Kinesiophobia, Pain, Muscle Functions, and Functional Performances among Older Persons with Low Back Pain

Hindawi Pain Research and Treatment Volume 2017, Article ID 3489617, 10 pages https://doi.org/10.1155/2017/3489617 Research Article Kinesiophobia, Pain, Muscle Functions, and Functional Performances among Older Persons with Low Back Pain Nor Azizah Ishak, Zarina Zahari, and Maria Justine Centre for Physiotherapy, Faculty of Health Sciences, Universiti Teknologi MARA, 42300 Bandar Puncak Alam, Selangor, Malaysia Correspondence should be addressed to Maria Justine; Received 17 October 2016; Revised 9 April 2017; Accepted 30 April 2017; Published 29 May 2017 Academic Editor: Donald A. Simone Copyright © 2017 Nor Azizah Ishak et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. This study aims (1) to determine the association between kinesiophobia and pain, muscle functions, and functional performances and (2) to determine whether kinesiophobia predicts pain, muscle functions, and functional performance among older persons with low back pain (LBP). Methods. This is a correlational study, involving 63 institutionalized older persons (age = 70.98 ± 7.90 years) diagnosed with LBP. Anthropometric characteristics (BMI) and functional performances (lower limb function, balance and mobility, and hand grip strength) were measured. Muscle strength (abdominal and back muscle strength) was assessed using the Baseline Mechanical Push/Pull Dynamometer, while muscle control (transverse abdominus and multifidus) was measured by using the Pressure Biofeedback Unit. The pain intensity and the level of kinesiophobia were measured using Numerical Rating Scale and Tampa Scale of Kinesiophobia, respectively. Data were analyzed using Pearson’s correlation coefficients and multivariate linear regressions. Results. No significant correlations were found between kinesiophobia and pain and muscle functions (all 𝑝 > 0.05). Kinesiophobia was significantly correlated with mobility and balance (𝑝 = 0.038, 𝑟 = 0.263). Regressions analysis showed that kinesiophobia was a significant predictor of mobility and balance (𝑝 = 0.038). Conclusion. We can conclude that kinesiophobia predicted mobility and balance in older persons with LBP. Kinesiophobia should be continuously assessed in clinical settings to recognize the obstacles that may affect patient’s compliance towards a rehabilitation program in older persons with LBP. 1. Introduction Kinesiophobia or “fear of movement” was originally defined as a state where an individual experiences excessive, irrational, and debilitating fear of physical movement and activity as a result of a feeling of susceptibility to painful injury or reinjury [1]. In clinical settings, fear was recognized as an important aspect in patients’ disability, which needs to be addressed to accomplish a successful outcome as it influences the rehabilitation strategies [2, 3]. Based on the fearavoidance model [4], when pain is perceived as threatening, pain catastrophizing occurs, which may develop pain related fear and anxiety, in turn leading to avoidance behaviour. Avoidance behaviour is a state where an individual withdraws from performing activities such as leisure, work, and socializing, which are associated with high levels of pain, which may aggravate the painful experience. Subsequently, avoidance behaviour as an adaptation to pain in the long term would develop disuse, disability, and depression [5]. Kinesiophobia had been widely assessed in various conditions including Parkinson’s disease, fibromyalgia, spinal stenosis, and low back pain (LBP) [6–9]. LBP is relatively common in older persons, and previous studies had suggested that LBP may lead to difficulty or inability in performing functional tasks in older persons, which further causes reduced mobility and balance [10–12]. Mobility is critical for older persons in maintaining their functional independence, in which those with poor mobility have higher rates of morbidity and mortality and poor quality of life [13–15]. In patients with LBP, several movements had been recognized as common to alleviate pain in the lower back such as lumbar flexion, extension, and rotation [16]. When certain movements alleviate pain, this will elicit fear and the individual tends to avoid these movements [17]. 2 Pain Research and Treatment Low back pain Body structures and function (impairment) (1) Physical (i) Muscle function (muscle strength and control) (2) Psychological: fear of movement or reinjury (kinesiophobia) and experience of pain Activities (1) Functional performances (i) Sitting (ii) Standing (iii) Walking Participation (i) Socializing with friends (ii) Leisure activities Figure 1: Theoretical framework based on the International Classification of Functioning, Disability and Health (ICF). Avoiding painful movements of the lumbar joints for a long time may reduce the activity of the back and abdominal muscles, thereby decreasing their strength and control especially in those with LBP. Suri et al. [18] highlighted that impairments of lumbar muscles may potentially lead to persistent LBP and impact functional limitations or physical performance. In older persons, the progressive deterioration of the musculoskeletal systems combined with deconditioning syndrome due to LBP would affect the strength of the lower back muscles [19]. A high level of kinesiophobia, potentially, may further reduce the muscle functions in older persons with LBP. Additionally, it is well known that functional limitations in older persons are partly due to normal aging processes [19–21], for instance, impairment during walking, squatting, climbing up and down the stairs, and performing sitting to standing actions. In addition, the presence of kinesiophobia in older persons with LBP may further deteriorate their overall functional performances such as sitting to standing actions, walking, and getting out of bed, which later affect their quality of life. Kinesiophobia leads to worsening of functional ability in older persons due to avoidance of physical activity, which in turn leads to reduced mobility and persistent pain [8]. A previous study had investigated the association between kinesiophobia and functional outcomes. In young adults, pain and movement related fear were the strongest predictors of functional performances [22]. In contrast, Vincent et al. [23] argued that fear of movement was not significantly correlated with functional measures among obese older persons with LBP. However, Vincent et al.’s study evaluated the functional measures using only SF-36 physical score, which was subjectively measured and may not be the best measure to represent the actual performances. In brief, there is no clear evidence of the influence of kinesiophobia on functional performances among older persons with LBP. Studies had shown that older persons with LBP demonstrated high lev (...truncated)