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Association of pain-related threat beliefs and disability with postural control and trunk motion in individuals with low back pain: a systematic review and meta-analysis

Abstract

Purpose

Low back pain (LBP) individuals with high levels of fear of pain might display changes in motor behavior, which leads to disability. This study aimed to systematically review the influence of pain-related threat beliefs or disability on trunk kinematic or postural control in LBP.

Method

Eight electronic databases were searched from January 1990 to July 1, 2020. Meta-analysis using random-effect model was performed for 18 studies on the association between pain-related threat beliefs or disability and lumbar range of motion. Pearson r correlations were used as the effect size.

Result

Negative correlations were observed between lumbar range of motion (ROM) and pain-related threat beliefs (r = − 0.31, p < 0.01, 95% CI: − 0.39, − 0.24) and disability (r =  − 0.24, p < 0.01, 95% CI: − 0.40, − 0.21). Nonsignificant correlations were reported between pain-related threat beliefs and center of pressure parameters during static standing in 75% of the studies. In 33% of the studies, moderate negative correlations between disability and postural control were observed.

Conclusion

Motor behaviors are influenced by several factors, and therefore, the relatively weak associations observed between reduced lumbar ROM with higher pain-related threat beliefs and perceived disability, and postural control with disability are to be expected. This could aid clinicians in the assessment and planning rehabilitation interventions.

Level of Evidence I

Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

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Funding

This work was supported by Iran University of Medical Sciences (984-99-16690), Iran, and JWSV is supported by the Asthenes research program “From Acute Aversive Sensations to Chronic Bodily Symptoms,” a long-term structural Methusalem funding (METH/15/011) by the Flemish government, Belgium.

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SS, SSA and IET conceived, planned and designed the study. SS and SSA searched databases, screened title/abstract and full text and extracted the data. SSA and RS contributed to risk of bias assessment. HJ, SS and RS contributed to data analysis. SS, SSA, IET, HJ and JWSV contributed to the interpretation of the results and drafted the article. JWSV, SS, RS and HJ provided critical feedback and revised and provided the final version of the manuscript, and all authors have approved the final version.

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Correspondence to Shabnam ShahAli.

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Shanbehzadeh, S., ShahAli, S., Ebrahimi Takamjani, I. et al. Association of pain-related threat beliefs and disability with postural control and trunk motion in individuals with low back pain: a systematic review and meta-analysis. Eur Spine J 31, 1802–1820 (2022). https://doi.org/10.1007/s00586-022-07261-4

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Keywords

  • Fear of pain
  • Catastrophizing
  • Motor behavior
  • Disability
  • Low back pain