title: Are fear-avoidance beliefs in low back pain patients a risk factor for low physical activity or vice versa? A cross-lagged panel analysis.
abstract: OBJECTIVE
  The assumption that low back pain (LBP) patients suffer from "disuse" as a consequence of high fear-avoidance beliefs is currently under debate. A secondary analysis served to investigate whether fear-avoidance beliefs are associated cross-sectionally and longitudinally with the physical activity level (PAL) in LBP patients.
  
  
  METHODS
  A total of 787 individuals (57% acute and 43% chronic LBP) were followed up over a period of one year with measurements of fear-avoidance beliefs and physical activity level. Fear-avoidance beliefs concerning physical activity were measured by the physical-activity subscale of the FABQ (Fear-Avoidance Beliefs Questionnaire), the physical activity level was assessed in weighted metabolic equivalents (MET) hours/week with a German self-report questionnaire. Data were investigated by structural equation modelling in a cross-lagged panel design for the whole sample and separately for acute and chronic LBP.
  
  
  RESULTS
  The acute and chronic sub sample increased their total physical activity level significantly after one year. The structural equation modelling results did not support the disuse-aspect inherent in the fear-avoidance belief model. Cross-lagged path coefficients were low (.04 and .05 respectively) and, therefore, did not allow to predict final physical activity by initial fear-avoidance beliefs or vice versa.
  
  
  CONCLUSIONS
  Consequently, due to missing links between fear-avoidance beliefs and physical activity in a longitudinal design, the assumptions of the fear-avoidance belief model have to be questioned. These findings are in line with other investigations published recently. Most probably, "fear-avoidance belief" represents a cognitive scheme that does not limit activity per se, but only is directed to the avoidance of specific movements.
authors.affiliation: Institute for Medical Psychology, Philipps-University Marburg, Germany.
authors.forename: Corinna
authors.initials: C
authors.lastname: Leonhardt
authors.forename: Dirk
authors.initials: D
authors.lastname: Lehr
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Chenot
authors.forename: Stefan
authors.initials: S
authors.lastname: Keller
authors.forename: Judith
authors.initials: J
authors.lastname: Luckmann
authors.forename: Heinz-Dieter
authors.initials: HD
authors.lastname: Basler
authors.forename: Erika
authors.initials: E
authors.lastname: Baum
authors.forename: Norbert
authors.initials: N
authors.lastname: Donner-Banzhoff
authors.forename: Michael
authors.initials: M
authors.lastname: Pfingsten
authors.forename: Jan
authors.initials: J
authors.lastname: Hildebrandt
authors.forename: Michael M
authors.initials: MM
authors.lastname: Kochen
authors.forename: Annette
authors.initials: A
authors.lastname: Becker