630 Fear Avoidance Beliefs and Behaviours of Burn Survivors: A Mixed Methods Approach

Abstract Introduction The Fear-Avoidance (FA) Model describes a cascade of events after pain that is perceived as threatening, which may lead to avoidance of valued and meaningful life activities and greater disability. Literature examining burn survivors (BS) suggests they may experience FA, however, the evaluation tool that has been used is four items extracted from the Tampa Scale of Kinesiophobia that were modified for BS, but never formally validated with this population. Therefore, the aim of this study was to explore the lived-experience of BS with respect to FA and determine whether the questionnaire reflects and accurately measures their lived-experience. Methods A mixed methods approach was used with quantitative data collected using the modified questionnaire followed by individual interviews to gather qualitative data about the participants’ opinion and perceived relevance of the questionnaire using cognitive debriefing as well as their lived-experience of FA. Participants were recruited using purposeful sampling so that a range of FA beliefs and behaviors were explored. The inclusion criteria were adults BS who required hospitalization and skin grafting whose burn injury occurred within the past 3 years. Results 17 participants (9 ♂, 8 ♀, mean age = 51, mean TBSA burned = 22%, mean days post-burn = 458). The overall mean score of the questionnaire was 1.63 where >1 is considered FA. Five major themes emerged from the thematic analysis of the interviews: perceived vulnerability to re-injury; others as fear influencers; difficulties & hardships during recovery; engagement in activity, and active thoughts. The questionnaire results identified 12 FA participants vs 9 based on the interviews. Only one of the questions was able to discriminate FA participants from non FA participants and none of the current questions clearly resonated with BS. Conclusions This study demonstrated that the modified questionnaire did not demonstrate the ability to quantify or reflect the BS lived-experience of FA. However, this remains an important issue since more than half of the participants reported avoiding engagement in valued life activities due to fear of pain or injury even months or years after their injury. Further research should focus on protective factors that may aid patients in reducing or preventing FA. Applicability of Research to Practice FA should be evaluated and addressed with BS using an assessment tool that has been specifically validated with this population.