Comparative analysis of attitudes and threat perceptions towards physical activities in individuals with and without low back pain

Background Low back pain (LBP) is a leading cause of disability, significantly impacting daily functioning and healthcare systems. Psychological factors, particularly fear-back pain attitudes beliefs, influence LBP progression and movement-related threat perception. However, comparative differences in attitudes between individuals with and without LBP remain underexplored. Objective This study investigates differences in threat perceptions and attitudes toward physical activities between LBP and non-LBP individuals using the short electronic PHODA-SeV, Back-Paq, and an ad hoc questionnaire assessing pain experience, activity impact, social support, motivation, cultural influence, and treatment choices. Methods A cross-sectional comparative study was conducted with 84 participants. Perceived threat levels were assessed using PHODA-SeV (0–100 scale), while beliefs about back pain were evaluated via Back-Paq (5-point Likert scale). The Back-Paq assessed constructs such as back resilience, injury vulnerability, activity avoidance, postural concerns, and recovery beliefs. Statistical analyses included Chi-square tests, Kruskal–Wallis tests, Welch’s ANOVA, Mantel–Haenszel Chi-square, Principal Component Analysis (PCA), and Multinomial Logistic Regression to examine associations between LBP history, cognitive beliefs, and movement-related fear. Results LBP individuals exhibited lower PHODA-SeV scores (46.85) than non-LBP individuals (50.51), though the difference was statistically insignificant. However, LBP history was significantly associated with beliefs regarding back fragility and injury risk ( p < 0.05). Multinomial logistic regression revealed that females with LBP were 4.7 times more likely to report fear-avoidance behaviors ( p = 0.023). PCA identified key cognitive components, including back pain attitudes beliefs, passive coping strategies, significantly influencing threat perception ( p < 0.01). High-threat activities included falling backward, vacuuming, and lifting toddlers, while sitting postures and static tasks were perceived as least threatening. Conclusion Distinct cognitive and behavioral differences exist between LBP and non-LBP individuals, emphasizing the need for targeted rehabilitation and education strategies to mitigate back pain attitudes maladaptive beliefs, and enhance movement confidence. Gender-specific interventions and biomechanical training may improve physical activity engagement and long-term recovery outcomes.