A prospective study predicting the outcome of chronic low back pain and physical therapy: the role of fear-avoidance beliefs and extraspinal pain

Feitosa, Aloma S.A.; Lopes, Jaqueline Barros; Bonfa, Eloisa; Halpern, Ari S.R.

doi:10.1016/j.rbre.2016.03.002

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Revista Brasileira de Reumatologia

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Original articles • Rev. Bras. Reumatol. 56 (5) • Sep-Oct 2016 • https://doi.org/10.1016/j.rbre.2016.03.002 copy

A prospective study predicting the outcome of chronic low back pain and physical therapy: the role of fear-avoidance beliefs and extraspinal pain

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify the prognostic factors for conventional physical therapy in patients with chronic low back pain (CLBP).

Methods:

Prospective observational study.

Participants:

One hundred thirteen patients with CLBP selected at the Spinal Disease Outpatient Clinic.

Main outcome measures:

Pain intensity was scored using the Numeric Rating Scale (NRS), and function was measured using the Roland-Morris Disability Questionnaire (RMDQ).

Results:

The Fear-Avoidance Beliefs Questionnaire work subscale results (FABQ-work; odds ratio [OR] = 0.27, 95% confidence interval [CI] 0.13–0.56, p < 0.001) and extraspinal pain (OR = 0.35, 95% CI 0.17–0.74, p = 0.006) were independently associated with a decreased response to conventional physical therapy for CLBP.

Conclusion:

We identified high FABQ-work and extraspinal pain scores as key determinants of a worse response to physical therapy among CLBP patients, supporting the need for a special rehabilitation program for this subgroup.

Keywords
Fear-avoidance beliefs; Extraspinal pain; Therapeutic response; Chronic low back pain

Variables	All (n = 113)
Age, years	53.0 (12.2)^a a Data are expressed as the mean (standard deviation).
Female, n (%)	81 (71.7)
BMI, kg/m²	27.9 (5.1)^a a Data are expressed as the mean (standard deviation).
Smoking, n (%)	16 (14.2)
Pain below the knee, n (%)	73 (64.6)
Physical activity, n (%)	90 (79.6)
Irritability, n (%)	13 (11.5)
Depression, n (%)	83 (73.5)
Catastrophic thinking, n (%)	35 (31.0)
FABQ-physical, n (%)	13 (11.5)
FABQ-work, n (%)	46 (36.3)
Extraspinal pain, n (%)	35 (31.0)

	NRS			RMDQ
	Nonresponse	Response	p	Nonresponse	Response	p
First, n (%)	29 (26)	84 (74)	0.03	23 (20)	90 (80)	0.87
Second, n (%)	44 (39)	69 (61)	0.03	24 (21)	89 (79)	0.87

	NRS				p	RMDQ				p
	First		Second			First		Second
	Non-responder	Responder	Non-responder	Responder		Non-responder	Responder	Non-responder	Responder
	n = 29	n = 84	n = 44	n = 69		n = 23	n = 90	n = 24	n = 89
Age, years^a a Data are expressed as the mean (standard deviation).	53.9 (13.9)	52.7 (11.6)	53.3 (12.3)	52.8 (12.2)	0.71	53.5 (11.6)	52.8 (12.4)	54.1 (10.0)	52.7 (12.7)	0.65
Female	20 (68.9)	61 (72.6)	33 (75)	48 (69.5)	0.81	15 (65.2)	66 (66.7)	17 (70.8)	64 (71.9)	0.61
BMI, kg/m² ^a a Data are expressed as the mean (standard deviation).	27.0 (5.0)	28.3 (5.1)	28.0 (5.5)	27.9 (4.8)	0.62	26.9 (5.3)	28.2 (5.0)	28.1 (5.9)	27.9 (4.8)	0.60
Smoking	5 (17.2)	11 (13.1)	7 (15.9)	9 (13)	0.58	5 (21.7)	11 (12.2)	4 (16.7)	12 (13.5)	0.36
Pain below the knee	20 (69.0)	53 (63.1)	33 (75.0)	40 (58.0)	0.13	17 (73.9)	56 (62.2)	17 (70.8)	56 (62.9)	0.30
Physical activity	21 (72.4)	69 (82.1)	34 (77.3)	56 (81.2)	0.37	18 (78.3)	72 (80.0)	19 (79.2)	71 (79.8)	0.88
Irritability	6 (20.6)	7 (8.3)	7 (15.9)	6 (8.7)	0.09	3 (13.0)	10 (11.1)	4 (16.7)	9 (10.1)	0.50
Depression	22 (75.9)	61 (72.6)	34 (77.3)	49 (71.0)	0.51	19 (82.6)	64 (71.1)	19 (79.2)	64 (71.9)	0.29
Catastrophic thinking	10 (34.5)	25 (29.8)	17 (38.6)	18 (26.1)	0.25	11 (47.8)	24 (26.7)	9 (37.5)	26 (29.2)	0.12
FABQ-physical	3 (10.3)	10 (11.9)	7 (15.9)	6 (8.7)	0.52	3 (13.0)	10 (11.1)	4 (16.7)	9 (10.1)	0.47
FABQ-work	16 (55.2)	25 (29.8)	26 (59.1)	15 (21.7)	<0.001	10 (43.5)	31 (34.4)	13 (54.2)	28 (31.5)	0.09
Extraspinal pain	14 (48.3)	21 (25.0)	21 (47.7)	14 (20.3)	0.002	12 (52.2)	23 (25.6)	9 (37.5)	26 (29.2)	0.06

Variable	OR	(CI 95%)	p
Evaluation time
First	1.00
Second	0.49	(0.30–078)	0.003

FABQ-work
No	1.00
Yes	0.27	(0.13–0.56)	<0.001

Extraspinal pain
No	1.00
Yes	0.35	(0.17–0.74)	0.006

	NRS				RMDQ
	Bivariate		Multivariate		Bivariate		Multivariate
	Estimate (SE)	p	Estimate (SE)	p	Estimate (SE)	p	Estimate (SE)	p
Age, years	0.19 (0.27)	0.499			0.2 (0.22)	0.365
Female	−7.9 (7.35)	0.282			−1.95 (5.94)	0.743
BMI, kg/m²	0.03 (0.66)	0.964			0.21 (0.53)	0.700
Smoking	3.15 (9.53)	0.741			−2.63 (7.68)	0.732
Pain below the knee	−10.44 (6.89)	0.130			−8.33 (5.55)	0.133
Physical activity	4.15 (8.25)	0.615			7.18 (6.62)	0.278
Irritability	−11.54 (10.37)	0.266			−12.68 (8.31)	0.127
Depression	−8.48 (7.49)	0.257			−13.56 (5.93)	0.022
Catastrophic thinking	−6.04 (7.17)	0.400			−7.84 (5.75)	0.173
FABQ-physical	0.56 (10.43)	0.958			−2.97 (8.39)	0.723
FABQ-work	−17.33 (6.72)	0.010	−13.8 (6.53)	0.035	−13.5 (5.42)	0.013	−10.66 (5.27)	0.043
Extraspinal pain	−23.92 (6.83)	<0.001	−21.47 (6.79)	0.002	−19.16 (5.5)	<0.001	−17.26 (5.48)	0.002

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[1] *Corresponding author. ariradu@einstein.br