Relationships Between Pain-Related Psychological Factors, Gait Quality, and Attention in Chronic Low Back Pain

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Project Summary/Abstract Poor gait quality in chronic low back pain (cLBP) contributes to decreased mobility and functional decline. Those with cLBP and pain-related psychological factors (e.g., fear-avoidance, pain catastrophizing) are at elevated risk for these poor clinical outcomes. However, the relationships between fear-avoidance/pain catastrophizing and gait quality in cLBP remain unknown, largely due to use of inconsistent gait quality metrics in small samples. To improve clinical outcomes in this at-risk population, there is a critical need to 1) examine relationships between fear-avoidance/pain catastrophizing and gait quality using rigorous metrics, and 2) conduct a mechanistic exploration of contributors to gait quality impairments. As a first step toward the long-term goal of improving physical therapy interventions for cLBP, the overall objective of this proposal is to 1) determine the relationship between fear-avoidance/pain catastrophizing and gait quality, and 2) test the contribution of attention on gait quality in those with heightened fear-avoidance/pain catastrophizing. The rationale is that establishing the ways in which fear-avoidance/pain catastrophizing are related to gait quality may lead to new treatment interventions (e.g., cognitive reframing surrounding movement, attention-shifting strategies) to improve clinical outcomes in this high-risk population. The central hypothesis is that 1) fear-avoidance/pain catastrophizing is associated with worse gait quality, and 2) reduced attention capacity associated with fear/catastrophizing contributes to poor gait quality. Aim 1 is to determine the relationship between fear-avoidance/pain catastrophizing and gait quality in cLBP. Aim 2 is to determine the role of attention in the relationship between fear-avoidance/pain catastrophizing and gait quality. Under Aim 1, accelerometry-based gait quality metrics will be derived from a large, existing raw data set (n=500) collected as part of an ongoing grant (1U19AR076725-01). For Aim 2, 50 participants will be recruited to perform a dual-task assessing the impact of attention on gait quality. The proposed project is significant because it uses rigorous, accelerometry-based metrics to examine relationships between fear- avoidance/pain catastrophizing and gait quality, and it is the first and necessary step toward identification of novel treatment targets (i.e., fear, attention-related deficits) that when prioritized in physical therapy, may improve outcomes in this population. Under this fellowship, the applicant will gain unique opportunities for integration of top-tier research and clinical training through University of Pittsburgh’s DPT/PhD in Bioengineering program. The proposed project will be completed within the University of Pittsburgh NIH-funded BACPAC Consortium Mechanistic Research Center, where the trainee will have unrivaled access to experts across the country, recruitment and biostatistical support, and novel infrastructure to advance her toward a career as an independent clinician-scientist. A mentorship team consisting of experts in chronic low back pain, gait, attention, translational research, and pain psychology will support the applicant’s training goals in research methods/design, gait accelerometry, human movement, professional development, and mentorship.