Relationship between fear avoidance beliefs and burnout syndrome in patients with lumbar disc herniation (original) (raw)
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European Spine Journal, 2007
The central role of fear of pain and consequent avoidance behaviour has gained increasing acceptance as a cognitive-behavioural pain dimension of utmost importance in relation to back pain [9, 12, 16, 18,. This concept, which was introduced by Lethem in 1983 , proposes that avoidance behaviour results in an exaggerated pain perception . Several studies have mean-while highlighted the effect of fear avoidance of physical activities and work on low-back pain and related disability [10, 13, 17, 19,. Patients who believe that physical activity and work may be harmful tend to avoid these expectedly painful activities, with the consequence that the inappropriate avoidance behaviour is reinforced .
Turkish neurosurgery, 2012
The aim of this study is to investigate the relationship between fear and avoidance beliefs with the disability of patients with chronic low back pain and the prediction of quality of life. 105 outpatients with chronic low back pain were included in the study. Patients were evaluated with a sociodemographic questionnaire Visual Analog Scale Roland Morris Disability Questionnaire Beck anxiety inventory Beck depression inventory, Somatosensory Amplification Scale Fear and avoidance beliefs questionaire and Short form-36 health survey questionnaire. As pain intensity increased, FABQ increased. Higher levels of anxiety, depression, FABQ (work) leads to higher level of disability. The disability predictors were found to be pain intensity and level of anxiety. When levels of pain intensity, level of anxiety and depression, FABQ increased, physical function decreased. Pain intensity and FABQ (physical) were found to be the predictors of quality of life. Findings of our study were compatibl...
Frontiers in Psychology
IntroductionLumbar disc herniation (LDH) is one of the most common conditions associated with functional disability, affecting patients’ quality of life (QOL). Disability can be affected by cognitive factors, such as pain catastrophizing. Similarly, unfulfilled basic psychological needs (i.e., autonomy, competence, relatedness) are associated with biases in pain perception and QOL. Using the fear-avoidance model and the self-determination theory, this study investigates: (1) the separate contribution of pain-related variables and basic psychological needs satisfaction in predicting QOL in patients proposed for LDH surgery; (2) pre- and post-surgical differences in pain catastrophizing and basic psychological needs satisfaction.MethodsFirst, we used hierarchical regression on 193 patients (Mage = 46.10, SDage = 11.40) to identify predictors of QOL. Second, we performed paired t-tests on 55 patients to investigate pre- and post-surgical differences in pain catastrophizing and basic ps...
Disability and Rehabilitation, 2010
Purpose. The primary aim of this study was to analyse the predictive value of cognitive and behavioural factors, in relation to pain, disability and quality of life (QoL) one year after lumbar disc surgery. Method. The study design was prospective. Fifty-nine patients scheduled for first time lumbar disc surgery were included. Pain, disability, QoL, coping, fear avoidance beliefs, expected outcome and sick leave were assessed preoperatively and 12 months after surgery. Multiple backward stepwise logistic regression analyses were performed to study the contribution of the preoperatively measured independent behavioural/cognitive factors (coping, fear avoidance beliefs and assessed chance to return to work within 3 months) to the dependent variables pain, disability and quality of life at 12 months after surgery. Results. Low expectations on work return within 3 months after surgery was significantly predictive for residual leg pain, odds ratio (OR) ¼ 8.2, back pain, OR ¼ 9.7, disability, OR ¼ 13.8 and sick leave, OR ¼ 19.5. Low QoL, was best predicted by preoperatively high scores on fear avoidance beliefs OR ¼ 6.6 and being a woman OR ¼ 6.0. The regression model explained 26-40% of the variance in pain, disability, QoL and sick leave. Conclusions. Eliciting patients' expectations on work return after surgery could contribute to early identification of those who run the risk of developing long-term disability and sick-leave.
Prevalence of fear-avoidance belief in patients with neck and back pain seeking physiotherapy
International Journal of Endorsing Health Science Research (IJEHSR), 2021
Background: Fear-avoidance beliefs and signs specifically non-organics are considered the psychological factors that have been determined in playing a major role in the advancement of prolonged disability. The current study was directed to explore the prevalence of fear-avoidance belief in patients with neck and back pain seeking physiotherapy and identifying the superior level of fear-avoidance beliefs regarding work or bodily performances which causes chronicity and disability in patients. Methodology: An observational study was conducted at the Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences, Ojha Campus, Karachi-Pakistan, from 1st Dec 2019 to 29th Feb 2020. Standard Fear Avoidance Belief Questionnaire (FAB-Q) was used to assess the fear level. The queries determined from the questionnaire were distributed into two types; FABQ-work-related and FABQ-physical activity-related. Results: A total of 100 patients were included in the study, with a me...
Journal of Public Health
Aim This study aimed to determine the predictors of fear-avoidance beliefs, pain, and disability indices in patients with chronic low back pain (LBP). Subjects and Methods A cross-sectional study was carried out on patients with chronic LBP attending the rheumatology outpatient clinics at Suez Canal University Hospital. Convenience sampling was used, and the main outcome measures were fear-avoidance beliefs, pain, and disability indices, which were measured using structured questionnaires. Results Mean age was 47 ± 13.4 years; mean body mass index (BMI) was 30.4 ± 5.47. Mean scores of the fear-avoidance belief questionnaire (
Acute Pain, 2007
Returning to work after disc surgery appears to be more heavily influenced by psychological aspects of work than by MR-identified morphological alterations. It is still not known whether psychosocial factors of importance for outcome after disc surgery are present preoperatively or develop in the postoperative phase. The aim of this study was to investigate the presence of work-related stress, life satisfaction and demanding life events, among patients undergoing first-time surgery for lumbar disc herniation in comparison with patients scheduled for arthroscopic knee surgery. Sixty-nine patients with disc herniation and 162 patients awaiting arthroscopy were included in the study, during the time period March 2003 to May 2005. Sixty-two percent of the disc patients had been on sick leave for an average of 7.8 months and 14 percent of the knee patients had been on sick leave for an average of 4.2 months. The psychosocial factors were investigated preoperatively using a questionnaire, which was a combination of the questionnaire of quality of work competence (QWC), life satisfaction (LiSat9) and life events as a modification of the social readjustment scale. There were no significant differences between the two groups in terms of work-related stress or the occurrence of demanding life events. The disc patients were significantly less satisfied with functions highly interrelated to pain and discomfort, such as present work situation, leisure-time, activities of daily living (ADL) function and sleep. Patients with disc herniation on sick leave were significantly less satisfied with their present work situation than knee patients on sick leave; this subgroup of patients with disc herniation also reported significantly higher expectations in relation to future job satisfaction than knee patients. The results indicate that psychosocial stress is not more pronounced preoperatively in this selected group of disc patients, without co-morbidity waiting for firsttime disc surgery, than among knee patients awaiting arthroscopy. It was notable that the disc patients had high expectations in terms of improved job satisfaction after treatment by surgery.
A longitudinal study on the predictive validity of the fear–avoidance model in low back pain
Pain, 2005
Recently, fear-avoidance models have been quite influential in understanding the transition from acute to chronic low back pain (LBP). Not only has pain-related fear been found to be associated with disability and increased pain severity, but also treatment focused at reducing pain-related fear has shown to successfully reduce disability levels. In spite of these developments, there is still a lack in well-designed prospective studies examining the role of pain-related fear in acute back pain. The aim of the current study was to prospectively test the assumption that pain-related fear in acute stages successfully predicts future disability. Subjects were primary care acute LBP patients consulting because of a new episode of LBP (%3 weeks). They completed questionnaires on background variables, fear-avoidance model variables and LBP outcome (Graded Chronic Pain Scale, GCPS) at baseline, 3, 6, and 12 months follow-up and at the end of the study. Twohundred and twenty-two acute LBP patients were included, of whom 174 provided full follow-up information (78.4%). A backward ordinal regression analysis showed previous LBP history and pain intensity to be the most important predictors of end of study GCPS. Of the fearavoidance model variables, only negative affect added to this model. Our results do not really support the longitudinal validity of the fearavoidance model, but they do feed the discussion on the role of pain-related fear in early stages of LBP. q 2005 Published by Elsevier B.V. on behalf of International Association for the Study of Pain.
The Spine Journal, 2011
BACKGROUND CONTEXT: For patients with low back pain, fear-avoidance beliefs (FABs) represent cognitions and emotions that underpin concerns and fears about the potential for physical activities to produce pain and further harm to the spine. Excessive FABs result in heightened disability and are an obstacle for recovery from acute, subacute, and chronic low back pain. PURPOSE: This article summarizes past research concerning the etiology, impact, and assessment of FABs; reviews the results and relevance to clinical practice of trials that have addressed FAB as part of low back pain treatment; and lists areas in need of further study. STUDY DESIGN: This article reports on a plenary presentation and discussion of an expert panel and workshop entitled ''Addressing fear-avoidance beliefs in a fear-avoidant world-translating research into clinical practice'' that was held at Forum X, Primary Care Research on Low Back Pain, during June 2009, at the Harvard School of Public Health in Boston, MA, USA. METHODS: Important issues including the definition, etiology, impact, and treatment of FAB on low back pain outcomes were reviewed by six panelists with extensive experience in FAB-related research. This was followed by a group discussion among 40 attendees. Conclusion and recommendations were extracted by the workshop panelist and summarized in this article. RESULTS: Fear-avoidance beliefs are derived from both emotionally based fears of pain and injury and information-based beliefs about the soundness of the spine, causes of spine degeneration, and importance of pain. Excessively elevated FABs, both in patients and treating health care providers, have a negative impact on low back pain outcomes as they delay recovery and heighten disability. Fear-avoidance beliefs may be best understood when patients are categorized into subgroups of misinformed avoiders, learned pain avoiders, and affective avoiders as these categories elucidate potential treatment strategies. These include FAB-reducing information for misinformed avoiders, pain desensitizing treatments for pain avoiders, and fear desensitization along with counseling to address the negative cognition in affective avoiders. Although mixed results have been noted, most clinical trials have documented improved outcomes when FAB is addressed as part of treatment. Deficiencies in knowledge about brief methods for assessing FAB during clinical encounters, the importance of medical explanations for back pain, usefulness of subgroup FABs, core points for information-based treatments, and efficient strategies for transferring FAB-reducing information to patients hamper the translation of FAB research into clinical practice.
The Spine Journal, 2014
BACKGROUND CONTEXT: Psychological factors including fear avoidance beliefs are believed to influence the development of chronic low back pain (LBP). PURPOSE: The purpose of this study was to determine the prognostic importance of fear avoidance beliefs as assessed by the Fear Avoidance Beliefs Questionnaire (FABQ) and the Tampa Scale of Kinesiophobia for clinically relevant outcomes in patients with nonspecific LBP. DESIGN/SETTING: The design of this study was a systematic review. METHODS: In October 2011, the following databases were searched: BIOSIS, CINAHL, Cochrane Library, Embase, OTSeeker, PeDRO, PsycInfo, PubMed/Medline, Scopus, and Web of Science. To ensure the completeness of the search, a hand search and a search of bibliographies was conducted and all relevant references included. A total of 2,031 references were retrieved, leaving 566 references after the removal of duplicates. For 53 references, the full-text was assessed and, finally, 21 studies were included in the analysis. RESULTS: The most convincing evidence was found supporting fear avoidance beliefs to be a prognostic factor for work-related outcomes in patients with subacute LBP (ie, 4 weeks-3 months of LBP). Four cohort studies, conducted by disability insurance companies in the United States, Canada, and Belgium, included 258 to 1,068 patients mostly with nonspecific LBP. These researchers found an increased risk for work-related outcomes (not returning to work, sick days) with elevated FABQ scores. The odds ratio (OR) ranged from 1.05 (95% confidence interval [CI] 1.02-1.09) to 4.64 (95% CI, 1.57-13.71). The highest OR was found when applying a high cutoff for FABQ Work subscale scores. This may indicate that the use of cutoff values increases the likelihood of positive findings. This issue requires further study. Fear avoidance beliefs in very acute LBP (!2 weeks) and chronic LBP (O3 months) was mostly not predictive. CONCLUSIONS: Evidence suggests that fear avoidance beliefs are prognostic for poor outcome in subacute LBP, and thus early treatment, including interventions to reduce fear avoidance beliefs, may avoid delayed recovery and chronicity. Ó