{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T23:43:50Z","timestamp":1788565430926,"version":"build-2803163510"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T00:00:00Z","timestamp":1665014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"SWORD Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Fear-avoidance beliefs (FAB) have been associated with poorer prognosis and decreased adherence to exercise-based treatments in musculoskeletal (MSK) pain. However, the impact of high FAB on adherence and outcomes in upper extremity MSK (UEMSK) pain is poorly explored, particularly through exercise-based digital care programs (DCP).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>Assess the adherence levels, clinical outcomes and satisfaction in patients with UEMSK pain and elevated FAB after a fully remote multimodal DCP. Associations between FABQ-PA and clinical outcomes were conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Secondary analysis of an ongoing clinical trial. Participants with UEMSK pain (shoulder, elbow, and wrist\/hand) and elevated FAB-physical activity (FABQ-PA \u2265 15) were included. Adherence (completion rate, sessions\/week, total exercise time) and mean change in clinical outcomes\u2014disability (QuickDASH), numerical pain score, FABQ-PA, anxiety (GAD-7), and depression (PHQ-9)\u2014between baseline and end-of-program were assessed. Associations between FABQ-PA and clinical outcomes were conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>520 participants were included, with mean baseline FABQ-PA of 18.02 (SD 2.77). Patients performed on average 29.3 exercise sessions (2.8 sessions\/week), totalizing 338.2 exercise minutes. Mean satisfaction was 8.5\/10 (SD 1.7). Significant improvements were observed in all clinical outcomes. Higher baseline FAB were associated with higher baseline disability (P\u2009&amp;lt;\u2009.001), and smaller improvements in disability (P\u2009&amp;lt;\u2009.001) and pain (P\u2009=\u2009.001). Higher engagement was associated with greater improvements in FABQ-PA (P\u2009=\u2009.043) and pain (P\u2009=\u20090.009).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study provides evidence of the potential benefits of a structured and multimodal home-based DCP in the management of UEMSK pain conditions in patients with elevated FAB in a real-world context.<\/jats:p><\/jats:sec>","DOI":"10.1093\/pm\/pnac149","type":"journal-article","created":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T13:49:41Z","timestamp":1665064181000},"page":"451-460","source":"Crossref","is-referenced-by-count":8,"title":["Fear Avoidance Beliefs in Upper-Extremity Musculoskeletal Pain Conditions: Secondary Analysis of a Prospective Clinical Study on Digital Care Programs"],"prefix":"10.1093","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8440-2044","authenticated-orcid":false,"given":"Dora","family":"Janela","sequence":"first","affiliation":[{"name":"SWORD Health, Inc , Draper, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8981-7049","authenticated-orcid":false,"given":"Fab\u00edola","family":"Costa","sequence":"additional","affiliation":[{"name":"SWORD Health, Inc , Draper, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9679-4639","authenticated-orcid":false,"given":"Maria","family":"Molinos","sequence":"additional","affiliation":[{"name":"SWORD Health, Inc , Draper, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7504-9560","authenticated-orcid":false,"given":"Robert G","family":"Moulder","sequence":"additional","affiliation":[{"name":"Institute for Cognitive Science, University of Colorado Boulder , Boulder, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8737-7569","authenticated-orcid":false,"given":"Jorge","family":"Lains","sequence":"additional","affiliation":[{"name":"PM&R, Rovisco Pais Medical and Rehabilitation Centre , Tocha, Portugal"},{"name":"PM&R, Faculty of Medicine, Coimbra University , Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2536-601X","authenticated-orcid":false,"given":"Justin K","family":"Scheer","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California , San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6025-8511","authenticated-orcid":false,"given":"Virg\u00edlio","family":"Bento","sequence":"additional","affiliation":[{"name":"SWORD Health, Inc , Draper, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2456-5888","authenticated-orcid":false,"given":"Vijay","family":"Yanamadala","sequence":"additional","affiliation":[{"name":"SWORD Health, Inc , Draper, Utah, USA"},{"name":"Department of Surgery, Quinnipiac University Frank H. 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