MAINTAINING PHYSICAL ACTIVITY DURING COVID-19: THE INFLUENCE OF PSYCHOSOCIAL VARIABLES IN INDIVIDUALS WITH BACK PAIN

ABSTRACT

Purpose Stressor events, such as COVID-19, may trigger adaptive or maladaptive pain management strategies among individuals with persistent low back pain (LBP). Emerging research shows individuals with lower fear avoidance, depression and anxiety, and greater positive affect and quality of life can better maintain positive pain management strategies during stressor events. For individuals with persistent LBP, physical activity (PA) has been shown to be a beneficial pain management strategy. This study investigated psychosocial variables of individuals with LBP who demonstrated adaptive pain management strategies during COVID-19, indicated by the maintenance of physical activity. Methods Twenty-five individuals with persistent LBP (age 22.4 (3.4) years, 7m, 18f) from an existing longitudinal cohort participated. Participants completed a baseline survey prior to COVID-19. This survey quantified demographics, pain severity, frequency, and duration. Other baseline measures were the Physical Activity Scale, the WHOQOL-Bref physical, psychological, social, and environmental quality of life subscales, Fear Avoidance Beliefs Questionnaire, Hospital Anxiety and Depression Scale, and Trait Affect scale. Participants then completed follow-up surveys for 18 months. During COVID-19 lockdown, the impact of lockdown on PA was assessed. The cohort was dichotomized into individuals reporting the same or more PA (MPA) and those reporting less PA (LPA) and baseline characteristics were compared between groups. Results The LPA group contained 17 individuals and the MPA group contained 8 individuals. There was no significant demographic difference between groups. The MPA group had greater duration of LBP symptoms (p=0.015, d =1.16). The MPA group trended towards higher physical quality of life (p=0.101, d=0.79) and higher environmental quality of life (p=0.057, d=0.96) at baseline. Individuals in the MPA group had lower negative affect (fatigue domain) scores than the LPA group (p=0.038, d=0.86). Depression scores were lower in the MPA group (p=0.006, d=1.12). Conclusions Individuals with persistent LBP who had greater duration of symptoms, better physical and environmental quality of life, lower negative affect, and less depression were more likely to maintain or increase physical activity during COVID-19. These characteristics may facilitate positive adaptation to a stressor event.