Observed outcomes associated with a quota-based exercise approach on measures of kinesiophobia in patients with chronic low back pain

Abstract

Study design: Prospective series of consecutive cases.

Objectives: To observe if kinesiophobia was altered through an education- and quota-based exercise physical therapy program, and to observe the relationship of kinesiophobia with other measures related to chronic low back pain.

Background: The role of kinesiophobia in worsening the chronic low back pain predicament has been documented in numerous studies. However, less is known of the effect of an exerciseonly-based physical therapy program's ability to alter kinesiophobia and improve functional abilities in patients with chronic low back pain.

Methods: Eighty-two patients with at least 3 months of low back pain, and a moderate level of disability (Oswestry score greater than or equal to 20) were willing to participate in this study. Sixty-eight of these patients completed treatment. For 68 compliant patients, females comprised 56%, the mean age was 43 years, the mean duration of symptoms was 28 months, and the primary anatomic diagnosis was disc degeneration (70%). Patients underwent a course of non-pain-contingent, quota-based physical therapy to address impairments in flexibility, strength, and lifting capacity. These were quantified prior to and following treatment using validated methods. Before and after treatment, patients completed the Fear-Avoidance Beliefs Questionnaire (FABQ), Tampa Scale of Kinesiophobia (TSK) Questionnaire, Oswestry Disability Index (ODI) Questionnaire, and a 0-to-10 visual analog scale for back and lower extremity pain. A 12-month follow-up was conducted using mailed questionnaires.

Results: The mean number of physical therapy visits was 14. Clinically and statistically significant (P<.001) improvement in flexibility, strength, and lifting ability were observed. Statistically significant (P<.001) improvement in back pain, disability, and measures of kinesiophobia were also noted at discharge and maintained at 12-month follow-up. At discharge, Oswestry scores correlated with TSK (r = .59, P<.001), FABQ-Activities (r = .55, P<.001), and FABQ-Work (r = .50, P<.001) scores.

Conclusion: In this study we observed that kinesiophobia decreased during an intensive physical therapy program in which exercises were performed in a quota-based manner. Following the successful performance of non-pain-contingent, quota-based exercise, patients' fears of injury lessened, and this may have had a positive influence on disability.