Transfer des Fear-Avoidance Modells in die Praxis : Messung von Disability und Generalisierung von Lernerfahrungen im Kontext einer randomisiert-kontrollierten Studie

Based on the prominent Fear-Avoidance Model Graded in vivo Exposure was adapted to the treatment of chronic low back pain (CLBP) patients. Concerning the selection of patients and the evaluation of treatment effects adequate measurements e.g. for pain-related disability are crucial. First studies found positive effects for exposure therapy in CLBP. But, results of experimental studies questioned the generalization of exposure experiences. This dissertation was realized in the context of a randomized controlled trial evaluating the effectiveness of Graded in vivo Exposure in CLBP, which is described in study I. The dissertation deals with two main subjects. First, we developed a German version of the Quebec Back Pain Disability Scale (QBPDS) and analysed its psychometric properties in a sample of N = 180 CLBP sufferers. The German version approved to be reliable, valid and comparable to other national versions. The exploration of the underlying factor structure proposed a modification of the original six factors into a four-factor solution. Second, the generalization of exposure effects was investigated in N = 53 CLBP patients. While confronted to an unknown fear-eliciting movement in a novel context, participants of the exposure group showed less harm expectations compared to participants who received either cognitive behavioral therapy or no treatment at all. No group differences were found for pain expectations indicating a specific exposure effect which is the reduction of harm expectations as an aspect of fear avoidance. In conclusion, this dissertation provides a German version of the Quebec Back Pain Disability Scale, which demonstrated good psychometric qualities and is comparable to other international versions. Further, we demonstrated the successful generalization of exposure effects in CLBP giving evidence for the long term stability of this treatment.