Fear Avoidance

How many graded statements are in the physical activity level of the FABQ?

5

External Locus of control

Individual believes that an improvement will only be achieved via external factors ind of their individual control of ability

Internal Locus of Control

Individual believes that they are in control of their situation and can achieve improvement via internal factors

Discuss the relationship of the pt experience with healthcare providers in the clinic and pt outcomes

-Clinician focus on psychosocial aspects of pt life, not just injury -Pts need to feel that clinicians are invested in their well-being

Acute pain exists along a continuum of what two extremes?

-Confrontation (adaptive) -Avoidance (maladaptive)

Symptom Magnification Syndrome

-Conscious or unconscious self-destructive learning pattern of behavior which is maintained through social reinforcement and typically controls the individuals life activities

Example of secondary gains

-Drugs -Win a lawsuit -Avoid work/military services

What quetsionnaires can be used to assess Fear Avoidance beliefs

-FABQ (workers Comp) -ODI

Treatment for pts with acute LBP and high levels of fear avoidance?

-Graded exercise prescription along with pt education

Benefits of PT recognizing psychological aspect of pain

-Improve QOL -Pt outcomes -Reduce health care costs

(Blank) generally more positive with better outcomes when compare to (Blank)

-Internal LOC -External LOC

Effects of PT of biopsychosocial aspects of pain

-PT must be able to recognize and treat pyshcological aspect of pain -Improve pt's QOL -Improve pt's outcomes -Reduce cost in healthcare

Discuss the importance of pt education and its relationship with pt outcomes

-Pain doesn't always mean damage -You can manage your pain with the right knowledge

How can PTs increase self-efficacy/self-esteem?

-Pt education -Willingness to listen/understand -Communication

How do you explain back pain to a pt?

-Pt friendly language -Explain that pain doesn't always have to limit them -Teach them how use prophylactic exercise to avoid future episodes or decrease their intensity/duration

What should be documented?

-Secondary gains, malingering, and non-organic signs of pain

5 sings of Waddell Signs

-Tenderness: skin discomfort on light palpation -Simulation: axial loading an pain on simulated rotation -Distraction: distracted SLR -Non-anatomical sensory changes: regional sensory changes and regional weakness -Overreaction

Secondary gain and Malingering Effects on PT

-Use Waddell's signs -Pt could exagerate pain -Pt may report poor outcome to tx -Document everything you see

Specific education provided by the PT for the pt with acute LBP

1. LBP can be painful, but rarely means that there has been a serious injury to the back 2. Most LBP resolves quickly 3. The pain cycle repeats itself with inactivity and stress 4. Worrying about back pain can cause stress-related mm spasms 5. The mind can help control stress and pain through relaxation techniques (visualization, positive self-talk, etc) 6. Inactivity causes weak or stiff mm that are morelikely ti be re-injured 7. Activity benefits overall health and wellbeing

ODI Characteristics

1. Modified ODI doesn't talk about sex 2. Scored from 0-5 3. Scored out of 5

Characteristics of FABQ

1. Most useful to predict pt outcomes, particularly related to work 2. Higher score indicates increased levels of fear-avoidance beliefs 3. 0-6; "0": Completely disagree "6": Completely agree 4. Scored out of 96

How many graded statements are in the Work section of the FABQ?

11

What is maladaptive thought to be associated with?

Chronic disability

What are conversion disorder symptoms triggered by?

Commonly triggered by mental factors such as conflicts or other stresses

Fact of Crap. LBP is pathological.

Crap. LBP is non-pathological meaning that ALL avoidance behavior is maladaptive and will likely lead to prolonged disability

Why are outcome measures and psychsocial views important?

Determining long term disability /chronic pain

How do you confront fear avoidance behavior?

Exercise and Education

"My back will never stop hurting because the PT wont believe me when I tell her my disc is slipped."

External Locus of Control

What is the single best predictor of return to work after low back injury?

FABQ

How is the FABQ used in gauging fear avoidance?

FABQ most useful to predict pt outcomes, particularly return to work

Fact or Crap. Taking time to discuss common myths about LBP and exercise durng each PT session helps pts return to work faster than those pts receiving typical PT w/o education and discussion about LBP.

Fact

Fact or crap? Person's reaction to painful expereince will fall on a spectrum ranging from confrontation (adaptive) to avaoidance (maladaptive)

Fact

Fact or Crap. A pt can shift from internal to external locus of control.

Fact. If pt has a negative response to tx or suffer from chronic pain or injuries

What does FABQ stand for?

Fear Avoidance Belief Questionnaire

What is the FABQ based off of?

Fear-avoidance Model of Exaggerated Pain Perception

What is the Fear Avoidance Model of Exaggerated Pain Perception

Helps to explain why some ppl with acute painful conditions progress to chronic pain, whereas others are able to recover

What is meant by secondary gains and malingering?

Intentionally and purposefully feign illness to achieve some recognizable goal

"Im going to work hard wth my PT to get rid of this back pain"

Internal Locus of Control

How do you differentiate a Malingerer vs conversion disorder?

Look for inconsistencies in sx

What is the best way to treat back pain?

MOVE

Is symptom abatement considered a primary intervention?

NO

Conversion Disorder

Physical Sx that resemble those of a nervouse system (neurlogc) disorder development

Why is education important?

To help your pt understand how to overcome their fear pf pain

How to find non-organic signs of pain?

Wadell's Signs; used to detect malingering

Malingerer

Workers comp pt looking for secondary gains

What is not a good thing to do to help with LBP?

bed rest/prolonged rest

Quota driven

improve pt activity tolerance by progressing intensity, duration, frequency of exercise regardless of symptom intensity

(+) Wadell Sign

presence of 3 out of 5 indicate correlation with disability

Biopsychosical approach

systemically considers biological, psychological, and social factors and their complex interaction in understanding health, illness, and health care delivery