Fear of movement is not associated with objective and subjective physical activity levels in chronic nonspecific low back pain

Flávia A. Carvalho, Chris G. Maher, Marcia R. Franco, Priscila K. Morelhão, Crystian B. Oliveira, Fernanda G. Silva, Rafael Z. Pinto*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

38 Citations (Scopus)


Objectives: To assess the association of physical activity measures, derived with an accelerometer and a self-reported questionnaire, with fear of movement in patients with chronic nonspecific low back pain (LBP) and to investigate the association between disability and fear of movement in this population. Design: Cross-sectional study. Setting: Outpatient physical therapy university clinics. Participants: Patients (N=119) presenting with nonspecific LBP of >3 months' duration. Interventions: Not applicable. Main Outcome Measures: Physical activity levels measured objectively with an accelerometer (ie, counts per minute, time spent in moderate-to-vigorous and light physical activity per day, number of steps per day, and number of 10-minute bouts of moderate-to-vigorous physical activity per day) and subjectively with a self-reported questionnaire (Baecke Physical Activity Questionnaire); fear of movement (Tampa Scale of Kinesiophobia); pain (11-point numerical rating scale); disability (Roland Morris Disability Questionnaire); and depression (Beck Depression Inventory). The associations were examined with correlational, univariate, and multivariable linear regression analyses. Results: None of the objective physical activity measures were associated with fear of movement. The apparent association of self-reported physical activity levels with fear of movement (correlational analyses: r=−.18; P<.05; univariate regression analyses: β=−.04; 95% confidence interval [CI], −.07 to −.01; P=.04) was not confirmed in multivariable analyses. Fear of movement was consistently associated with disability in both correlational (r=.42; P<.01) and multivariable (β=.21; 95% CI, .11–.31; P<.001) analyses. Conclusions: Our data support one aspect of the fear-avoidance model—that higher fear of movement is associated with more disability—but not the aspect of the model linking fear of movement with inactivity.

Original languageEnglish
Pages (from-to)96-104
Number of pages9
JournalArchives of Physical Medicine and Rehabilitation
Issue number1
Publication statusPublished - 1 Jan 2017
Externally publishedYes


  • activities of daily living
  • fear
  • low back pain
  • motor activity
  • rehabilitation


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