Dissertations / Theses on the topic 'Fear avoidance belief of pain'

Dissertação de Mestrado em Fisioterapia, área de especialização em Condições Músculo-Esqueléticas
A dor crónica lombar, é uma condição de saúde cuja prevalência tem aumentado nas últimas décadas. É uma condição que pode ser bastante incapacitante para o indivíduo e por consequência, ter importante impacto social e económico na sociedade. É um fenómeno complexo, multifactorial e pouco estudado na população portuguesa. Objectivo: Estudar a associação entre a catastrofização da dor, crenças de medo evitamento da dor, intensidade da dor e a incapacidade funcional auto reportada em indivíduos com dor crónica lombar. Metodologia: Estudo observacional analítico de corte transversal, com uma amostra de 38 indivíduos com dor crónica lombar, seleccionados a partir de uma população de 186 trabalhadores de uma unidade local de saúde. A recolha de dados foi realizada através de 4 instrumentos de avaliação: Questionário de caracterização e levantamento de factores de risco e impacto associados à dor crónica lombar; Questionário de incapacidade de Roland e Morris; Escala de catastrofização da dor; e Questionário de crenças de medo evitamento da dor. A análise dos dados foi feita através de estatística descritiva pela distribuição de frequências e medidas de tendência central para análise da prevalência e caracterização da amostra e por estatística inferencial para estudar as relações entre variáveis através do teste de correlação não paramétrico de Spearman. Resultados: A variável catastrofização da dor obteve um valor de correlação com a incapacidade auto-reportada de rs=0,473, para p<0,01; a variável crença de medo evitamento da dor relacionada com o trabalho obteve um valor de correlação com a incapacidade auto-reportada de rs=0,462 para p<0,01, a percepção da intensidade actual de dor e a intensidade percepcionada no ano anterior, obtiveram valores de correlação com a incapacidade auto-reportada de rs=0,327 e rs= 0,359 respectivamente para valor de p<0,05. Conclusão: As variáveis psicossociais catastrofização da dor e crença de medo evitamento da dor relacionada com o trabalho, influenciam de forma moderada a incapacidade em indivíduos com dor crónica lombar. A associação entre a intensidade da dor e a incapacidade parece ter um papel menos importante demonstrando associações baixas.
Abstract: Chronic low back pain is a health condition whose prevalence has increased in recent decades. It is a condition that can be quite disabling for the individual and therefore have important social and economic impact on society. It is a complex phenomenon, multifactorial and poorly studied in the Portuguese population. Objective: To study the association between pain catastrophizing, fear avoidance beliefs, pain, pain intensity and self-reported functional disability in individuals with chronic low back pain. Methods: Observational analytical cross sectional study of a sample of 38 individuals with chronic low back pain, selected from a population of 186 workers at a local health unit. Data collection was performed through four assessment instruments: questionnaire characterization, evaluation of risk factors and impact associated to chronic low back pain, questionnaire Roland and Morris disability, pain catastrophizing scale and fear avoidance beliefs questionnaire. Data analysis was performed using descriptive statistics for the distribution of frequencies and measures of central tendency to analyze the prevalence and characteristics of the sample and inferential statistics to study the relationships between variables by testing for Spearman nonparametric correlation. Results: The pain catastrophizing variable had a correlation value rs= 0,473, p<0,01 with the self-reported disability, the variable of fear avoidance belief of pain related to the work achived a correlation value with the self-reported disability, rs = 0.462 p <0.01, current pain intensity and in the previous year obtained values of correlation with self-reported disability rs = 0.327 and rs = 0.359 respectively for values of p <0.05 .Conclusion: The psychosocial variables of pain catastrophizing and fear avoidance belief of pain related to the work had a moderate association with disability in individuals with chronic low back pain. The association between pain intensity and disability seems to have a less important role demonstrating low associations.

RESUMO: A dor crónica lombar, é uma condição de saúde cuja prevalência tem aumentado nas últimas décadas. É uma condição que pode ser bastante incapacitante para o indivíduo e por consequência, ter importante impacto social e económico na sociedade. É um fenómeno complexo, multifactorial e pouco estudado na população portuguesa. Objectivo: Estudar a associação entre a catastrofização da dor, crenças de medo evitamento da dor, intensidade da dor e a incapacidade funcional auto reportada em indivíduos com dor crónica lombar. Metodologia: Estudo observacional analítico de corte transversal, com uma amostra de 38 indivíduos com dor crónica lombar, seleccionados a partir de uma população de 186 trabalhadores de uma unidade local de saúde. A recolha de dados foi realizada através de 4 instrumentos de avaliação: Questionário de caracterização e levantamento de factores de risco e impacto associados à dor crónica lombar; Questionário de incapacidade de Roland e Morris; Escala de catastrofização da dor; e Questionário de crenças de medo evitamento da dor. A análise dos dados foi feita através de estatística descritiva pela distribuição de frequências e medidas de tendência central para análise da prevalência e caracterização da amostra e por estatística inferencial para estudar as relações entre variáveis através do teste de correlação não paramétrico de Spearman. Resultados: A variável catastrofização da dor obteve um valor de correlação com a incapacidade auto-reportada de rs=0,473, para p<0,01; a variável crença de medo evitamento da dor relacionada com o trabalho obteve um valor de correlação com a incapacidade auto-reportada de rs=0,462 para p<0,01, a percepção da intensidade actual de dor e a intensidade percepcionada no ano anterior, obtiveram valores de correlação com a incapacidade auto-reportada de rs=0,327 e rs= 0,359 respectivamente para valor de p<0,05. Conclusão: As variáveis psicossociais catastrofização da dor e crença de medo evitamento da dor relacionada com o trabalho, influenciam de forma moderada a incapacidade em indivíduos com dor crónica lombar. A associação entre a intensidade da dor e a incapacidade parece ter um papel menos importante demonstrando associações baixas.--------------------------ABSTRACT: Chronic low back pain is a health condition whose prevalence has increased in recent decades. It is a condition that can be quite disabling for the individual and therefore have important social and economic impact on society. It is a complex phenomenon, multifactorial and poorly studied in the Portuguese population. Objective: To study the association between pain catastrophizing, fear avoidance beliefs, pain, pain intensity and self-reported functional disability in individuals with chronic low back pain. Methods: Observational analytical cross sectional study of a sample of 38 individuals with chronic low back pain, selected from a population of 186 workers at a local health unit. Data collection was performed through four assessment instruments: questionnaire characterization, evaluation of risk factors and impact associated to chronic low back pain, questionnaire Roland and Morris disability, pain catastrophizing scale and fear avoidance beliefs questionnaire. Data analysis was performed using descriptive statistics for the distribution of frequencies and measures of central tendency to analyze the prevalence and characteristics of the sample and inferential statistics to study the relationships between variables by testing for Spearman nonparametric correlation. Results: The pain catastrophizing variable had a correlation value rs= 0,473, p<0,01 with the self-reported disability, the variable of fear avoidance belief of pain related to the work achived a correlation value with the self-reported disability, rs = 0.462 p <0.01, current pain intensity and in the previous year obtained values of correlation with self-reported disability rs = 0.327 and rs = 0.359 respectively for values of p <0.05 .Conclusion: The psychosocial variables of pain catastrophizing and fear avoidance belief of pain related to the work had a moderate association with disability in individuals with chronic low back pain. The association between pain intensity and disability seems to have a less important role demonstrating low associations.

RESUMO: O absentismo à actividade profissional devido à condição de Dor Lombar apresenta-se como um problema de saúde pública com elevados custos económicos nas sociedades ocidentais. É estimado que cerca de 20% a 47% dos utentes com Dor Lombar não retornam à sua actividade profissional no período de 3 meses, sendo responsáveis por 75% a 90% de todos os custos e baixas médicas associadas à condição. Objectivo: O objectivo deste estudo foi analisar a capacidade de retorno à actividade profissional em utentes com Dor Crónica Lombar (DCL), que procuraram a Fisioterapia em situação de agudização dos seus sintomas, e averiguar a sua relação com os níveis de Incapacidade auto-reportados. Secundariamente pretendemos avaliar a influência das Crenças de medo-evitamento, nos níveis de Incapacidade auto-reportados. Metodologia: Foi efectuado um estudo correlacional prospectivo no qual se observou uma amostra de 56 utentes com DCL que tivessem apresentado novos episódios de agudização dos seus sintomas. Após 3 meses de follow-up (n=42) foi avaliado o “regresso ao trabalho em boas condições” e a sua relação com os níveis de Incapacidade iniciais, bem como o contributo das Crenças de medo-evitamento para essa Incapacidade funcional. Resultados: Foi verificada uma correlação negativa entre os níveis de Incapacidade funcional e o Sucesso no “regresso ao trabalho em boas condições” (ρ = -0.369; p =0.016), sendo que os scores mais elevados da Incapacidade correspondem à Falha nesse regresso. Verificámos também uma correlação positiva entre a existência das Crenças de medo-evitamento relativas ao Trabalho e a Incapacidade (r =0.511; p =0,001), apresentando estas Crenças um valor preditivo (β= 0.533; p =0.001) na Incapacidade auto-reportada. Conclusões: A capacidade de retorno à actividade profissional nos utentes com DCL, após um novo episódio de agudização dos seus sintomas, está relacionada com níveis de Incapacidade funcional. Os factores psicossociais, nomeadamente as Crenças de medo-evitamento relativas ao Trabalho apresentam um valor preditivo para essa Incapacidade auto-reportada.------------------------------ABSTRACT:Work-absenteeism due to the condition of Low Back Pain (LBP) presents itself as a public health problem with high economic costs in Western societies. It is estimated that 20% to 47% of patients with LBP not returned to their work-activity in period of 3 months, accounting for 75% to 90% of all medical costs and sickness compensation associated. Objective: The aim of the present study was to assess the ability to return to work on patients with chronic LBP, who searched for physical therapy in a situation of worsening of their symptoms, and examine their relationship with levels of self-reported disability. Secondly we intend to evaluate the influence of fear-avoidance beliefs to the levels of self-reported disability. Methods: We conducted a prospective cross-sectional study in which we observed 56 patients chronic LBP with new episodes of exacerbation of their symptoms. After a 3 months follow-up (n = 42) we evaluated the “return to work in good health” and its relationship with initial levels of disability and the contribution of fear-avoidance beliefs for that disability. Results: There was a negative correlation between levels of disability and “return to work in good health” success (ρ = -0.369, p = 0.016), with the highest scores correspond to the failure in the work-return. We also found a positive correlation between the existence of fear-avoidance beliefs for work and disability (r = 0.511; p = 0.001), with a predictive value of these fear-avoidance beliefs (β = 0.533; p = 0.001) in self-reported disability. Conclusions: The ability to return to work in chronic LBP patients, after a new episode of exacerbation of symptoms is related to the levels of functional disability. Psychosocial factors, including fear-avoidance beliefs for work showed a predictive value for the self-reported disability.

Pain catastrophizing emerges in the literature as one of the most important psychological determinants of both pain itself and the negative outcomes commonly associated with it. However, despite decades of research confirming the impact of catastrophizing, there are still areas that remain unexplored or in which the surface has only been scratched. The overall aim of this dissertation was to expand existing knowledge about catastrophizing and to advance the theoretical framework around the concept. The role of catastrophizing was explored in three distinct areas: during pain in childbirth, in exposure treatment for back pain patients, and in a problem solving context. The findings from the three studies confirmed the vital role of catastrophizing in these areas. Firstly, catastrophizing played a critical role in pain in childbirth; women who catastrophized reported labor pain as more intense and the subsequent recovery period as longer than women who did not catastrophize. Secondly, catastrophizing was identified as a moderator of treatment effect in exposure in vivo for back pain patients with pain-related fear; patients who catastrophized were not helped by the exposure. Thirdly, catastrophizing played a role in a problem solving context; although this is in line with contemporary models such as the misdirected problem solving model, the results suggested a somewhat different pathway to this previous model. Taken together, these findings underscore the instrumental role of catastrophizing in diverse areas and imply a need for catastrophzing to be assessed and addressed in clinical contexts. In addition, the findings highlight a need for further development of the theoretical framework around catastrophizing as well as treatment interventions that directly target catastrophizing. Based on these needs, a new model of catastrophizing was proposed – a model of catastrophizing from a process perspective. In this model, the proposed function of catastrophizing is to down-regulate negative affect, as a form of internal avoidance. The model is a complement to existing theoretical models and provides a framework for developing treatment interventions that directly target catastrophizing, for example by problem solving skills training. Successful interventions for people who catastrophize would lead to several gains – for the individual in less suffering and increased ability to handle pain problems, and for society as a whole in reduced costs for health care for these individuals.

Persistent pain and disability are commonly associated with musculoskeletal injury and can result in considerable personal suffering and societal burden. The Fear Avoidance Model provides a theoretical account of how pain-related disability develops, and has inspired a large body of research that aims to mitigate the negative consequences of musculoskeletal injury. While The Fear Avoidance Model is currently the leading theory of pain-related disability, there are several theoretical and empirical aspects of the model that have yet to be fully addressed; this manuscript-based thesis aims to explore these aspects. This thesis consists of five chapters: a general introduction, three empirical studies, and a general discussion. The general introduction provides a broad theoretical context for the three empirical studies. The studies included in this thesis aim to address two empirical gaps in the literature; the studies evaluate specific prospective relationships proposed by the Fear Avoidance Model, and assess alternate relationships among model-relevant variables. The general discussion provides a detailed exploration of various theoretical assumptions that are made within the Fear Avoidance Model that may help account for the observed findings.
La douleur et l'invalidité persistante sont souvent associées avec des blessures musculo-squelettiques et peuvent entrainer une souffrance personnelle majeure ainsi qu'un fardeau social considérable. Le Modèle Cognitivo-Comportemental de la Peur liée à la douleur (MCCP) donne un compte rendu théorique de la manière dont l'invalidité associée à la douleur se développe et a inspiré une grande partie de la recherche qui vise à atténuer les conséquences de blessures musculo-squelettiques. Tandis que le MCCP est la théorie de premier ordre sur l'invalidité associée à la douleur, plusieurs aspects théoriques et empiriques du modèle n'ont pas encore été pleinement adressés. Cette thèse vise à examiner ces aspects. Cette thèse consiste en cinq chapitres : une introduction générale, trois études empiriques et une conclusion générale. L'introduction présente le cadre théorique pour les trois études empiriques. Les études incluses dans cette thèse visent à combler deux lacunes empiriques ; les études évaluent des relations prospectives spécifiques proposées par le MCCP, et examinent les relations alternatives entre les variables pertinents au modèle. La discussion générale fournit une exploration détaillée de diverses hypothèses théoriques développées dans le MCCP qui peuvent aider à expliquer les résultats des trois études.

Chronic neck pain (CNP) is a common and disabling condition, accounting for substantial healthcare and societal costs. Previous studies have demonstrated that certain cognitive factors are related to levels of adjustment (levels of disability, pain and depression) in chronic pain conditions. However, this association has not been adequately explored in patients with CNP. The aim of study one was to determine the relationship between specific cognitive factors and levels of adjustment in participants with CNP. Furthermore, study two explored whether the relationship between the cognitive factors and levels of adjustment differed between those patients with idiopathic CNP and those with Chronic Whiplash Associated Disorder (CWAD). Finally, study three compared the efficacy of a physiotherapy led intervention, specifically designed to modify cognitive factors to a conventional physiotherapy intervention.Study one: Hierarchical multiple regression analyses were performed. Greater catastrophizing and lower functional self-efficacy beliefs were associated with greater levels of pain and disability. Additionally, lower functional self-efficacy beliefs were also associated with greater levels of depression. Study two: Data were dichotomised into two groups: those with CWAD and those with idiopathic CNP. T-tests were performed to compare differences in the cognitive scores and the same regression analyses as study one were performed for each sub-group. No significant differences existed between the two groups in terms of levels of pain, disability, depression or the cognitive factors. In both groups greater catastrophizing and lower functional self-efficacy beliefs were related to levels of disability. Likewise, lower self-efficacy beliefs were related to levels of depression in those participants with idiopathic CNP and those with CWAD. However, amongst those with idiopathic CNP, greater levels of catastrophizing and lower levels of pain vigilance and awareness were related to greater pain intensity. In contrast, amongst those with CWAD, none of the cognitive measures were significantly related to levels of pain intensity.Study three: Participants were randomly allocated to either a progressive neck exercise programme or an intervention which specifically targeted the modification of cognitive factors. T-tests revealed that treatment targeting cognitive factors resulted in greater improvements in pain and pain-related fear. Moreover, Χ2 tests revealed that a greater proportion of patients made clinically meaningful reductions in pain and disability in the group targeting cognitive factors. This thesis highlights that cognitive factors play an important role in determining levels of adjustment in patients with CNP. Furthermore, treatments designed to specifically target these factors result in superior clinical outcomes when compared to conventional physiotherapy interventions.

Aims This study examines the effects of surgery for chronic low back pain (CLBP) as well as fear avoidance, disability and levels of rated physical activity in patients treated in 2011. An additional aim was to assess patient’s experience of physiotherapy in primary care following the surgery as well the effect of physiotherapy on above mentioned outcome measures. Method A cross-sectional study design was used and a stratified random sample from 189 patients who were treated surgically in a hospital setting. This resulted in a sample of 112 respondents, half of whom where female. Ages ranged between 25-78 years. Questionnaires were sent by mail and data from 79 patients was collected. Non-parametric statistics were used. Outcome measures used were Tampa Scale for Kinesiophobia, Roland Morris Disability Questionnaire and the physical activity scale. Results More than one in four patients reported high levels of kinesiophobia, more than one in three experienced disability and less than a third were physically active. Patients with total disc replacement had better outcome than patients with lumbar fusion. A higher degree of kinesiophobia correlated significantly to experiencing more disability (rs=0.53, p<0.001) and being less physically active (rs=-0.48, p<0.001), and there were significant negative correlations between disability and levels of rated physical activity (rs=-0.37, p<0.001). Rehabilitation in primary care did not affect the results significantly. Conclusions The results of this study hint that the fear avoidance model is relevant in patients treated surgically for chronic low back pain. Physiotherapists and other health care professionals should screen for these beliefs and try to target them. This may assist patients to pursue health promoting activities and activities in daily life.
Syfte och frågeställningar Denna studie undersöker effekterna av kirurgi för kronisk ländryggssmärta liksom kinesiofobi, funktionsnedsättning och skattade fysiska aktivitetsnivåer hos patienter som behandlats under 2011. Ett annat syfte var att utvärdera patienternas upplevelser av sjukgymnastik i primärvård samt effekten av sjukgymnastik på ovannämnda utfallsmått postoperativt. Metod Tvärnsittsstudie med stratifierat randomiserat urval från 189 patienter som behandlats kirurgiskt i sjukhusmiljö. Detta resulterade i 112 respondenter, varav hälften var kvinnor. Åldrarna sträckte sig från 25-78 år. Enkäter från 79 patienter kunde analyseras. Icke-parametrisk statistik användes för analys. De utfallsmått som användes var Tampaskalan för kinsiofobi, Roland Morris funktionsnedsättningsskala och en skala för fysisk aktivitet. Resultat Mer än en fjärdedel av alla patienter rapporterade höga nivåer av kinesiofobi, mer än en tredjedel upplevde funktionsnedsättning och mindre än en tredjedel skattade sig som fysiskt aktiva. Patienter som opererats med diskprotes hade bättre resultat än patienter som opererats med steloperation. En högre grad av kinesiofobi korrelerade signifikant med att uppleva en större funktionsnedsättning (rs=0.53, p<0.001)  och lägre skattad fysisk aktivitet (rs=-0.48, p<0.001). Det fanns även en signifikant negativ correlation mellan funktionsnedsättning och skattad fysisk aktivitet (rs=-0.37, p<0.001). Rehabilitering i primärvård påverka inte resultatet signifikant. Slutsats Resultaten i denna studie pekar mot att rädsla-undvikande-modellen är relevant hos patienter som behandlats kirurgiskt för kronisk ländryggssmärta. Sjukgymnaster och annan häslo- och sjukvårdspersonal bör undersöka om dessa tankar finns hos denna patientgrupp och behandla dem. Detta för att underlätta för patienter att delta i aktiviteter för förbättrad hälsa och aktivitet i dagliga livet.

Bakgrund: Långvarig smärta antas drabba var femte person i Sverige och bland dem är rörelserädsla vanligt. Rörelserädsla är komplext och kan påverka en person biomedicinskt, psykologiskt och socialt, varför fysioterapeuten bör använda ett beteendemedicinskt arbetssätt. Forskning har visat att fysioterapeuter har svårt att identifiera psykosociala faktorer kopplade till rörelserädsla. Syfte: Att studera hur fysioterapeuter beskriver sitt arbete med patienter med rörelserädsla relaterat till långvarig smärta. Metod: En kvalitativ intervjustudie genomfördes. Sju fysioterapeuter från olika typer av verksamheter rekryterades genom ett ändamålsenligt bekvämlighetsurval. Data analyserades manifest med en induktiv ansats. Resultat: Analysen resulterade i fem kategorier med tre till fem underkategorier vardera: “Uppfattning om utmärkande drag och beteenden hos patienter med rörelserädsla”, “Grundförutsättningar för ett framgångsrikt arbete”, “Identifiera och skapa förståelse för patientens rörelserädsla”, “Strategier för att förändra tankar och känslor i samband med rörelse” och “Omständigheter som kan göra arbetet utmanande eller svårt”. Slutsats: Ett biopsykosocialt och beteendemedicinskt arbetssätt beskrevs användas vid arbetet med dessa patienter. Arbetet beskrevs som komplext och utmanande för en fysioterapeut att hantera ensam. Teamarbete, tydliga målsättningar och en god relation mellan parterna uttrycktes vara viktigt för att lyckas.
Background: Chronic pain is assumed to affect every fifth person in Sweden and fear of movement is common. Fear of movement is complex and affects a person biomedically, psychologically and socially, why physiotherapist's should use a behavioral medicine approach. Research has shown that physiotherapist's have difficulty identifying psychosocial factors involved in fear of movement. Aim: To study how physiotherapist's describe their work with patients with fear of movement related to chronic pain. Method: A qualitative interview study was conducted. Seven physiotherapist's were recruited through a purposive convenience sample. Data was analyzed manifestly with an inductive approach. Result: The analysis resulted in five main categories: “Perception of distinguishing features and behaviors in patients with fear of movement”, “Essential prerequisites for successful work”, “Identify and create understanding of the patient's fear of movement”, “Strategies for changing thoughts and emotions related to movement” and “Circumstances that can make the work challenging or difficult”. Conclusion: A biopsychosocial and behavioral medicine approach was described to be used when working with these patients. The work was described as challenging for physiotherapist's to handle alone. Teamwork, clear goal setting and a good patient-therapist relationship were expressed to be important.

Bibliographic record: RYŠAVÁ, Markéta. Health professionals' beliefs concerning the non-specific back pain and their influence on following the recommended therapy procedures. Prague: Charles University, 2nd Faculty of Medicine, Department of Rehabilitation and Sports Medicine, 2021. 138 p., Appendixes, Supervisor of the work: Mgr. Tomáš Kavka Abstract: Nonspecific back pain (nonspecific LBP) is the most common reason for visiting a doctor and it is the leading cause of activity limitation and inability to work by patients. The theoretical part of this thesis describes the issue of LBP and related clinical guidelines. In addition, it summarizes current research results of the influence of health professionals' fear-avoidance beliefs (FA beliefs) on their clinical decision making for LBP patients. The practical part relates to the research of FA beliefs and non-adherence to clinical guidelines regarding care of individuals experiencing LBP among health professionals in the Czech Republic. The degree of FA beliefs was evaluated using a translated and cross-culturally adapted questionnaire "Fear- Avoidance Beliefs Tool", while the degree of non-adherence was evaluated using a self- reported questionnaire in connection to fictitious clinical vignette. A generalized linear model was used for data processing. The...

A self-perpetuating cycle of catastrophizing, pain related fear (PRF), and avoidance following tissue stress or damage has been proposed to underlie the development of chronic pain in some individuals (Vlaeyen, Kole-Snijders, Rotteveel, et al., 1995; Vlaeyen & Linton, 2000). A number of instruments have been designed to measure aspects of PRF and catastrophizing, and research utilizing them has provided support for many aspects of the pain related fear/avoidance cycle (Vlaeyen & Linton, 2000). However, there has been relatively little research on PRF or catastrophizing early in the transition to chronic pain and disability. The current study examined the structure of PRF and catastrophizing early in the course of a low-back pain episode, and the prediction of three-month outcome from those variables. Work disabled individuals with lowback pain completed questionnaires, including measures of PRF (i.e.. Pain Anxiety Symptoms Scale (McCracken, Zayfert & Gross, 1992), Fear Avoidance Beliefs Questionnaire, (Waddell, Newton, Henderson, Somerville & Main, 1993), Tampa Scale of Kinesiophobia (Vlaeyen, Kole- Snijders, Boeren & van Eek, 1995)) and catastrophizing (Pain Catastrophizing Scale (Sullivan, Bishop & Pivik, 1995)), by mail at less than seven weeks post-pain onset and a second set of questionnaires, including measures of pain, perceived disability, depressive symptoms, and return to work at 3 months post-onset. Confirmatory factor analyses indicated that in this sample, all of the instruments except the TSK conformed to the factor structure intended by the scale designers. Structural Equation Modeling provided support for the relationships between pain level, PRF, catastrophizing and avoidance proposed by Vlaeyen and Linton to characterize fear-avoidance cycle. Regression analyses demonstrated that at least some aspects of PRF and/or catastrophizing contributed significantly to the prediction of all aspects of three-month outcome after controlling for demographics and initial pain level. These results provide support for the role of catastrophizing and PRF in the development of chronic pain and for the mechanisms proposed by Vlaeyen and Linton (2000) to underlie that effect, but suggest there may be utility further refinement of PRF measures. Limitations to the study and broader theoretical and clinical implications are discussed.
Arts, Faculty of
Psychology, Department of
Graduate

A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirement for the degree of Master of Science in Physiotherapy Johannesburg, 2017
Background: The cognitive elements of fear avoidance and pain catastrophising in individuals suffering from chronic pain, including chronic low back pain and chronic musculoskeletal conditions, have been found to be significant impediments to recovery. However, little is known about the influence of fear avoidance and pain catastrophising on chronic non-specific neck pain, especially in the context of a South African population. The purpose of this study was to determine the prevalence of fear avoidance and pain catastrophising in patients suffering from chronic neck pain of three or more months’ duration who were attending physiotherapy in private clinics in Johannesburg, South Africa. The objectives of this study were to establish the prevalence of fear avoidance, the prevalence of pain catastrophising, and to establish the association between demographic variables and fear avoidance and pain catastrophising respectively. Methods: In order to fulfil the objectives, a cross-sectional design was used on the basis of the validated Tampa Scale for Kinesiophobia-11 (TSK-11) and the Pain Catastrophising Scale (PCS) questionnaires to determine the prevalence of fear avoidance and pain catastrophising respectively in patients suffering with chronic neck pain. The patients were sampled sequentially from randomly selected private practices in Johannesburg, South Africa, with the particular focus being on musculoskeletal conditions. The demographic data included gender, age, pain intensity, marital status, highest level of education attained, employment status, duration of neck pain, and whether or not the participant had had to reduce his/her work load as a result of the pain experienced. These factors were tested in terms of their association between fear avoidance and pain catastrophising respectively, and of the association between fear avoidance and pain catastrophising itself. A total of 106 participants were interviewed. The data from the questionnaires and the demographic questionnaires were analysed using Statistica, version 12. The results were considered significant when p-values of 0.05 were attained. Results: A total of 106 participants with a mean age of 48.7 years (SD=14.8; range 20-80 years) were drawn sequentially from a randomly selected total of 25 private practices. Female participants constituted 81.1% (n=86) of the total participants and 76.4% had some form of tertiary education. The majority (76.4%) were working and most (79.2%) had not reduced their work load as a result of their pain. Many participants were in a relationship (67.9%) and the pain intensity showed a mean of 4.4 on the VAS (SD=2.2; range 0.3-8.7), with the median pain duration being 96 months (8 years) (IQR=30-180 months) (2.5-15 years); range 3-756 months (0.25-63 years)). The TSK-11–Total showed a mean score of 22.9 and 25.5% of the participants (n=106) presented with significant fear avoidance measured on theTSK-11-Total scale. The prevalence was based on a cut-off equivalent to the midpoint scale. The median score for the PCS-Total was 12. The prevalence of clinically relevant scores for the PCS-Total was 15.1% (n=106) of the population studied, based on a cut-off score of =30. There was a significant, positive correlation between the TSK-Total and the PCS-Total and its subscales; and between the TSK-SF and the PCS-Total and its subscales. Significant association was found between the highest level of education and the TSK-11-Total score. The mean TSK-11 score for those with secondary education (26.0 ± 3.4) was higher than that for patients with a tertiary education (21.9 ± 1.5), indicating that those with a secondary education were more likely to be fear avoidant than those with a tertiary education. There was a significant, positive correlation between pain intensity and the TSK-Total score, and a significant positive correlation between pain intensity and the PCS-Total score. No significant association was found for fear avoidance and pain catastrophising in respect of any of the other demographic variables. Conclusion: This prevalence study established that of the sample of adults attending physiotherapy for chronic non-specific neck pain, 25.5% suffer from fear avoidance and 15.1% suffer from pain catastrophising. An association was found between the total scores for fear avoidance and pain catastrophising. Furthermore, an association was also found between fear avoidance and its subscale, somatic focus, and between pain catastrophising and all its subscales, namely rumination, magnification and helplessness. Yet another positive association was found between secondary education and fear avoidance, and a positive correlation between pain intensity and both fear avoidance and pain catastrophising respectively.
MT2018

This study assessed physical activity levels and subjective measures of fear and avoidance in youth with chronic pain, and examined the effects of graded exposure-based treatment on these relations. Children and adolescents with chronic pain participated in a series of individualized treatment sessions involving a parent, physical therapist and psychologist. The early sessions consisted of psychoeducation and the later sessions consisted of exposure activities in which patients were gradually exposed to activities they had been avoiding due to pain or fear. While in treatment each participant wore an actigraph, a wrist watch used to monitor physical activity, and completed daily diaries in which they reported fear and avoidance ratings. Actigraph data were used to calculate mean and peak activity per minute. Data were examined across treatment phases. Participants in this study were 10 children and adolescents (ranging in age from 8-17) with chronic pain. The study was divided into Baseline, Education and Exposure periods. Treatment ranged from 9 to 15 sessions. Across time, mean and peak activity remained at baseline levels, while avoidance reports decreased over the course of treatment. Curvilinear regression models estimated moderate relationships between physical activity levels and reports of avoidance and pain, with more activity observed at lower and higher (rather than moderate) levels of self-reported avoidance and pain. Linear mixed models did not demonstrate any interactions between physical activity and avoidance, and physical activity and fear, by treatment phase. These findings suggest that the relations between physical activity, pain perception, fear, and activity avoidance in youth with chronic pain is complex and warrants further inquiry.
2018-07-11T00:00:00Z

Low back pain has become one of the most influential musculoskeletal diseases of modern society. It is one of most expensive diseases in terms of medical costs and increased worker absenteeism, which can lead to permanent disability and places strain on the economy as a whole. Pain has been recognised as a disease in itself, which has certain consequences when it becomes chronic. Many kinds of treatment options exist with varying degrees of success. The question is thus which treatment option is the most favourable and cost-effective. Conservative treatment is the most recommended form of treatment when no serious underlying diseases are present. Exercise has been shown to be very effective in the treatment of chronic low back pain but there are still questions regarding the use of exercise therapy. The predetermined goal of the study was to ascertain whether an aggressiveprogressive exercise programme, and specifically what kind of exercises, would be more effective in the treatment of chronic low back pain. This was achieved through a number of steps, which included an extensive literature review, the identification of an appropriate test battery with related minimum physical requirements and cut scores, subject recruitment and screening of subjects, the implementation of the intervention and the subsequent re-testing of the subjects. Once the data was completed, the next step was to make use of two case studies to assist in illustrating the effectiveness of individual patients compared to the sample as a whole. These case studies were of patients who completed the entire programme but one took longer to complete the programme. This assists in illustrating the value of maintaining exercise protocol. The results from the present study are extremely positive. The two case studies provided a glimpse of the potential value that could be added through the implementation of more aggressive-progressive exercise interventions in the treatment of chronic low back pain. The final product will greatly assist exercise therapists concerned with the treatment of chronic low back pain along with cognitive-behavioural techniques. Hopefully this study will provide insight into managing chronic low back pain in South Africa from an exercise standpoint. Secondly the study will provide practical techniques to implement in an era in which economic difficulties are rife.AFRIKAANS: Laerugpyn het een van die invloedrykste muskuloskeletale siektes van die moderne samelewing geword. Dit is een van die duurste siektes in terme van mediese koste en verhoogde siekverlof deur werkers, wat kan lei tot permanente ongeskiktheid en ’n verhoogde las plaas op die ekonomie as ’n geheel. Pyn word erken as ’n siekte op sy eie wat sekere gevolge het wanneer dit chronies begin raak. Verskeie soorte behandelingsopsies is beskikbaar met variërende grade van sukses. Die vraag is dus watter behandelingsopsie is die bruikbaarste en koste-doeltreffendste. Konserwatiewe behandeling is die mees aanbevole metode van behandeling wanneer daar geen ernstige onderliggende siektetoestande teenwoordig is nie. Dit is reeds bewys dat oefening baie doeltreffend is in die behandeling van chroniese laerugpyn. Daar bestaan egter steeds vrae rondom die gebruik van oefening as terapie.Die vooropgestelde doelwit van die studie was om te bepaal of ’n aggressiewe-progressiewe inoefeningsprogram doeltreffend sal wees in die behandeling van chroniese laerugpyn, en meer spesifiek watter tipe oefening die doeltreffendste sal wees. Die navorsing het bestaan uit ’n paar stappe wat ingesluit het ’n intensiewe literatuursoektog, die identifisering van ’n gepaste toetsbattery met verwante minimum fisieke vereistes en afsnytellings, die verkryging en evaluering van proefpersone, die implementering van die intervensieprogram en die daaropvolgende hertoetsing van die proefpersone.Nadat die invordering van die data en die gepaardgaande analise van die data voltooi is, was die volgende stap om gebruik te maak van twee gevallestudies ten einde die doeltreffendheid van die intervensieprogram vir individuele proefpersone te ilustreer deur dit te vergelyk met die groep as ’n geheel. Die twee gevallestudies was van proefpersone wat die intervensieprogram volledig voltooi het, alhoewel die een proefpersoon langer geneem het om die intervensieprogram te voltooi. Dit help om die navolgingswaarde van ’n inoefeningsprotokol te illustreer. Die resultate van die huidige studie is uiters positief. Die twee gevallestudies gee ’n mate van insig wat betref die potensiële waarde wat verkry kan word deur die implementering van ’n meer aggressiewe-progressiewe inoefeningsintervensie vir die behandeling van chroniese lae rugpyn. Die finale produk sal die nodige ondersteuning aan oefeningsterapeute bied wat onseker is oor die behandeling van chroniese laerugpyn deur middel van aggressiewe-progressiewe inoefeningsintervensies en kognitiewe gedragstegnieke. Hierdie studie sal dus die begrip en insig van die behandeling van chroniese laerugpyn in Suid-Afrika verhoog vanuit ’n oefeningsuitgangspunt. Tweedens sal die studie die gebruik van praktiese oefentegnieke aanmoedig in ’n era waarin ekonomiese tye moeilik is.
Thesis (DPhil)--University of Pretoria, 2011.
Biokinetics, Sport and Leisure Sciences
unrestricted

L’invalidité attribuable à la douleur représente un problème important en raison de ses coûts personnels, financiers et sociétaux. L’effort scientifique mène à l’identification des facteurs de risque pour l’évolution de la douleur vers un état qui mine la capacité de la personne affligée à vaquer à ses occupations fondamentales. Cet effort met en relief le rôle déterminant que jouent les facteurs psychosociaux à chaque stade de l’évolution vers l’invalidité en raison de la douleur. Parmi les facteurs mis en cause, se trouvent les difficultés psychologiques (dépression, anxiété, somatisation, trouble de la personnalité, catastrophisme et évitement de l’activité), l’insatisfaction au travail et le contexte de réclamation. Forts de cette connaissance, les pays industrialisés se dotent de lignes directrices pour la prise en charge de la douleur aiguë dans le but de réduire les coûts, tant pour la personne que pour la société. Vingt ans après la parution des premiers guides de pratique, et la publication subséquente de dizaines d’autres guides véhiculant essentiellement les mêmes informations, les médecins peinent toujours à appliquer les recommandations. À partir des données probantes issues de la littérature scientifique, le présent ouvrage propose une synthèse critique des résultats pour pousser la réflexion et faire avancer la démarche dans le sens d’une réduction des coûts personnels, financiers et sociétaux.
Disability due to pain is a significant problem owing to its personal, financial and societal costs. Scientific efforts are aimed towards the identification of the risk factors for the development of pain leading to a state which undermines the afflicted person’s ability to attend to his/her basic functions. These efforts highlight the key role that psycho-social factors play in each stage of the progression towards disability due to pain. Among the influencing factors are psychological difficulties (depression, anxiety, somatization, personality disorder, catastrophization and activity avoidance), dissatisfaction at work and the compensation context. In light of this awareness, industrialized countries have instituted policies for the management of acute pain with the aim of reducing costs, both for the patient and for society. Twenty years after the appearance of the first clinical practice guidelines and the subsequent publication of numerous other guides propounding essentially the same information, physicians are still struggling to apply the recommendations. Relying on the evidence from the scientific literature, this study proposes a critical synthesis of the results to provoke thought and to advance the process towards a reduction in the personal, financial and societal costs of pain.