Poster Sessions - 2018 Research Day

Event Title

Modified Yellow Flag Questionnaire to Identify Fear Avoidance and Guide Treatment In a Patient with Concomitant Peroneal Tendon Tears: A Case Report

Location

Hall of Governors

Start Date

4-6-2018 4:00 PM

End Date

4-6-2018 5:30 PM

Abstract

Background and Purpose: Peroneal tendons play a significant role in functional ankle stability. Fear avoidance of activity may affect recovery in patients with ankle instability. Currently, there is a lack in research in fear avoidance identification and change in plan of care to include pain education for patients with ankle instability. The aim of this case report was to determine plausible modification of the Yellow Flags Questionnaire (YFQ) at identifying fear avoidance behaviors in a patient with concomitant peroneus longus and brevis tears. A secondary purpose was to assess short term functional outcomes following the addition of pain educational interventions for this patient.

Case Description: A 55-year-old female with greater than one-year history of chronic left ankle sprain, which resulted in decreased performance of ADLs due to significant amount of left ankle pain. Conservative therapy was attempted to no avail. Surgery was performed after an MRI revealed a complete peroneal longus and brevis tendon tear.

Outcomes: A modified Yellow Flags Questionnaire (YFQ) was administered at week 8 of 10 with clinical signs of pain catastrophizing with low intensity weight bearing activities. The YFQ score was 46[SD1] , indicating that the patient was at moderate risk of developing chronic pain as a functional limitation. The Lower Extremity Functional Scale (LEFS) and the numeric pain rating scale (NPRS) were the main targeted outcomes throughout treatment. The percent change from re-examination to discharge was greater than examination to re-examination for both LEFS and NPRS scores (58% vs 29% and 67% vs 25%, respectively), indicating an increase in patient perceived function in ADLs.

Discussion: A modified YFQ is plausible for detecting fear avoidance behaviors and guiding a change in interventions to include patient education on pain[SD2] with movement. The history of ongoing diminished functional capabilities due to a chronic ankle sprain prior to surgery may have contributed to a re-wiring in the nervous system, causing inappropriate fear avoidance behaviors. This case study sheds light on the need for further research on developing reliable fear avoidance questionnaires for patients with chronic ankle conditions.

[SD1]How does this score relate to the onset or development of fear avoiding behaviors?

[SD2]What about pain – causes, impact, etc? Please explain briefly.

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Apr 6th, 4:00 PM Apr 6th, 5:30 PM

Modified Yellow Flag Questionnaire to Identify Fear Avoidance and Guide Treatment In a Patient with Concomitant Peroneal Tendon Tears: A Case Report

Hall of Governors

Background and Purpose: Peroneal tendons play a significant role in functional ankle stability. Fear avoidance of activity may affect recovery in patients with ankle instability. Currently, there is a lack in research in fear avoidance identification and change in plan of care to include pain education for patients with ankle instability. The aim of this case report was to determine plausible modification of the Yellow Flags Questionnaire (YFQ) at identifying fear avoidance behaviors in a patient with concomitant peroneus longus and brevis tears. A secondary purpose was to assess short term functional outcomes following the addition of pain educational interventions for this patient.

Case Description: A 55-year-old female with greater than one-year history of chronic left ankle sprain, which resulted in decreased performance of ADLs due to significant amount of left ankle pain. Conservative therapy was attempted to no avail. Surgery was performed after an MRI revealed a complete peroneal longus and brevis tendon tear.

Outcomes: A modified Yellow Flags Questionnaire (YFQ) was administered at week 8 of 10 with clinical signs of pain catastrophizing with low intensity weight bearing activities. The YFQ score was 46[SD1] , indicating that the patient was at moderate risk of developing chronic pain as a functional limitation. The Lower Extremity Functional Scale (LEFS) and the numeric pain rating scale (NPRS) were the main targeted outcomes throughout treatment. The percent change from re-examination to discharge was greater than examination to re-examination for both LEFS and NPRS scores (58% vs 29% and 67% vs 25%, respectively), indicating an increase in patient perceived function in ADLs.

Discussion: A modified YFQ is plausible for detecting fear avoidance behaviors and guiding a change in interventions to include patient education on pain[SD2] with movement. The history of ongoing diminished functional capabilities due to a chronic ankle sprain prior to surgery may have contributed to a re-wiring in the nervous system, causing inappropriate fear avoidance behaviors. This case study sheds light on the need for further research on developing reliable fear avoidance questionnaires for patients with chronic ankle conditions.

[SD1]How does this score relate to the onset or development of fear avoiding behaviors?

[SD2]What about pain – causes, impact, etc? Please explain briefly.