Generalization of fear of movement-related pain and avoidance behavior as predictors of work resumption after back surgery: a study protocol for a prospective study (WABS)

Rini Masuy, Lotte Bamelis, Katleen Bogaerts, Bart Depreitere, Kris De Smedt, Jeroen Ceuppens, Bert Lenaert, Sarah Lonneville, Dieter Peuskens, Johan Van Lerbeirghe, Patrick Van Schaeybroeck, Peter Vorlat, Steefka Zijlstra, Ann Meulders, Johan W S Vlaeyen, Rini Masuy, Lotte Bamelis, Katleen Bogaerts, Bart Depreitere, Kris De Smedt, Jeroen Ceuppens, Bert Lenaert, Sarah Lonneville, Dieter Peuskens, Johan Van Lerbeirghe, Patrick Van Schaeybroeck, Peter Vorlat, Steefka Zijlstra, Ann Meulders, Johan W S Vlaeyen

Abstract

Background: Previous studies indicated that about 20% of the individuals undergoing back surgery are unable to return to work 3 months to 1 year after surgery. The specific factors that predict individual trajectories in postoperative pain, recovery, and work resumption are largely unknown. The aim of this study is to identify modifiable predictors of work resumption after back surgery.

Methods: In this multisite, prospective, longitudinal study, 300 individuals with radicular pain undergoing a lumbar decompression will be followed until 1-year post-surgery. Prior to surgery, participants will perform a computer task to assess fear of movement-related pain, avoidance behavior, and their generalization to novel situations. Before and immediately after surgery, participants will additionally complete questionnaires to assess fear of movement-related pain, avoidance behavior, optimism, expectancies towards recovery and work resumption, and the duration and severity of the pain. Six weeks, 3 months, 6 months, and 12 months after surgery, they will again complete questionnaires to assess sustainable work resumption, pain severity, disability, and quality of life. The primary hypothesis is that (generalization of) fear of movement-related pain and avoidance behavior will negatively affect sustainable work resumption after back surgery. Second, we hypothesize that (generalization of) fear of movement-related pain and avoidance behavior, negative expectancies towards recovery and work resumption, longer pain duration, and more severe pain before the surgery will negatively affect work resumption, pain severity, disability, and quality of life after back surgery. In contrast, optimism and positive expectancies towards recovery and work resumption are expected to predict more favorable work resumption, better quality of life, and lower levels of pain severity and disability after back surgery.

Discussion: With the results of this research, we hope to contribute to the development of strategies for early identification of risk factors and appropriate guidance and interventions before and after back surgery. Trial registration The study was preregistered on ClinicalTrials.gov: NCT04747860 on February 9, 2021.

Keywords: Avoidance; Avoidance generalization; Back surgery; Disability; Fear generalization; Fear of movement-related pain; Low back pain; Postoperative pain; Predictors of return to work; Quality of life.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Study design. Note. The first icon represents the consult with the surgeon, the second one the consult with the research assistant. The third icon (the computer) represents the assessment of the computer task. The fourth icon (the notepad) represents the assessments of the questionnaire. The fifth and last icon, presented in blue, represents the surgery

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Source: PubMed

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