In vivo exposure for fear of pain and avoidance of movement in low back pain

quasi-experimental study. The 27 patients who participated graded the damage associated with the movements in each of the 40 activities of daily living depicted in pictures using a scale from 0 to 100. The patients chose five out of all the activities that received a score higher than 50 to carry out the exposure. The intensities of fear and anxiety were measured before and after each exposure session.

Results:

the frequencies of the gender were equal, and the mean age was 44.9 years. The activities chosen more frequently for the exposure were shoveling (33.3%) and running (33.3%). There was reduction of fear and anxiety before and after exposure (p<0.001).

Conclusions:

hierarchization and in vivo exposure were effective in reducing fear and anxiety.

Descriptors:
Fear; Movement; Back Pain; Chronic Pain; Nursing

Picture	Activity description	Harm thermometer n=27
Picture	Activity description	Mean (SD)	Median (min-max)	95% CI
PHODA 98	Falling backward on the grass	84.5 (18.8)	90 (30-100)	77.2	92.0
PHODA 2	Shoveling soil with bent back	69.8 (27.4)	76 (10-100)	59.0	80.7
PHODA 85	Carrying a child on the hip	68.0 (22.4)	70 (28-100)	59.2	76.8
PHODA 4	Lifting flowerpot with slightly bent back	67.5 (24.2)	70 (10-99)	58.0	77.2
PHODA 18	Lifting a filled basket while walking up the stairs	66.0 (27.2)	74 (10-100)	55.2	76.8
PHODA 20	Lifting beer crate out of car with slightly bent back	65.7 (22.8)	60 (0-100)	56.7	74.7
PHODA 29	Vacuum cleaning under coffee table with bent back	65.5 (26.5)	79 (20-100)	54.8	76.2
PHODA 49	Trampoline jumping	63.7 (26.8)	70 (10-100)	53.2	74.4
PHODA 50	Rope skipping	63.1 (27.4)	70 (10-100)	52.3	73.9
PHODA 93	Running through the forest	59.5 (28.7)	60 (10-100)	48.2	70.9
PHODA 33	Mopping floor with a squeegee with slightly bent back	56.8 (28.1)	60 (10-100)	45.8	68.0
PHODA 99	Mowing the lawn manually	56.3 (26.6)	64 (5-100)	45.8	66.9
PHODA 83	Lifting a toddler from its cot with bent back	56.2 (31.6)	50 (5-100)	43.8	68.8
PHODA 7	Picking up shoes from floor with bent back	55.4 (25.6)	60 (10-90)	45.4	65.6
PHODA 27	Clearing out the dishwasher with bent back	55.4 (27.2)	60 (10-100)	44.7	66.2
PHODA 95	Cycling from a low kerb	54.5 (26.7)	50 (10-100)	44.0	65.1
PHODA 40	Back twist exercise on a fitness device	54.1 (25.9)	60 (10-100)	43.6	64.6
PHODA 11	Taking book from shelf behind oneself (with twisted back)	52.9 (26.9)	60 (0-90)	42.3	63.6
PHODA 96	Looking aside while cycling	52.7 (31.7)	50 (0-100)	40.2	65.2
PHODA 44	Back muscle exercise bending forward on a fitness device	52.3 (28.2)	50 (10-100)	40.9	63.7
PHODA 100	Drilling a hole in a stone wall above the head	52.0 (27.7)	60 (10-100)	41.1	63.0
PHODA 3	Lifting flowerpot squatting down	51.8 (30.2)	60 (0-90)	39.9	63.7
PHODA 8	Picking up shoes from floor squatting down	51.3 (29.3)	50 (10-100)	39.7	62.9
PHODA 23	Carrying two shopping bags with both hands while walking	51.0 (28.5)	50 (10-100)	39.8	62.4
PHODA 22	Carrying a shopping bag with one hand while walking	49.6 (31.4)	50 (10-100)	37.2	62.1
PHODA 74	Riding a bicycle in a street with speed bumps	48.8 (31.4)	40 (0-100)	36.5	61.3
PHODA 73	Cleaning the windows with arm stretched above the head	47.8 (27.0)	46 (10-100)	37.1	58.5
PHODA 51	Abdominal muscle exercises on the floor with a fitness device	47.3 (27.0)	50 (5-90)	36.5	58.3
PHODA 59	Getting out of bed by first placing one foot on the ground	46.7 (31.2)	40 (0-100)	34.4	59.1
PHODA 36	Leg stretch exercise on a fitness device	46.3 (27.1)	40 (10-100)	35.6	57.0
PHODA 28	Taking a box from the sink cupboard above the head	44.2 (29.7)	40 (10-100)	32.5	56.0
PHODA 47	Taking a box filled with bottles from a shelf above the head	44.0 (26.8)	40 (10-90)	33.4	54.6
PHODA 26	Carrying rubbish bag with one hand while walking	43.4 (30.3)	40 (10-100)	31.4	55.4
PHODA 60	Walking up the stairs	40.3 (29.0)	30 (0-90)	28.8	51.8
PHODA 15	Ironing in sitting position	39.0 (26.8)	30 (0-90)	28.4	49.6
PHODA 57	Making the bed with bent back	37.8 (28.7)	32 (5-94)	26.5	49.2
PHODA 14	Ironing in standing position	35.3 (23.3)	30 (5-90)	26.2	44.6
PHODA 61	Walking down the stairs	31.4 (24.1)	20 (0-80)	21.9	41.0
PHODA 94	Walking through the forest	31.1 (21.9)	20 (0-80)	22.5	39.8
PHODA 92	Doing the dishes in standing position	30.5 (19.2)	30 (2-80)	22.9	38.1
TOTAL		52.2 (14.8)	53.6 (26.6 - 79.6)	46.4	58.1

Picture	Activity description	Choice for exposure sessions 1 and 2 n (%)
PHODA 2	Drilling a hole in a stone wall above the head	9 (33.3)
PHODA 93	Taking book from shelf behind oneself (with twisted back)	9 (33.3)
PHODA 23	Ironing in standing position	7 (25.9)
PHODA 33	Ironing in sitting position	7(25.9)
PHODA 51	Lifting a filled basket while walking up the stairs	7 (25.9)
PHODA 20	Shoveling soil with bent back	6 (22.2)
PHODA 40	Lifting beer crate out of car with slightly bent back	6 (22.2)
PHODA 44	Carrying a shopping bag with one hand while walking	6 (22.2)
PHODA 50	Carrying two shopping bags with both hands while walking	6 (22.2)
PHODA 29	Carrying rubbish bag with one hand while walking	5 (18.5)
PHODA 59	Clearing out the dishwasher with bent back	5 (18.5)
PHODA 60	Taking a box from the sink cupboard above the head	5 (18.5)
PHODA 95	Vacuum cleaning under coffee table with bent back	5 (18.5)
PHODA 4	Lifting flowerpot squatting down	4 (14.8)
PHODA 49	Mopping floor with a squeegee with slightly bent back	4 (14.8)
PHODA 85	Leg stretch exercise on a fitness device	4 (14.8)
PHODA 3	Lifting flowerpot with slightly bent back	3 (11.1)
PHODA 8	Back twist exercise on a fitness device	3 (11.1)
PHODA 18	Back muscle exercise bending forward on a fitness device	3 (11.1)
PHODA 27	Taking a box filled with bottles from a shelf above the head	3 (11.1)
PHODA 28	Trampoline jumping	3 (11.1)
PHODA 36	Rope skipping	3 (11.1)
PHODA 83	Abdominal muscle exercises on the floor with a fitness device	3 (11.1)
PHODA 96	Making the bed with bent back	3 (11.1)
PHODA 7	Getting out of bed by first placing one foot on the ground	2 (7.4)
PHODA 11	Walking up the stairs	2 (7.4)
PHODA 14	Walking down the stairs	2 (7.4)
PHODA 15	Picking up shoes from floor with bent back	2 (7.4)
PHODA 47	Cleaning the windows with arm stretched above the head	2 (7.4)
PHODA 99	Riding a bicycle in a street with speed bumps	2 (7.4)
PHODA 22	Picking up shoes from floor squatting down	1 (3.7)
PHODA 61	Lifting a toddler from its cot with bent back	1 (3.7)
PHODA 94	Carrying a child on the hip	1 (3.7)
PHODA 100	Doing the dishes in standing position	1 (3.7)
PHODA 26	Running through the forest	0 (0.0)
PHODA 57	Walking through the forest	0 (0.0)
PHODA 73	Cycling from a low kerb	0 (0.0)
PHODA 74	Looking aside while cycling	0 (0.0)
PHODA 92	Mowing the lawn manually	0 (0.0)

Variable	N	Exposure 1	Exposure 2	F-test	p value
Variable	N	Mean (SD)	Mean (SD)	F-test	p value
Fear (0-10)
Before exposure	27	6.5 (2.9)	1.5 (2.1)	62.8	< 0.001^a
After exposure	27	1.9 (2.5)	0.5 (0.8)	62.8	< 0.001^a
Anxiety (0-10)
Before exposure	27	5.7 (3.0)	1.1 (1.6)	68.8	< 0.001^a
After exposure	27	1.8 (2.2)	0.1 (0.3)	68.8	< 0.001^a

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E-mail: reben@abennacional.org.br

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[1] Corresponding author: Érica Brandão de Moraes. E-mail: ericabrandao@id.uff.br