Model of Fear of Movement/(Re)injury Runs Clockwise From Catastrophizing

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Abstract
Objective: The aim of the study is to provide evidence that catastrophizing is the primer of the cognitive-behavioral model of fear of movement/(re)injury. Design: A cross-sectional analysis of 180 outpatients with chronic nonspecific low back pain who completed the Pain Catastrophizing Scale, the Tampa Scale of Kinesiophobia, the Roland-Morris Disability Questionnaire, the Hospital Anxiety and Depression Scale–Depression, and a pain intensity numerical rating scale. The intercorrelations of the outcome measures were estimated using Pearson’s correlation coefficient (r), and regression analyses were used to examine their predictive values by following the left side of the fear of movement/(re)injury clockwise from the Pain Catastrophizing Scale (P = 0.05). A postdictive analysis dichotomizing the sample into high- and low-level catastrophizers evaluated the effects of addressing catastrophizing on disability and pain. Results: The intercorrelations of the Pain Catastrophizing Scale with the Tampa Scale of Kinesiophobia, Roland-Morris Disability Questionnaire, Hospital Anxiety and Depression Scale–Depression and numerical rating scale were respectively r = 0.59, r = 0.54, r = 0.18, and r = 0.44. Pain Catastrophizing Scale was a significant predictor of Tampa Scale of Kinesiophobia; Pain Catastrophizing Scale and Tampa Scale of Kinesiophobia significantly predicted Roland-Morris Disability Questionnaire and Hospital Anxiety and Depression Scale–Depression; and Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia, Roland-Morris Disability Questionnaire and Hospital Anxiety and Depression Scale–Depression significantly predicted numerical rating scale. The postdictive analysis showed that addressing catastrophizing reduces disability and pain experience by 14% in high-level catastrophizers and 86% in low-level catastrophizers. Conclusions: Our findings provide evidence that catastrophizing is the primer of the fear of movement/(re)injury.

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