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Fear avoidance beliefs in upper-extremity musculoskeletal pain conditions: secondary analysis of a prospective clinical study on digital care programs.

BACKGROUND
Fear-avoidance beliefs (FAB) have been associated with poorer prognosis and decreased adherence to exercise-based treatments in musculoskeletal (MSK) pain. However, the impact of high FAB on adherence and outcomes in upper extremity musculoskeletal (UEMSK) pain is poorly explored, particularly through exercise-based digital care programs (DCP).


OBJECTIVE
Assess the adherence levels, clinical outcomes and satisfaction in patients with UEMSK pain and elevated FAB after a fully remote multimodal DCP. Associations between FABQ-PA and clinical outcomes were conducted.


METHODS
Secondary analysis of an ongoing clinical trial. Participants with UEMSK pain (shoulder, elbow, and wrist/hand) and elevated FAB - physical activity (FABQ-PA ≥ 15) were included. Adherence (completion rate, sessions/week, total exercise time) and mean change in clinical outcomes - disability (QuickDASH), numerical pain score, FABQ-PA, anxiety (GAD-7) and depression (PHQ-9)- between baseline and end-of-program were assessed. Associations between FABQ-PA and clinical outcomes were conducted.


RESULTS
520 participants were included, with mean baseline FAB 18.02 (SD 2.77). Patients performed on average 29.3 exercise sessions (2.8 sessions/week), totalizing 338.2 exercise minutes. Mean satisfaction was 8.5/10 (SD 1.7). Significant improvements were observed in all clinical outcomes. Higher baseline FAB were associated with higher baseline disability (p<.001) and smaller improvements in disability (p<.001) and pain (p=.001). Higher engagement was associated with greater improvements in FABQ-PA (p = 0.043) and pain (p = 0.009).


CONCLUSIONS
This study provides evidence of the potential benefits of a structured and multimodal home-based DCP in the management of UEMSK pain conditions in patients with elevated FAB in a real-world context.


TRIAL REGISTRATION
ClinicalTrials.gov, NCT04092946. Registered 17/09/2019; https://clinicaltrials.gov/ct2/show/NCT04092946.