The interviews revealed high acceptance, satisfaction, and practicality. Besides improvements in function and pain, patients mentioned more positive attitudes towards pain, activity, and self-confidence. There was a clinically relevant increase in physical function by 20.3%, a decrease in pain intensity, and a reduction in catastrophizing and avoidance behavior. CONCLUSION This graded activity program demonstrated feasibility and high acceptance in aged individuals and therapists. Future studies with larger samples must confirm effectiveness. The principles also appear applicable to other chronic pain conditions. The program could easily be implemented in routine primary care.