Fear-avoidance beliefs are associated with changes of back shape and function

Psychosocial function in people with chronic low back pain (cLBP) is often impaired, indicating poor well-being. Fear-avoidance beliefs (FAB) are common concomitants of cLBP. Fear-avoidance beliefs are gaining attention as a potential prognostic factor for chronification and resulting disability in cLBP. This article aims to examine the associations of back function with FAB.

This study presents data from a cohort study (DRKS00027907). In the present cross-sectional analyses, we included 914 participants (480 nonchronic LBP [ncLBP], 227 cLBP, 207 asymptomatic). Fear-avoidance beliefs were assessed using the fear-avoidance belief questionnaire (FABQ). The association between the FAB and clinical measures (Ott and Schober test, the sit-to-stand test [STS], and the finger-floor distance [FFD]) were analyzed. Back shape and function were also measured using a noninvasive device. The association between FABQ scores and clinical measures was assessed using age, body mass index, sex, and pain intensity-adjusted multiple linear regression models.

Associations between FAB and both clinical (Ott, Schober, STS, FFD) and noninvasive device measures were small. All relevant clinical measures were attenuated in individuals with elevated FAB.

We were able to demonstrate the association of both back shape and function in both clinical tests and noninvasive device measurements with self-reported fear-avoidance beliefs. However, the effect sizes were small. This may be attributed to the different assessment methods (objective vs self-report), resulting in reduced common method variance. In addition to the FAB, there may be other factors (eg, altered neuronal pathways; actual avoidance behavior such as reduced physical activity) that contribute to functional impairment.