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Updated: Sep 15, 2025
Investigating Pain-Related Avoidance Behavior using a Robotic Arm-Reaching Paradigm
Published on: October 3, 2020
Associations Between Fear-Avoidance or Pain Catastrophizing and Gait Quality in Chronic Low Back Pain: A
Anna H Bailes1, Gina P McKernan2, Mark S Redfern3
1Department of Bioengineering, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15213, United States.
Importance:
Chronic low back pain (cLBP) is associated with reduced gait speed and other gait quality impairments. Fear-avoidance and pain catastrophizing impact movement in cLBP, but their specific impact on gait quality is unknown.
Objective:
This study aimed to determine associations between fear-avoidance or pain catastrophizing and gait quality in cLBP.
Design:
This was a cross-sectional study.
Setting:
This study occurred at a university.
Participants:
There were 500 individuals (56.6 [SD = 16.5] years old; 311 female) with cLBP.
Interventions:
Participants completed the Fear-Avoidance Beliefs Questionnaire - Physical Activity (FABQ-PA) and 6-item Pain Catastrophizing Scale. Participants were divided into high and low fear-avoidance subgroups based on an established FABQ-PA cutoff (>14).
Main Outcomes And Measures:
Gait speed was measured during a 4-meter walk test, while step time average, step time variability, and symmetry were derived from a lumbar inertial measurement unit worn during a 2-minute walk test. Multiple linear regression models were used to determine relationships between fear-avoidance or pain catastrophizing and gait quality. T tests were used to determine gait quality differences between high versus low fear-avoidance subgroups.
Results:
High fear-avoidance was associated with reduced gait speed (B = -0.0039), but pain catastrophizing was not. The high fear-avoidance subgroup had slower gait speed (mean difference = 0.05 m/s), longer step time (mean difference = 0.02 s), and higher step time variability (mean difference = 0.004 s) compared to the low fear-avoidance subgroup.
Conclusions:
Fear-avoidance is associated with slower gait speeds, even after adjusting for demographics, pain, and disability. The established FABQ-PA cutoff is robust in detecting gait differences between high versus low fear-avoidance subgroups.
Relevance:
It may be important to consider fear-avoidance in the delivery of multi-modal interventions to address gait impairments. Future studies are needed to determine the impact of addressing fear-avoidance alongside traditional gait interventions in cLBP.
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