Department of Sport and Rehabilitation Sciences, University of Liege, ISEPK BAT B21, Sart-Tilman, 4000 Liège, Belgium; Department of Physical Medicine and Rehabilitation, Liège University Hospital, Sart Tilman, 4000 Liège, Belgium.
Spine J. 2013 Sep;13(9):1039-47. doi: 10.1016/j.spinee.2013.02.037. Epub 2013 Apr 24.
BACKGROUND CONTEXT: It has been controversially stated that pain-related fear is a more important determining factor for disability in chronic low back pain (CLBP) than pain or physical impairment in itself. So far, the relationship between psychological and physiological determinants of chronic pain, that is, pain-related fear and physiological abilities, remains unclear. PURPOSE: To evaluate whether pain-related fear assessed by different tools (both task specific and non task specific) is related to physical capacity measured by specific spine tests and, secondarily, to explore the relationship between different pain-related fear assessment tools. STUDY DESIGN/SETTING: Cross-sectional study. PATIENT SAMPLE: Fifty patients with CLBP (50% women; meanage [standard deviationage]: 44.2 [9.5 years]). OUTCOME MEASURES: Physical capacity by means of three specific spine tests, that is, the finger-floor distance test (flexibility), a maximal isometric strength test of trunk extensor muscles (strength), and the Sorensen test (endurance). Pain-related fear by means of self-report measures, that is, the Tampa Scale for Kinesiophobia (TSK), the Photograph Series of Daily Activities (PHODA), and a fear visual analog scale (FVAS) tailored to the spine tests. METHODS: Participants were asked to complete the TSK and PHODA and to perform the three spine tests. Right before performing each of the spine tests, an FVAS was filled out. Linear regression analyses controlling for gender and age were performed to study the association between the pain-related fear measurements and the results of the spine tests. To investigate the relationship between the pain-related fear measurements, correlation tests were performed. RESULTS: The linear regression analyses revealed that neither the TSK and PHODA scores nor the FVAS scores were significantly related to the physical capacity measurements. The correlational tests showed no significant correlation between the PHODA, TSK, and FVAS scores. CONCLUSIONS: The present study shows that neither the task-specific tool (FVAS) nor the non task-specific questionnaires (TSK and PHODA) were significantly correlated to the spine tests in patients with CLBP. This is contrary to earlier evidence according to which physical capacity is inversely related to the level of pain-related fear, and it suggests that one should not draw conclusions about physical capacity based on pain-related fear scores. Furthermore, the different assessment tools for pain-related fear were surprisingly not correlated with each other.
背景：有人颇具争议地指出，在慢性下背痛（CLBP）中，与疼痛或身体损伤本身相比，与疼痛相关的恐惧是导致残疾的更重要决定因素。到目前为止，慢性疼痛的心理和生理决定因素之间的关系，即与疼痛相关的恐惧和生理能力，仍不清楚。
目的：评估通过不同工具（特定任务和非特定任务）评估的与疼痛相关的恐惧是否与特定脊柱测试测量的身体能力相关，其次，探索不同与疼痛相关的恐惧评估工具之间的关系。
研究设计/设置：横断面研究。
患者样本：50 名 CLBP 患者（50%为女性；平均年龄[标准差年龄]：44.2[9.5 岁]）。
测量结果：通过三种特定脊柱测试来衡量身体能力，即手指-地板距离测试（灵活性）、最大躯干伸肌等长力量测试（力量）和 Sorensen 测试（耐力）。通过自我报告措施，即坦帕运动恐惧量表（TSK）、日常活动照片系列（PHODA）和针对脊柱测试定制的恐惧视觉模拟量表（FVAS）来评估与疼痛相关的恐惧。
方法：要求参与者完成 TSK 和 PHODA，并进行三项脊柱测试。在进行每项脊柱测试之前，填写 FVAS。进行线性回归分析，控制性别和年龄，以研究与脊柱测试结果相关的与疼痛相关的恐惧测量值之间的关联。为了研究与疼痛相关的恐惧测量值之间的关系，进行了相关测试。
结果：线性回归分析显示，TSK 和 PHODA 评分以及 FVAS 评分均与身体能力测量值无显著相关性。相关测试显示，PHODA、TSK 和 FVAS 评分之间无显著相关性。
结论：本研究表明，在 CLBP 患者中，特定任务工具（FVAS）和非特定任务问卷（TSK 和 PHODA）均与脊柱测试无显著相关性。这与先前的证据相反，根据先前的证据，身体能力与与疼痛相关的恐惧水平呈反比，这表明不应根据与疼痛相关的恐惧评分来得出对身体能力的结论。此外，与疼痛相关的恐惧的不同评估工具彼此之间令人惊讶地没有相关性。
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