The Relationship Between Fear-Avoidance Beliefs, Disability, and Physical Capacity in Patients with Chronic Low Back Pain

OBJECTIVE: The objective of this study was to document the multi-dimensional profile of patients referring with chronic low back pain (CLBP) and determine the relationship among fear-avoidance belief and disability and physical capacity in the Pakistani population. METHODS: A cross-sectional survey was conducted at the Physiotherapy Department of the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences. Consecutive sampling was used among the population of CLBP, and objective measures were fear-avoidance beliefs (FABQ-total) and Roland Morris questionnaire (RMDQ) and pain. Each participant performed a physical capacity test, which included a 6-minute walk test (6MWT), abdominal muscular endurance (AME), hand grip strength (HGS), and Functional reach test (FRT). RESULT: Of the 136 participants, 70(51.5%) were males. The mean and SD of the tests performed were: 6MWT (487.97±51.46), AME (9.31±4.68), FRT (35.14±2.79), HGS (33.31±14.55), VAS (5.51±1.27), RMDQ (18.25±2.17), FABQ-total (48.18±5.31). Multivariate regression revealed that symptom duration, FRT, AME, HGS, VAS, RMDQ were all found to be associated with fear-avoidance belief, accounting for 60% (adjusted R(2) = 0.60) of variability. Likewise, only 6-MWT, FRT, FABQ-total were the significant predictors of disability (adjusted R(2)=0.282). CONCLUSION: It has been demonstrated that sub-maximal exercise capacity, strength, endurance, pain and flexibility are the contributing factors for the change in disability and fear-avoidance beliefs among the individuals with CLBP. The findings of this study could have inference for increasing productivity both at individual and organizational levels by formulating effective strategies to manage CLBP.