DNP Scholarly Projects


Kayla Heldman


Low back pain affects over 80% of the population impacting their quality of life and causing both disability and loss of work productivity. Acute low back pain is seen as a “favorable” prognosis yet many patients continue to suffer from chronic low back pain. Psychological barriers such as fear-avoidance beliefs have been shown to be a contributing factor in low back pain rehabilitation and chronicity. This project was designed to evaluate if fear-avoidance was a health determinant that affects how primary care providers create treatment plans and to explore the relationship between fear-avoidance beliefs with physical therapy outcomes. Specifically, the purpose of this scholarly project was to determine if there was an association between fear-avoidance beliefs and the use of medication, duration of physical therapy treatment, initial functional ability, and overall functional change following physical therapy in patients with acute low back pain. In this cross-sectional study, a retrospective, convenience sample of 6,528 individuals with acute low back pain of less than three months were evaluated. The results show that high fear-avoidance beliefs were significantly associated with the use of prescription medication, decreased functional ability score, and decreased overall functional score change following physical therapy treatment. Prescription medication was also demonstrated to be a significant predictor of functional ability prior to physical therapy. This study’s results suggest that fear-avoidance beliefs were an important predictor of clinical outcomes. Clinical implications include considerations for fear-avoidance beliefs in patients with acute low back pain when assessing and creating treatment plans.



First Advisor

Giese, Jeannie

Scholarly Project Team Member

Price, Joseph

Scholarly Project Team Member

O'Neil Craig


Nursing, School of


Health Sciences & Nursing, Gordon E. Inman College of

Document Type

Scholarly Project


Doctorate of Nursing Practice (DNP)

Degree Level


Degree Grantor

Belmont University


Backache; Pain--Diagnosis; Avoidance (Psychology); Physical therapy

Included in

Nursing Commons