Fear Avoidance Beliefs in Upper-Extremity Musculoskeletal Pain Conditions: Secondary Analysis of a Prospective Clinical Study on Digital Care Programs

Dora Janela; Fabíola Costa; Maria Molinos; Robert G Moulder; Jorge Lains; Justin K Scheer; Virgílio Bento; Vijay Yanamadala; Steven P Cohen; Fernando Dias Correia

doi:10.1093/pm/pnac149

Fear Avoidance Beliefs in Upper-Extremity Musculoskeletal Pain Conditions: Secondary Analysis of a Prospective Clinical Study on Digital Care Programs

Pain Med. 2023 Apr 3;24(4):451-460. doi: 10.1093/pm/pnac149.

Authors

Dora Janela¹, Fabíola Costa¹, Maria Molinos¹, Robert G Moulder², Jorge Lains^{3

4}, Justin K Scheer⁵, Virgílio Bento¹, Vijay Yanamadala^{1

6

7}, Steven P Cohen^{8

9}, Fernando Dias Correia^{1

10}

Affiliations

¹ SWORD Health, Inc, Draper, Utah, USA.
² Institute for Cognitive Science, University of Colorado Boulder, Boulder, Colorado, USA.
³ PM&R, Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal.
⁴ PM&R, Faculty of Medicine, Coimbra University, Coimbra, Portugal.
⁵ Department of Neurological Surgery, University of California, San Francisco, California, USA.
⁶ Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, Connecticut, USA.
⁷ Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, Connecticut, USA.
⁸ Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
⁹ Departments of Anesthesiology and Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
¹⁰ Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.

Abstract

Background: Fear-avoidance beliefs (FAB) have been associated with poorer prognosis and decreased adherence to exercise-based treatments in musculoskeletal (MSK) pain. However, the impact of high FAB on adherence and outcomes in upper extremity MSK (UEMSK) pain is poorly explored, particularly through exercise-based digital care programs (DCP).

Objective: Assess the adherence levels, clinical outcomes and satisfaction in patients with UEMSK pain and elevated FAB after a fully remote multimodal DCP. Associations between FABQ-PA and clinical outcomes were conducted.

Methods: Secondary analysis of an ongoing clinical trial. Participants with UEMSK pain (shoulder, elbow, and wrist/hand) and elevated FAB-physical activity (FABQ-PA ≥ 15) were included. Adherence (completion rate, sessions/week, total exercise time) and mean change in clinical outcomes-disability (QuickDASH), numerical pain score, FABQ-PA, anxiety (GAD-7), and depression (PHQ-9)-between baseline and end-of-program were assessed. Associations between FABQ-PA and clinical outcomes were conducted.

Results: 520 participants were included, with mean baseline FABQ-PA of 18.02 (SD 2.77). Patients performed on average 29.3 exercise sessions (2.8 sessions/week), totalizing 338.2 exercise minutes. Mean satisfaction was 8.5/10 (SD 1.7). Significant improvements were observed in all clinical outcomes. Higher baseline FAB were associated with higher baseline disability (P < .001), and smaller improvements in disability (P < .001) and pain (P = .001). Higher engagement was associated with greater improvements in FABQ-PA (P = .043) and pain (P = 0.009).

Conclusions: This study provides evidence of the potential benefits of a structured and multimodal home-based DCP in the management of UEMSK pain conditions in patients with elevated FAB in a real-world context.

Keywords: Digital Therapeutic; Ehealth; Musculoskeletal Conditions; Physical Therapy; Telerehabilitation.

MeSH terms

Disability Evaluation
Extremities
Fear
Humans
Low Back Pain* / therapy
Musculoskeletal Pain* / therapy
Prospective Studies
Surveys and Questionnaires

Supplementary concepts

Acrophobia