The Fear Avoidance Model Disentangled: Improving the Clinical Utility of the Fear Avoidance Model
The Fear Avoidance Model Disentangled: Improving the Clinical Utility of the Fear Avoidance Model
Background: The model of fear avoidance proposes that fear of movement in back pain patients is an obstacle to recovery and leads over time to increased disability. Therefore, fear of movement should be targeted explicitly by interventions.Aims: To review the evidence (1) for the causal components proposed by the model, and (2) about interventions that attempt to reduce fear of movement. In addition, we aim to propose alternatives and extensions to the current model in order to increase the clinical utility of the model.Methods: A collaborative narrative review.Results: The fear avoidance model needs to be conceptually expanded and further tested to provide adequate and appropriate clinical utility. Currently, although there is experimental support for the model, observational studies in patients show contradictory results. Interventions based on the model have not delivered convincing results, only partly due to methodological shortcomings. Some assumptions inherent in the current model need adjusting, and other factors should be incorporated to indicate subgroupings within patients high in avoidance behavior. In addition, both theoretical and methodological limitations were identified in measurements of fear and avoidance.Conclusions: Future research should elucidate whether the proposed subgrouping of patients with avoidance behavior is helpful. Further research should focus on developing more accurate and psychometrically sound assessment tools as well as targeted interventions to improve activities and participation of patients with chronic disabling musculoskeletal pain disorders.
fear avoidance, subgrouping, pain, LOW-BACK-PAIN, EXPOSURE IN-VIVO, CHRONIC MUSCULOSKELETAL PAIN, RANDOMIZED CONTROLLED-TRIAL, PROGNOSTIC-FACTORS, RISK FACTOR, FOLLOW-UP, BASE-LINE, DISABILITY, KINESIOPHOBIA
739-746
Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c
Smeets, Rob J. E. M.
1fbd0303-bb5d-4928-80f5-d125d7fc866e
Simmonds, Maureen J.
4cba605a-3ca2-4387-a62d-aadd6f1e3c93
Sullivan, Michael J. L.
95dd5292-bf32-4289-84d5-1dda53d94754
2010
Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c
Smeets, Rob J. E. M.
1fbd0303-bb5d-4928-80f5-d125d7fc866e
Simmonds, Maureen J.
4cba605a-3ca2-4387-a62d-aadd6f1e3c93
Sullivan, Michael J. L.
95dd5292-bf32-4289-84d5-1dda53d94754
Pincus, Tamar, Smeets, Rob J. E. M., Simmonds, Maureen J. and Sullivan, Michael J. L.
(2010)
The Fear Avoidance Model Disentangled: Improving the Clinical Utility of the Fear Avoidance Model.
Clinical Journal of Pain, 26 (9), .
(doi:10.1097/AJP.0b013e3181f15d45).
Abstract
Background: The model of fear avoidance proposes that fear of movement in back pain patients is an obstacle to recovery and leads over time to increased disability. Therefore, fear of movement should be targeted explicitly by interventions.Aims: To review the evidence (1) for the causal components proposed by the model, and (2) about interventions that attempt to reduce fear of movement. In addition, we aim to propose alternatives and extensions to the current model in order to increase the clinical utility of the model.Methods: A collaborative narrative review.Results: The fear avoidance model needs to be conceptually expanded and further tested to provide adequate and appropriate clinical utility. Currently, although there is experimental support for the model, observational studies in patients show contradictory results. Interventions based on the model have not delivered convincing results, only partly due to methodological shortcomings. Some assumptions inherent in the current model need adjusting, and other factors should be incorporated to indicate subgroupings within patients high in avoidance behavior. In addition, both theoretical and methodological limitations were identified in measurements of fear and avoidance.Conclusions: Future research should elucidate whether the proposed subgrouping of patients with avoidance behavior is helpful. Further research should focus on developing more accurate and psychometrically sound assessment tools as well as targeted interventions to improve activities and participation of patients with chronic disabling musculoskeletal pain disorders.
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Published date: 2010
Keywords:
fear avoidance, subgrouping, pain, LOW-BACK-PAIN, EXPOSURE IN-VIVO, CHRONIC MUSCULOSKELETAL PAIN, RANDOMIZED CONTROLLED-TRIAL, PROGNOSTIC-FACTORS, RISK FACTOR, FOLLOW-UP, BASE-LINE, DISABILITY, KINESIOPHOBIA
Identifiers
Local EPrints ID: 469361
URI: http://eprints.soton.ac.uk/id/eprint/469361
ISSN: 0749-8047
PURE UUID: d21ded0e-6285-4914-bc67-7f77e98232d1
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Date deposited: 13 Sep 2022 16:58
Last modified: 17 Mar 2024 04:11
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Contributors
Author:
Tamar Pincus
Author:
Rob J. E. M. Smeets
Author:
Maureen J. Simmonds
Author:
Michael J. L. Sullivan
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