Fear Avoidance Predicts Persistent Pain in Young Adults With Low Back Pain: A Prospective Study

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To (1) quantify relationships between low back pain (LBP) symptoms, physical activity, and psychosocial characteristics in young adults and (2) identify subclasses of young adults with distinct pain trajectories.


Prospective cohort study with 12-month follow-up.


One hundred twenty adults (mean ± SD age, 20.8 ± 2.6 years; 99 women) participated. Participants completed a baseline survey that measured anxiety, depression, fear avoidance, quality of life, and history and impact of any LBP. Participants completed follow-up surveys every 3 months for 1 year. Subclasses based on pain trajectories over time were identified using latent class analysis, and predictors of class membership at baseline were assessed.


Individuals with LBP at baseline had lower physical quality-of-life scores than back-healthy participants (P = .01). Subclass 1 (25% of individuals with LBP) had persistent moderate-to-high pain intensity over the 1-year study period. Subclass 2 (75% of individuals with LBP) had significantly improving pain over the 1-year study period. Higher fear avoidance (physical activity subscale) and pain interference at baseline were associated with greater odds of membership in subclass 1 (odds ratio = 1.2; 95% confidence interval: 1.0, 1.3 and odds ratio = 1.4; 95% confidence interval: 1.1, 1.6, respectively).


Most young adults with LBP had symptoms that improved over time. Levels of fear avoidance and pain interference may help to identify individuals at risk of persistent pain early in the lifespan.


This is a pre-copy-editing, author-produced PDF of an article accepted for publication in Journal of Orthopaedic & Sports Physical Therapy, volume 51, issue 8, in 2021 following peer review. The definitive publisher-authenticated version is available online at https://doi.org/10.2519/jospt.2021.9828.

Peer Reviewed



Journal of Orthopaedic & Sports Physical Therapy