High fear-avoiders of physical activity benefit from an exercise program for patients with back pain

Study Design. A subgroup analysis of patient outcomes from a randomized controlled trial comparing a Back to Fitness program with usual general practitioner care. Objectives. To test whether patients with high scores on measures of fear-avoidance and distress/depression benefit the most. Summary of Background Data. A fitness program, ongoing since the 1980s, was developed for use in the community and has been shown to be effective in reducing disability. Detailed analyses are needed to identify patient groups who benefit. Recent evidence points to the potentially important role of fear, distress, and depression. Method. Data from 98 patients allocated to normal general practitioner care and 89 patients allocated to a group exercise program were analyzed after categorizing baseline scores on fear-avoidance beliefs (high/low) and distress/depression (at risk/normal). The main outcome measure was the Roland Disability Questionnaire. Outcomes were compared between the intervention and control groups at 6 weeks, 6 months, and 12 months. Results. High fear-avoiders fared significantly better in the exercise program than in usual general practitioner care at 6 weeks and at 1 year. Low fear-avoiders did not. Patients who were distressed or depressed were significantly better off at 6 weeks, but the benefits were not maintained long-term. Conclusion. Patients with high levels of fear-avoidance beliefs could significantly benefit from the Back to Fitness program. The benefits of the exercise program for patients with high levels of distress/depression appear to be short-term only. Average attendance was only 4 to 5 classes, which may not be sufficient for more recalcitrant cases. Further research is indicated.