Is the Community 'Safe'? Exploring FearAvoidance Beliefs in Patients Transitioning from Clinical to Community-Based Activity

About the Project

Background and Rationale

While clinical guidelines unanimously recommend selfmanagement and physical activity for chronic musculoskeletal (MSK) pain, long-term adherence to these interventions remains poor once clinical supervision ceases (Meade et al., 2019). The "Fear-Avoidance Model" suggests that for many patients, pain is interpreted as a sign of damage, leading to catastrophic thinking and avoidance of movement (Vlaeyen et al., 2016). In a clinical setting, the presence of a physiotherapist acts as a "safety signal," allowing patients to move despite pain. However, the transition to community-based activities (e.g., local gyms or walking groups) removes this safety signal. Recent qualitative inquiry suggests that patients may view the community environment as "unsafe" or unpredictable, leading to a resurgence of protective behaviours and subsequent relapse (Bunzli et al., 2017). There is a paucity of research quantifying how these specific safety beliefs influence the uptake of social prescribing referrals. Understanding the "psychological safety" of the community environment is critical to improving the fidelity of the discharge process.

Study Aims

The aim of this mixed-methods study is to investigate the relationship between fear-avoidance beliefs, "safety behaviours," and the successful transition from one-to-one physiotherapy to independent community-based physical activity.

Supervisory Team

• Director of Studies: Dr Kostas Papadopoulos k.papadopoulos@worc.ac.uk
• Supervisors: Dr Helen Frank H.frank@worc.ac.uk
• Research Group: Living with Long-Term Conditions Research Group

Application Process

To begin the application process please go to: https://www.worc.ac.uk/research/research-degrees/applying-for-a-phd/.

The Interview

All successful applicants will be offered an interview with the proposed Supervisory Team. You will be contacted by a member of the Doctoral School Team to find a suitable date. Interviews can be conducted in person or over Microsoft Teams.

Funding your PhD

For information about Doctoral Loans please visit: https://www.worc.ac.uk/study/feesand-finance/doctoral-loans.aspx

During your PhD you can access the Research Conference Support Scheme to support the costs of presenting your research at an external conference.

For further information or an informal discussion on this project, please contact Dr Konstantinos Papadopoulos k.papadopoulos@worc.ac.uk

References

• Bunzli, S., Smith, A., Schütze, R., Lin, I. and O'Sullivan, P. (2017). 'Making sense of low back pain and pain-related fear'. Journal of Orthopaedic & Sports Physical Therapy, 47(9), pp. 628–636.
• Meade, L.B., Bearne, L.M. and Sweeney, L.H. (2019). 'Behaviour change techniques associated with adherence to prescribed exercise in patients with persistent musculoskeletal pain: Systematic review'. British Journal of Health Psychology, 24(1), pp. 10–30.
• Vlaeyen, J.W., Crombez, G. and Linton, S.J. (2016). 'The fear-avoidance model of pain'. Pain, 157(8), pp. 1588–1593.