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)

Abstract

Background Previous studies indicated that about 20% of the individuals undergoing back surgery are unable to return to work three months to one year after surgery. The specific factors that predict individual trajectories in postoperative pain, recovery, and work resumption are largely unknown. Aim 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 one-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, three months, six months, and twelve months after surgery, they will again complete questionnaires to assess sustainable work resumption, pain severity, disability, and quality of life. Hypothesis 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 Low back pain, back surgery, postoperative pain, predictors of return to work, fear of movement-related pain, avoidance, fear generalization, avoidance generalization, disability, quality of life