Rehabilitation Interventions for Fear Avoidance Beliefs and Behaviors in Sudden Onset Musculoskeletal Conditions: A Scoping Review

Abstract Fear avoidance (FA) describes beliefs and behaviors related to avoiding movements or activities after a painful event. FA is a prevalent issue that limits the recovery outcomes and social reintegration of burn survivors. However, as current literature focuses on chronic conditions, understanding the impact and treatment of FA within sudden onset musculoskeletal (MSK) conditions, specifically in the burn survivor population, is lacking. The purpose of this scoping review is to synthesize evidence-based rehabilitation interventions aimed at improving FA behaviors and beliefs after sudden onset MSK conditions, and to provide suggestions for clinical application with the burn survivor population. Ovid Medline, Ovid EMBASE, CINAHL and PsycINFO were sourced from inception to May 2023. Monthly Google Scholar searches and hand searching of included articles’ reference lists were done to add additional relevant publications. Eligibility criteria included: 1) adults with sudden onset MSK condition, 2) intervention from a rehabilitation professional, and 3) FA as primary outcome. Four authors performed data extraction using the TIDIER checklist. Seven intervention types were identified: 1) education; 2) exercise; 3) graded motor imagery; 4) manual therapy (MT); 5) multimodal – education with exercise; 6) multimodal – education with MT and exercise; and 7) multimodal - interactive gaming console with exercise. All intervention types, except MT, demonstrated significant decreases in FA. This review summarizes effective rehabilitation interventions to address FA while highlighting the role of rehabilitation professionals in improving function and alleviating potential disability stemming from FA despite physical recovery.