Article

This study examines the relationship between low back pain, disability
and fatigue and overt physical activity with respect to fear-avoidance and
endurance-related subgroups. METHOD: 49 patients completed questionnaires (Pain,
Disability, Fatigue, Depression, Pain-responses pattern) 6 months after lumbar
disc surgery and underwent an 8-hour accelerometer assessment measuring overall
physical activity (PAL), constant strain postures (CSP), standing time (ST) and
lying time (LT). Four subgroups, representing patterns of distress-endurance
(DER), eustress-endurance (EER), fear-avoidance (FAR) and adaptive responses (AR)
due to the avoidance-endurance model of pain-regulation were investigated.
RESULTS: Multivariate analyses of covariance revealed significantly higher pain,
disability and fatigue in FAR compared to AR patients and, as expected lower PAL
and CSP in FAR than in endurance patients. Both endurance groups revealed higher
pain accompanied by higher accelerometer-based physical activity (PAL, CSP) than
AR and FAR patients. Most of the subgroup differences displayed moderate to high
effect sizes. CONCLUSIONS: The results indicate different pathways to chronic
pain and disability with physical underuse in FAR patients and overuse/overload
in endurance patients suggesting the need for individually targeted
cognitive-behavioral treatments in the maladaptive groups. Implications for
Rehabilitation Improving the return to a normal physical activity level is an
important goal for the rehabilitation of patients after lumbar disc surgery.
Different pathways to chronic pain and disability with physical underuse in
fear-avoidance patients and overuse in endurance patients should be considered.
Different pain-related pain response pattern, based on the avoidance-endurance
model, indicate the need for individual targeting of rehabilitation programs.

Langue : ANGLAIS