Date Approved


Date Posted


Degree Type

Open Access Thesis

Degree Name

Doctor of Philosophy (PhD)

Department or School


Committee Member

Flora Hoodin, Ph.D., Chair

Committee Member

Michael E. Geisser, Ph.D.

Committee Member

Ellen I. Koch, Ph.D.

Committee Member

Kenneth W. Rusiniak, Ph.D.


Disability in chronic low back pain patients has been established as a function of variables across three areas: pain, cognitive-behavioral variables, and social variables. New technology has improved the ability to accurately measure physical activity, a significant component of disability, through the use of actigraphy for real-time ambulatory monitoring. The current study assessed between and within patient changes in physical activity as a function of current pain, anticipated pain, pain sensitivity, depression, pain anxiety, catastrophizing, and significant others' responses. Time-series and ordinary least squares regression analyses of 20 participants revealed that patients change their physical activity based on both their current experience of pain and their anticipation of future pain. Additionally, patients differ in amount of activity based on their sensitivity to pain, fear of pain, and receiving solicitous responses to their pain from a significant other. The results support the fear-avoidance model of pain through multiple findings: (1) some patients escape from current pain by decreasing activity; (2) some patients avoid future pain by engaging in low levels of activity when they anticipate their pain could worsen; (3) patients with higher sensitivity to pain engage in less physical activity; (4) patients who endorse more beliefs that their pain is harmful engage in less physical activity; and (5) patients whose significant others are overly responsive to the pain and inadvertently reinforce beliefs that pain is harmful also engage in less activity. However, a strength of this study was the ability to simultaneously analyze a wide variety of theoretically-based predictors. Results of this comprehensive analysis revealed that variables from the Social Model accounted for a statistically significant amount of the variance in physical activity. These results are particularly meaningful given that increase in physical activity is a core component of many treatments for chronic low back pain. By better understanding the variables that impact physical activity in low back pain patients, clinicians can more accurately assess patients and intervene more effectively.


Additional committee member: Kenneth W. Rusiniak, Ph.D.