Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2017; 27(02): 95-99
DOI: 10.1055/s-0043-100512
Wissenschaft und Forschung
© Georg Thieme Verlag KG Stuttgart · New York

Health Literacy and Fear Avoidance Beliefs Among Women with Chronic Low Back Pain

Gesundheitskompetenz und Angstvermeidungsüberzeugungen bei Patientinnen mit chronischen lumbalen Rückenschmerzen
Einas Al-Eisa
1   Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
,
Syamala Buragadda
2   Department of Rehabilitation Sciences, College of Applied Medical Sciences, Riyadh, King Saud University, Saudi Arabia
,
Ganeswararao Melam
3   Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
› Author Affiliations
Further Information

Publication History

received 18 September 2016

accepted 04 January 2017

Publication Date:
15 May 2017 (online)

Abstract

Purpose Low back pain is considered a major health issue universally. LBP patients may avoid certain activities due to their fear avoidance behavior. Health literacy has a huge influence on the health programs and service delivery models mainly in managing chronic low back pain. The aim of this study was to examine the relation between low back pain disability, fear avoidance beliefs’ and health literacy.

Materials and Methods 227 female low back pain patients of age between 20 and 55 years were analyzed. Disability, fear avoidance, and health literacy were subjectively assessed using the Oswestry Disability Index (ODI), the Fear Avoidance Beliefs’ Questionnaire (FABQ), and the Newest Vital Sign (NVS), respectively. Pearson correlation was used to determine the association between Disability, fear avoidance beliefs’ and health literacy.

Results The high disability group had significantly poor beliefs related to physical activity (FAB-PA) as well as work (FAB-W). Low disability group had adequate literacy compared to those with the high disability. Greater disability was associated with higher levels of fear avoidance beliefs related to physical activity(r=0.4; p−0.00) and work (r=0.3; p−0.00) and was negatively correlated with health literacy (r=− 0.4; p≤0.01).

Conclusion The study findings showed that moderate relationship exists between disability and elevated fear-avoidance beliefs and patients with limited health literacy may have difficulty in self-management of back pain further leading to chronic disability. A multidisciplinary approach focusing on these aspects while assessing disability due to low back pain is needed.

Zusammenfassung

Ziel Schmerzen im unteren Rückenbereich werden allgemein als bedeutendes Gesundheitsproblem angesehen. Patienten mit Schmerzen im unteren Rückenbereich sollten wegen ihres Angst-Vermeidungsverhaltens bestimmte Tätigkeiten vermeiden. Gesundheitskompetenz hat vor allem bei der Behandlung chronischer lumbaler Rückenschmerzen einen enormen Einfluss auf die Gesundheitsprogramme und Dienstleistungsmodelle. Ziel dieser Studie war es, die Beziehung zwischen durch Schmerzen im unteren Rückenbereich verursachter Behinderung, Angstvermeidungsüberzeugungen und Gesundheitskompetenz zu untersuchen.

Materialien und Methoden Es wurden 227 Patientinnen mit lumbalen Rückenschmerzen im Alter zwischen 20 und 55 Jahren untersucht. Behinderung, Angstvermeidung und Gesundheitskompetenz wurden subjektiv jeweils mit dem Oswestry Disability Index (ODI), dem Fear Avoidance Beliefs’ Questionnaire (FABQ) und dem Newest Vital Sign (NVS) beurteilt. Zur Bestimmung des Zusammenhangs zwischen Behinderung, Angstvermeidung und Gesundheitskompetenz wurde die Pearson-Korrelation verwendet.

Ergebnisse Die Gruppe mit hoher Behinderung hatte signifikant schwache Überzeugungen in Bezug auf körperliche Aktivität (FAB-PA) sowie Arbeit (FAB -W). Die Gruppe mit niedriger Behinderung hatte angemessene Gesundheitskompetenz im Vergleich zur Gruppe mit hoher Behinderung. Größere Behinderung war mit einem höheren Grad an Angstvermeidungsüberzeugungen im Zusammenhang mit körperlicher Aktivität (r=0,4; p−0,00) und Arbeit (r=0,3; p−0,00) assoziiert und negativ mit der Gesundheitskompetenz korreliert (r=− 0,4; p≤0,01).

Fazit Die Ergebnisse der Untersuchung zeigten, dass zwischen Behinderung und erhöhtem Angst-Vermeidungsglauben ein leichter Zusammenhang besteht und dass Patienten mit beschränkter Gesundheitskompetenz Schwierigkeiten bei der Selbstbehandlung von Rückenschmerzen haben können, was letztlich zu chronischer Behinderung führt. Es wird ein multidisziplinärer Ansatz benötigt, der diese Aspekte fokussiert und dabei Behinderung aufgrund von Schmerzen im unteren Rückenbereich abschätzt.

 
  • References

  • 1 Hoy D, March L, Brooks P. et al. Measuring the global burden of low back pain. Best Pract Res Clin Rheumatol 2010; 24: 155-165
  • 2 Walker BF, Muller R, Grant WD. Low back pain in Australian adults. Prevalence and associated disability. J Manipulative Physiol Ther 2004; 27: 238-244
  • 3 Becker A, Held H, Redaelli M. et al. Low back pain in primary care: costs of care and prediction of future health care utilization. Spine J 2010; 35: 1714-1720
  • 4 Martin BI, Deyo RA, Mirza SK. et al. Expenditures and health status among adults with back and neck problems. JAMA 2008; 299: 656-664
  • 5 Martin BI, Turner JA, Mirza SK. et al. Trends in health care expenditures,utilization, and health status among US adults with spine problems, 1997–2006. Spine J 2009; 34: 2077-2084
  • 6 Poiraudeau S, Rannou F, Le Henanff A. et al. Outcome of subacute low back pain: influence of patients’ and rheumatologists’ characteristics. J Rheumatol 2006; 45: 718-723
  • 7 Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med 2007; 147: 492-504
  • 8 Walsh NE, Brooks P, Hazes JM. et al. Standards of care for acute and chronic musculoskeletal pain: the Bone and Joint Decade (2000–2010). Arch Phys Med Rehabil 2008; 89: 1830
  • 9 Jordan JE, Briggs AM, Brand CA. et al. Enhancing patient engagement in chronic disease self-management support initiatives in Australia: the need for an integrated approach. Med J Aust 2008; 189: S9
  • 10 Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J 2010; 10: 38-43
  • 11 Sorensen K, Van den Broucke S, Fullam J. et al. Health literacy and public health: A systematic review and integration of definitions and models. BMC public health 2012; 12: 1
  • 12 US Department of Health and Human Services. National standards for culturally and linguistically appropriate services in health care. 2001
  • 13 McKinney J, Kurtz-Rossi S. Culture, Health and Literacy: A Guide to Health Education Materials for Adults with Limited English Literacy Skills. 2000
  • 14 Briggs AM, Jordan JE, Buchbinder R. et al. Health literacy and beliefs among a community cohort with and without chronic low back pain. J Pain 2010; 150: 275-283
  • 15 Briggs AM, Jordan JE, O’Sullivan PB. et al. Individuals with chronic low back pain have greater difficulty in engaging in positive lifestyle behaviours than those without back pain: An assessment of health literacy. BMC Musculoskelet Disord 2011; 12: 1
  • 16 Davidson M, Keating JL. A comparison of five low back disability questionnaires: reliability and responsiveness. Phys Ther 2002; 82: 8-24
  • 17 Fairbank JC, Pynsent PB. The Oswestry disability index. Spine J 2000; 25: 2940-2953
  • 18 Laufer Y, Elheiga-Na’amne BA, Rozen N. Translation and validation of the Arab version of the fear avoidance beliefs questionnaire. J Back Musculoskelet Rehabil 2012; 25: 201-208
  • 19 Weiss BD, Mays MZ, Martz W. et al. Quick assessment of Literacy in primary care: the newest vital sign. Ann Fam Med 2005; 3: 514-522
  • 20 Osborn CY, Weiss BD, Davis TC. et al. Measuring adult literacy in health care: performance of the newest vital sign. Am J Health Behav 2007; 31: S36-S46
  • 21 Al-Arfaj AS, Al-Saleh SS, Alballa SR. et al. How common is back pain in Al-Qaseem region. Saudi Med J 2003; 24: 170-173
  • 22 Weiner DK, Haggerty CL, Kritchevsky SB. et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the health ABC cohort and implications for the future. Pain Med 2003; 4: 311-320
  • 23 Basler H-D, Luckmann J, Wolf U. et al. Fear-avoidance beliefs, physical activity, and disability in elderly individuals with chronic low back pain and healthy controls. Clin J Pain 2008; 24: 604-610
  • 24 Fritz JM, George SZ, Delitto A. The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status. J Pain 2001; 94: 7-15
  • 25 Linton SJ, Vlaeyen J, Ostelo R. The back pain beliefs of health care providers: are we fear-avoidant?. J Occup Rehabil 2002; 12: 223-232
  • 26 Paasche-Orlow MK, Parker RM, Gazmararian JA. et al. The prevalence of limited health literacy. J Gen Intern Med 2005; 20: 175-184
  • 27 Omariba DWR, Ng E. Health literacy and disability: differences between generations of Canadian immigrants. Int J Public Health 2015; 60: 389-397
  • 28 DeWalt DA, Dilling MH, Rosenthal MS. et al. Low parental literacy is associated with worse asthma care measures in children. Ambul Pediatr 2007; 7: 25-31
  • 29 Kripalani S, Henderson LE, Chiu EY. et al. Predictors of medication self-management skill in a low-literacy population. J Gen Intern Med 2006; 21: 852-856