Gait dual-task cost in individuals with chronic low back pain and high avoidance or catastrophizing

Gait is a complex motor skill requiring high-level cognitive resources such as attention. Chronic low back pain (cLBP) is associated with attention impairments that may impact gait. Fear-avoidance and pain catastrophizing in cLBP may additionally contribute to attention impairments that affect gait.

Forty-five participants with cLBP (age 37.0±11.5 (21-59), 64% female) completed a gait task with and without a concurrent auditory information processing choice reaction time task (IP-CRT). Dual-task cost (DTC) was computed for gait and cognitive performance metrics. Participants also completed the Fear-Avoidance Beliefs Questionnaire-Physical Activity subscale (FABQ-PA), the Pain Catastrophizing Scale (PCS), and the Numeric Pain Rating Scale (NPRS).

PCS was positively associated with DTC for step length (r=0.32, p=0.04), and NPRS was positively associated with DTC for harmonic ratio (anterior-posterior direction) as a measure of symmetry (r=0.41, p<0.01). Higher NPRS scores were associated with reduced step length during single- (r=-0.37, p=0.02) and dual-task (r=-0.35, p=0.02), higher stance time variability during single- (r=0.36, p=0.02) and dual-task (r=0.35, p=0.02), lower harmonic ratio (vertical direction) during dual-task (r=-0.31, p=0.049), and slower reaction time during dual-task (r=0.41, p<0.01).

Individuals with high pain catastrophizing or high pain severity may alter step length and gait symmetry differently than their peers in response to increased cognitive loading. Pain severity, but not pain-related psychological factors, appears to be related to gait and cognitive performance, emphasizing the importance of reducing pain burden. Results support the continued study of intersections between pain, attention, and pain-related psychological burden in cLBP.