Gait Variability and Relationships With Fear, Avoidance, and Pain in Adolescents With Chronic Pain

Justin Beebe, Corey Kronman, Farah Mahmud, Molly Basch, Melinda Hogan, Eileen Li, Chris Ploski, Laura Simons
Physical Therapy 2021 January 22

OBJECTIVE: Some children with chronic pain struggle with fear of pain, avoidance behaviors, and associated disability; however, movement adaptations in the context of chronic pain in childhood is virtually unknown. Variability in adaptive movement responses previously observed between individuals might be largely explained by the presence of problematic psychological drivers (eg, fear, avoidance). The goals of this study were to (1) quantify the variability of gait and (2) examine relationships among pain, fear, avoidance, function, perceived and objective, and gait variability.

METHODS: This study used a cross-sectional design. Eligible patients were between 8 and 17 years of age and had musculoskeletal, neuropathic, or headache pain that was not due to acute trauma (eg, active sprain) or any specific or systemic disease. Participants completed the Numeric Pain Rating Scale (NPRS), Fear of Pain Questionnaire (FOPQ), Functional Disability Inventory (FDI), and 6-Minute Walk Test (6MWT) and received kinematic gait analysis. Relationships were analyzed among these measures, and the self-report and functional measures were examined to determine whether they predicted gait variability (GaitSD).

RESULTS: The 16 participants who were evaluated (13.8 [SD = 2.2] years of age; 13 female) had high NPRS scores (6.2 [SD = 2.1]), FOPQ-Fear scores (25.9 [SD = 12.1]), FOPQ-Avoidance scores (22.8 [SD = 10.2], and FDI scores (28.6 [SD = 9.4]) and low 6-Minute Walk Test (6MWT) distance (437.1 m [SD = 144.6]). Participants had greater GaitSD than age-predicted norms. Fear was related to self-selected GaitSD, and avoidance was related to both self-selected and standardized GaitSD. Avoidance predicted 43% and 47% of the variability in self-selected and standardized GaitSD, respectively.

CONCLUSIONS: Gait variability was significantly related to both fear of pain and avoidance behaviors, suggesting the interplay of these psychological drivers with movement. FOPQ-Avoidance was robust in accounting for GaitSD.

IMPACT: This study offers preliminary evidence in understanding movement adaptations associated with adolescents with chronic pain. They may lend to more directed interventions.

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