I can gradually become more active, despite the pain: The relationship between fear avoidance beliefs, depression, self-efficacy, and physical activity among people with back pain


Background: Back pain is a highly prevalent health condition responsible for considerable suffering across the world, high healthcare costs and increasing numbers of disability (Heidari et al., 2016). There is growing evidence for the idea that in back pain patients, pain-related fear of movement and depression may be more important barriers for activity than pain itself (Broda et al., 2015). Research on modifiable factors like self-efficacy, that may buffer the negative effect of fear avoidance beliefs, is needed. Methods: N=93 people with back pain participated in a longitudinal internet-based study and provided data on fear avoidance beliefs (Pfingsten, 2000), depression (Kohlmann et al., 2006), self-efficacy (Mangels et al., 2009), and physical activity (Fuchs et al., 2015). Mean age was 35.58 (SD=13.44, Range=18-69), 56.7% of the participants were female. Data analysis was done with correlation and multiple regression analysis in SPSS 24. Age, gender and frequency of physiotherapy treatment were used as control variables. Results: The model explained 36.3% of the variance. Baseline activity (ß=.53, p=.002) predicted physical activity 4 weeks later. In contrast to our hypothesis, neither self-efficacy (ß=-.15, p=.424) nor fear avoidance beliefs (ß=-.21, p=.176), nor depression (ß=.-.02, p=.912) were related to physical activity after 4 weeks. The relationship between fear avoidance beliefs physical activity was not moderated by self-efficacy (ß=.17, p=.244). Discussion: The role of fear avoidance beliefs, depression and pain-related self-efficacy have yet to be tested in a bigger sample with more frequent follow ups.