ArticlePhysical therapy2025
Associations Between Fear-Avoidance or Pain Catastrophizing and Gait Quality in Chronic Low Back Pain: A Cross-Sectional Study.
Article in Physical therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Unilateral Balance, Muscular Strength, Foot Arch Status, and Physical Performance in Young Adults with and Without Low Back Pain.Journal of clinical medicine · 2026Article
- AI-Supported Functional Pain Phenotyping in Low Back Pain Using Sensor-Based Gait and Neuromuscular Biomarkers.Sensors (Basel, Switzerland) · 2026Article
- Exploring the relationships between multisite musculoskeletal pain, pain characteristics, and physical function: a cross-sectional analysis.BMC musculoskeletal disorders · 2026Article
- Cortical activity during cognitive and walking tasks in individuals with chronic nonspecific low back pain: a functional near-infrared spectroscopy study.Frontiers in neuroscience · 2026Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
importanceChronic low back pain (cLBP) is associated with reduced gait speed and other gait quality impairments. Fear-avoidance and pain catastrophizing impact movement in cLBP, but their specific impact on gait quality is unknown.
objectiveThis study aimed to determine associations between fear-avoidance or pain catastrophizing and gait quality in cLBP.
designThis was a cross-sectional study.
settingThis study occurred at a university.
participantsThere were 500 individuals (56.6 [SD = 16.5] years old; 311 female) with cLBP.
interventionsParticipants completed the Fear-Avoidance Beliefs Questionnaire - Physical Activity (FABQ-PA) and 6-item Pain Catastrophizing Scale. Participants were divided into high and low fear-avoidance subgroups based on an established FABQ-PA cutoff (>14). MAIN OUTCOMES AND MEASURES: Gait speed was measured during a 4-meter walk test, while step time average, step time variability, and symmetry were derived from a lumbar inertial measurement unit worn during a 2-minute walk test. Multiple linear regression models were used to determine relationships between fear-avoidance or pain catastrophizing and gait quality. T tests were used to determine gait quality differences between high versus low fear-avoidance subgroups.
resultsHigh fear-avoidance was associated with reduced gait speed (B = -0.0039), but pain catastrophizing was not. The high fear-avoidance subgroup had slower gait speed (mean difference = 0.05 m/s), longer step time (mean difference = 0.02 s), and higher step time variability (mean difference = 0.004 s) compared to the low fear-avoidance subgroup.
conclusionsFear-avoidance is associated with slower gait speeds, even after adjusting for demographics, pain, and disability. The established FABQ-PA cutoff is robust in detecting gait differences between high versus low fear-avoidance subgroups. RELEVANCE: It may be important to consider fear-avoidance in the delivery of multi-modal interventions to address gait impairments. Future studies are needed to determine the impact of addressing fear-avoidance alongside traditional gait interventions in cLBP.
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