Fear-Avoidance Beliefs for Physical Activity Among Chronic Low Back Pain: A Multicenter Cross-Sectional Study

Abstract

Background

Among different psychological predictors of outcome in low back pain (LBP) adults, the negative influence of fear-avoidance beliefs in physical activity is an area of research attention. However, there is a lack of evidence on the burden of fear avoidance about physical activity among chronic LBP adults in Ethiopia.

Objective

To describe fear-avoidance beliefs about physical activity and explore its association with socio-demographic and clinical factors among low back pain patients attending physiotherapy treatment in 3 Amhara regional comprehensive hospitals.

Methods

A multi-center cross-sectional study was conducted and adults with chronic LBP (n = 263) participated. Data were collected by face-to-face interview using the modified Fear-Avoidance Belief Questionnaire about Physical Activity (mFABQ-PA) tool. Multivariable logistic regression at a p-value <0.05 significance level was used to identify predictors of fear-avoidance beliefs about physical activity.

Results

Among the 263 participants, 113 subjects (43%, 95% CI (36.9–49.0)) reported a higher cut-off (>15) mFABQ-PA. The logistic regression model demonstrated that LBP adults with a higher mFABQ-PA score were more likely to be urban residents (AOR 2.75, 95% CI (1.32, 5.88)), and ADL-related LBP (AOR 1.97 95% CI (1.18, 3.29)). The clinical-specific factor indicative of a higher cut-off score of mFABQ-PA was using analgesic medications (AOR 2.00, 95% CI (1.19, 3.37)). The model fit was 0.21 and 0.11 (R² = Nagelkerke’s, Cox & snell respectively).

Conclusion

High fear avoidance beliefs about physical activity in adults with low back pain were found and associated with residence, work, and medication intake. These findings might urge the researchers to explore further associations and assist clinicians in choosing subgroups to use behavioral therapy and graded exposure to physical activity.

Keywords:

• avoidance behavior
• fear-avoidance beliefs
• low back pain
• physical activity

Abbreviations

BMI, body mass index; AOR, adjusted odds ratio; CI, confidence interval; CLBP, chronic low back pain; COR, crude odds ratio; ETB, Ethiopian birr; mFABQ-PA, Modified fear-avoidance belief for physical activity; LBP, low back pain; OR, odds ratio; SD, standard deviation; PA, physical activity; SPSS, Statistical package for social sciences.

Data Sharing Statement

The datasets generated and/or analyzed during the current study are not publicly available due to privacy issues. However, data will be available upon reasonable request from the corresponding author.

Ethical Approval and Consent to Participate

This study was approved by the Institutional Review Committee of the College of Medicine and Health Sciences, the University of Gondar, Ethiopia (Ref. No. 453/2021). Official letters from the administrators of the University of Gondar and Bahir Dar specialized hospitals were obtained before contacting study participants. The purposes and the importance of the study have been clarified to each participant. They were also told that until they gave their formal approval, they were free to refuse to participate or answer any of the questions. To ensure data confidentiality at all levels of the study, the names of participants and any personal identifiers were not included.

Acknowledgment

The authors would like to thank the University of Gondar and Bahir Dar specialized hospital coordinators and staff members. Our thanks also go to the data collectors and the study participants.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, data, analysis and interpretation. MY, YA, SFD and TK trained the data collectors, supervised data collection, and approved completed questionnaires. All the authors took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was fully funded by the University of Gondar, scientific research grant number (19/453/13 CMHS, UOG) after defending the study proposal. The funder has no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.