Addressing Fear-Avoidance Beliefs in a Veteran with Sub-Acute Low Back Pain Who Is Non-Ambulatory

Abstract

Purpose: The aim of this case report is to discuss physical therapy management of a 59-year-old male veteran with sub-acute low back pain and elevated fear-avoidance beliefs about walking. Case Description: The patient is a 59-year-old male who was referred to physical therapy for evaluation and treatment of "Sciatica, right side." The patient was non-ambulatory for one month preceding his first physical therapy visit. His primary impairments on initial evaluation were elevated fear-avoidance beliefs, lower quarter weakness, and impaired gait mechanics. Interventions: Physical therapy management included strategies to address fear-avoidance beliefs in combination with gait training and lower quarter strengthening. Strategies used to manage fear-avoidance beliefs included patient education with cognitive restructuring, graded exposure in vivo, one-on-one patient care, and development of a therapeutic relationship. Outcomes: Fear-avoidance beliefs, disability, and gait were assessed at initial evaluation, 5 weeks, and 8 weeks (discharge). All outcome measures exceeded a minimal clinically important difference from initial evaluation to discharge. Conclusions: The patient demonstrated improvements in all functional outcome measures and was ambulating independently after eight weeks of physical therapy interventions aimed at reducing fear-avoidance behaviors.