The Role Of Movement Confidence And Kinesiophobia In The Clinical Course Of Low Back Pain: A Prospective Study

Background: Low back pain is the leading cause of disability worldwide, affecting 619 million people in 2020 and forecast to exceed 800 million by 2050. It is a frequent trigger for primary-care physiotherapy referral. Although guidelines favour active, exercise-centred management, outcomes vary with psychosocial factors: higher self-efficacy improves recovery while kinesiophobia worsens it. The contribution of movement-related confidence remains unknown. This study aimed to examine how confidence in movement ability and fear of movement influence the clinical progression of low back pain. Methods: This prospective observational study followed adults in primary care who began physiotherapy for acute or chronic low-back pain. Participants were evaluated at their first and final treatment sessions for pain intensity, functional disability, movement confidence (OPTIMAL confidence sub-scale) and fear of movement (Tampa Scale for Kinesiophobia). Spearman’s rank correlations examined relations among baseline variables, while Wilcoxon signed-rank tests tested within-patient change. Independent predictors of discharge disability were identified by multiple linear regression, with forward selection and checks for multicollinearity. All analyses were two-tailed with an alpha of 0.05. Results A total of 111 participants completed the baseline assessment; 98 completed the follow-up. Confidence and kinesiophobia improved significantly during physiotherapy (p < 0.001), with greater changes among patients who reported recovery. Confidence was significantly lower and kinesiophobia was greater in participants classified as having high psychosocial risk (p ≤ 0.001). Confidence showed the strongest correlation with disability (ρ = 0.563, p < 0.001). Neither baseline confidence nor kinesiophobia independently predicted outcome once baseline disability was considered. The regression model explained 47.1% of the variance in discharge disability. Conclusion Patients with low back pain who initiate physiotherapy in primary care often present with low confidence and moderate fear of movement. Although not predictive of outcome, confidence may serve as a sensitive marker of change during physiotherapy. Trial Registration: The study was prospectively registered at ClinicalTrials.gov (NCT05860426). Registration date: 26 April 2023.