Understanding discrepancies in a person's fear of movement and avoidance behaviour: a guide for musculoskeletal rehabilitation clinicians who support people with chronic musculoskeletal pain

BACKGROUND: Generic self-report measures do not reflect the complexity of a person's pain-related behaviour. Since variations in a person's fear of movement and avoidance behaviour may arise from contextual and motivational factors, a person-centred evaluation is required-addressing the cognitions, emotions, motivation and actual behaviour of the person. 

CLINICAL QUESTION: Most musculoskeletal rehabilitation clinicians will recognise that different people with chronic pain have very different patterns of fear and avoidance behaviour. However, an important remaining question for clinicians is "how can I identify and reconcile discrepancies in fear of movement and avoidance behaviour observed in the same person, and adapt my management accordingly?". 

KEY RESULTS: We frame a clinical case of a patient with persistent low back pain to illustrate the key pieces of information that clinicians may consider in a person-centred evaluation (i.e., patient interview, self-report measures and behavioural assessment) when working with patients to manage fear of movement and avoidance behaviour. 

CLINICAL APPLICATION: Understanding the discrepancies in a person's fear of movement and avoidance behaviour is essential for musculoskeletal rehabilitation clinicians, as they work in partnership with patients to guide tailored approaches to changing behaviours.