1. • the prevalence of pain related fear in patients with chronic
MEASUREMENT OF PAIN-RELATED FEAR IN PATIENTS WITH CHRONIC LOW BACK PAIN: CAN IT BE DONE IN A SIMPLE MANNER? Prof. Rob Oostendorp, PhD, PT 1,2, Nancy Demolon,MSc, PT2, Olaf VanderZanden, MSc, PT2, Prof. William Duquet, PhD2
INTRODUCTION
Three objectives:
• the prevalence of pain
related fear in patients with chronic
low back pain (CLBP) in a physical
therapy private practice setting;
• the differences in
characteristics of subjects with a
high versus low score on the Tampa Kinesiophobia Scale (TKS);
• which question(s)
have prognostic value for
classifying patients with CLBP in a
high versus low TKS score
category.
METHODS
• Patients with LBP (> 6 weeks)
• Questionnaires:
■ patients’ characteristics
(e.g., age, gender, education,
duration of LBP, medication)
■ pain intensity (Visual Analogue
Scale [VAS score range 0-100])
■ pain-related fear with regard to
injury and movement (Tampa
Kinesiophobia Scale [TKS
score range 17-68])
■ depression (Beck Depression
Inventory [BDI score range 0-63])
■ pain coping behaviour (Pain
Coping Inventory list [PCI]; six
subscales)
■ activities of daily living (Oswestry Low Back Pain Disability Questionnaire [OLBPDQ score range 0 – 100%])
RESULTS
• Fifty patients with CLBP participated. The TKS total score varied between 23 and 57. The median score (38.5) was chosen as cut-off point for a high (>38.5; n=24) versus a low (<38.5; n=26) score on the TKS.
• Use of medication, stopping of activities/hobbies due to LBP, worrying/catastrophizing, use of rest, depression and passive coping strategies were significantly higher (p≤0.05) in subjects with a high TKS score.
• The ‘agree’ option for the statement ‘the safest way to prevent an increase in pain is prevention of unnecessary movements’ (TKS statement 10) had the greatest predictive value (92%) for identifying subjects with a high TKS score (22 out of 24 patients).
CONCLUSIONS
• Pain-related fear of injury and movement is common in patients with LBP in primary care.
• Patients with a high or a low TKS score have significantly different characteristics.
• The ‘agree’ option for TKS statement 10 is a good prognostic indicator of a TKS score higher than the median score (high score category.
CLINICAL IMPLICATION
It is possible to measure pain-related fear in a simple manner in daily practice of physiotherapy. It is important to recognize pain-related fear in patients with LBP because the best available evidence for physiotherapeutic treatment for these patients is exercise therapy combined with cognitive behavioural principles exposing patients to pain-related activities.
• Assessment of Pain Related Fear
• Fear Hierarchy
• Photograh Series of Daily
Activities
KEYWORDS
low back pain, pain-related fear, physiotherapy, graded exposure
KEYREFERENCE
Vlaeyen JWS et al. The treatment of fear of movement/(re)injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo. Clin J Pain 2002;18(4):251-61
1Radboud University Nijmegen Medical Centre, Research Centre of Allied Health Sciences, Nijmegen, The Netherlands
2Free University of Brussels, Faculty of Medicine and Pharmacology, Department of Manual Therapy, Brussels, Belgium
Contact: Prof. R.A.B. Oostendorp;