Effect of Pain, Pain-Related Beliefs, and Fear-Avoidance Beliefs on Functional Disability and Fear of Falling in Patients With Degenerative Spinal Diseases: A Path Analysis Study.

PURPOSE: This study aimed to determine the effects of pain, pain-related beliefs, and fear-avoidance beliefs on functional disability and the fear of falling in patients with degenerative spinal diseases.

DESIGN

This cross-sectional correlational study was conducted between December 1, 2024, and March 1, 2025, at the Neurosurgery Clinics of two hospitals.

METHODS

The study sample comprised 102 patients who were diagnosed with degenerative spinal diseases, and who voluntarily consented to participate. Data were collected using the Patient Information Form, the Pain Beliefs Questionnaire (PBQ), the Falls Efficacy Scale-International (FES-I), the Oswestry Disability Index (ODI), the Fear-Avoidance Beliefs Questionnaire (FABQ), and the Visual Analog Scale (VAS). Path analysis was performed to determine the relationships among the variables.

RESULTS

Significant positive correlations were observed among the PBQ, FES-I, ODI, FABQ, and VAS scores. Path analysis further revealed that FABQpa (β = 0.20) and PBQ-OB (β = 0.34) exerted direct positive effects on FES-I scores. In addition, both the VAS (β = 0.45) and FES-I scores (β = 0.47) exerted significant direct effects on ODI scores. The FES-I score was identified as a mediator of the relationships among FABQpa, PBQ-OB, and ODI.

CONCLUSION

This study demonstrated that fear-avoidance and pain-related beliefs play critical roles in improving functional ability in patients with degenerative spinal diseases, even in the absence of the fear of falling.

CLINICAL IMPLICATIONS: To reduce the fear of falling and improve functional outcomes, interventions should incorporate strategies targeting both pain-related and fear-avoidance beliefs.