Influência da dor lombar crônica na percepção de affordances

Abstract

Individuals with chronic low back pain modify their movement patterns and avoid various motor tasks. These individuals likely reduce their exploration and use of available action possibilities in the environment. These possibilities for action are called affordances. From an ecological-enactive perspective, chronic pain progressively reduces the field of affordances, limiting opportunities for meaningful actions. There are still no studies comparing the perception of affordances in patients with and without chronic low back pain. Therefore, the aim of this study was to assess the exploration and perception of affordances in individuals with and without chronic low back pain. This was an exploratory cross-sectional observational study in which 27 individuals with pain and 28 asymptomatic individuals used a 60 cm bar attached to their shoulders (standardizing shoulder width) and performed tasks involving walking through three openings of 50, 70, and 120 cm while their movements were recorded using inertial sensors. They were also asked to judge the possibility of passing through an adjustable width doorway (ranging from 40 to 120 cm). Questionnaires on pain, functionality, kinesiophobia, and psychosocial aspects were administered. Exploratory movements were captured by the sensors during the moments preceding the passages, and affordance perception was quantified by the perception-action ratio, calculated by dividing the perceived action threshold (the narrowest passage judged as passable) by the shoulder width (60 cm). Comparisons between groups were made using appropriate statistical tests, considering ɑ < 0.05. The group with pain showed greater disability (p = 0.001), higher kinesiophobia (p = 0.031), and a higher perception-action ratio (p = 0.001), indicating a higher action threshold (narrowest judged passage) (p = 0.003) than participants without pain. In the pain group, significant positive correlations were found between the action threshold and pain levels (p = 0.001). However, no significant differences were observed between the groups in the exploratory movements prior to the passages through the 50 cm and 70 cm openings (p = 0.861 and p = 0.108, respectively). This study suggests that chronic low back pain may impact the perception of affordances, leading to an underestimation of action capabilities, even without significantly altering individuals’ exploratory movement patterns. Understanding the perception and exploration of affordances in people with chronic low back pain may help explain movement avoidance and the ongoing dysfunction associated with chronic pain.