Sensor-based Measurement of Fear Avoidance in Chronic Primary Low Back Pain: A Study Protocol

Heuler A, Hebel I, Richer R, Rohleder N, Barke A, Weise C (2025)

Publication Language: English

Publication Type: Conference contribution, Abstract of a poster

Publication year: 2025

Event location: Berlin

Abstract

Background. Chronic primary low back pain is a highly prevalent health condition affecting millions worldwide. It significantly affects daily functioning and overall quality of life, often causing severe distress. A critical factor in chronic back pain is fear avoidance (FA) behavior. In FA behavior individuals avoid physical activities, which they believe might worsen their pain (particularly movements such as lifting objects). This avoidance can lead to a vicious cycle of physical inactivity resulting in disuse, deconditioning and disability. Further consequences of FA include increased helplessness, distress, and social withdrawal.

Research Question. The aim of our interdisciplinary research project is to measure participants’ anticipatory FA and stress response while they watch and rate back-stressing and neutral movements they know they will subsequently execute. The second aim is to distinguish high and low FA participants by virtue of their movement patterns during standard movement tasks using cutting-edge machine learning algorithms.

Methods. 50 healthy participants (18-65 years) will be recruited for the study. Since initial results show that healthy individuals also exhibit FA, albeit to a lesser extent, they will serve as an analogue sample to actual back pain patients. In this study, a back pain simulator will be used to induce lower back pain. Participants will first be shown images of back-straining and neutral movements. They will be asked to rate their level of fear and expected pain when performing these movements. In the second task, participants will perform movement tasks from the Back Performance Scale both with and without wearing the back pain simulator. We will assess participants’ pain (intensity and localization), fear, avoidance, and stress through self-report and established psychophysiological (heart rate variability, skin conductance level) and biological parameters (cortisol, alpha-amylase). Additionally, we will measure stress and movements using contactless sensor technology developed as part of the collaborative research center (CRC) EmpkinS as well as sensor-based reference systems. The experimental setup will be tested in a pilot study with n = 15 participants. 

Expected Results. Based on previous findings, we expect observing differences in the execution of movement tasks between participants with high and low FA. We predict that individuals with high FA will show reduced movements, particularly in the lower back, indicating higher pain, FA, and stress.

Conclusion. Research on anticipatory stress and FA is crucial for better understanding their relationship and addressing contradictory findings. Identifying FA in movement execution using sensor technology and machine learning is an innovative approach that could lay the foundation for developing a real-time biofeedback application. At the conference, we will present and discuss findings of the pilot study.

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Additional Organisation(s)

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Involved external institutions

Universität Duisburg-Essen (UDE) Germany (DE)

How to cite

APA:

Heuler, A., Hebel, I., Richer, R., Rohleder, N., Barke, A., & Weise, C. (2025). Sensor-based Measurement of Fear Avoidance in Chronic Primary Low Back Pain: A Study Protocol. Poster presentation at 4. Deutscher Psychotherapiekongress, Berlin, DE.

MLA:

Heuler, Annika, et al. "Sensor-based Measurement of Fear Avoidance in Chronic Primary Low Back Pain: A Study Protocol." Presented at 4. Deutscher Psychotherapiekongress, Berlin 2025.

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