Task-specific fear rather than general kinesiophobia assessment is associated with kinematic differences in chronic low back pain during lumbar flexion: a preliminary investigation

Key points

1. 01Task-specific fear (NRS after bending task) correlated with angular velocity of lumbar flexion and return from flexion at both comfortable and fastest paces.
2. 02General kinesiophobia (TSK-11) did not significantly correlate with any kinematic measure in this sample.
3. 03Task-specific fear and TSK-11 did not correlate with each other (r=0.2, p=0.16), suggesting they measure different constructs.
4. 04The difference in predictive ability was statistically significant only for peak angular velocity of lumbar return at fastest speed (z=2.86, p=0.004).
5. 05The study is explicitly preliminary with a small, employed sample having relatively low pain and disability scores.

How it was conducted

Design

Cross-sectional preliminary study

Participants

54 company employees with chronic low back pain (mean age 47.1 years; range 25-63 years; LBP duration at least 6 months; NRS pain 1-9)

Task-specific fear measure

Numerical Rating Scale (0-10) completed immediately after lumbar flexion task

General kinesiophobia measure

Tampa Scale for Kinesiophobia-11 (TSK-11), Japanese version, completed before task

Kinematic outcome

Wireless accelerometers at L3 and S2 recording maximum lumbar flexion angle (degrees) and peak angular velocity of flexion and return from flexion (degrees/s) at comfortable and fastest paces

Analysis

Pearson correlations with Bonferroni correction (significance set at p<0.01) and hierarchical multiple linear regression controlling for pain intensity and TSK-11

What they found

• Task-specific fear correlated with peak angular velocity of lumbar flexion at comfortable pace (r=0.43, p=0.001) and return from flexion (r=0.41, p=0.002).
• Task-specific fear correlated with peak angular velocity of lumbar flexion at fastest pace (r=0.21, p=0.009) and return from flexion (r=0.59, p=0.0004).
• TSK-11 did not significantly correlate with peak angular velocity of lumbar flexion at comfortable pace (r=0.24, p=0.08), return from flexion (r=0.18, p=0.19), or any fastest-pace kinematic variable.
• Task-specific fear was not correlated with TSK-11 (r=0.2, p=0.16).
• Hierarchical regression: task-specific fear was independently associated with peak angular velocity of lumbar flexion at comfortable pace (p=0.003, R_adj=0.29) and fastest pace (p=0.02, R_adj=0.35), and with return from flexion at comfortable pace (p=0.006, R_adj=0.3) and fastest pace (p=0.0009, R_adj=0.36).
• Between-group comparison of correlation coefficients: significant difference for peak angular velocity of return from flexion at fastest speed between task-specific fear and TSK-11 (z=2.86, p=0.004); no significant difference for the other kinematic variables.

Limitations

• Small preliminary sample (n=54) of employed workers with relatively low pain intensity and disability, limiting generalisability to more severely affected patients.
• Task order and scale inquiries were not randomised, and practice trials preceded the task, which may have influenced fear ratings and kinematic data.
• Only post-task fear was measured; fear before the movement was not assessed, so whether fear expectations versus in-task experience drives kinematics is unclear.
• Movement-evoked pain and resting pain were not separated as potential confounders.

Why it matters

For patients

People with chronic low back pain who score low on general fear questionnaires may still have meaningful fear of specific movements that affects how they move, so clinicians may benefit from asking about fear right after a particular activity.

For clinicians

Adding a simple NRS fear rating after a functional movement test (such as lumbar flexion) may capture movement-limiting fear that the TSK-11 misses, and could help tailor graded exposure or cognitive-functional therapy targets.

For readers

This preliminary study supports growing evidence that situational, task-specific fear is a distinct and potentially more sensitive predictor of movement behaviour than trait kinesiophobia questionnaires, though replication in larger and more diverse samples is needed.