Background and aims: There is abundant evidence for compromised movement performance in low back pain (LBP). It has been proposed that not only pain severity, but also cognitive-affective factors such as fear and catastrophizing might influence movement, but no overview exists regarding the specific influence of such factors on movement performance in LBP.
Methods: A systematic review was performed and reported following the PRISMA-guidelines. A comprehensive search strategy was used in Pubmed, Web of Science, Embase, CINAHL and PsycArticles to identify all relevant studies. Possible risk-of-bias (ROB), levels of evidence and conclusion were determined of the included studies.
Results: Fifty-two studies were included (ROB 40-90%), the majority performed in chronic LBP. Catastrophizing and fear were respectively studied in 18 and 46 studies. Studied movement performance parameters included trunk muscle timing, activity, endurance and strength, range of motion, general endurance and deconditioning, balance, proprioception and coordination. Limited evidence indicates that in LBP the presence of a motor control strategy with tight control/guarding is mediated through catastrophizing and fear, rather than by pain severity. Furthermore, altered proprioception in LBP appears to be mediated through fear. However, these inferences need further exploration as most are based upon single studies.
Conclusions: This systematic review is the first to summarize and specify the influence of catastrophizing and fear on movement performance in LBP, as assumed in current theoretical models of pain-related disability and suffering. Implementation of bio-psychosocial assessment and treatment seems valuable for patients with disturbed motor control, trunk muscle endurance, mobility, and lifting performance.

THE INFLUENCE OF CATASTROPHIZING AND FEAR ON MOVEMENT PERFORMANCE IN LOW BACK PAIN: A SYSTEMATIC REVIEW