Landers MR, Creger RV, Stutelberg KS, Baker CL; Department of Physical Therapy, University of Nevada, Las Vegas. Merrill.Landers@ccmail.nevada.edu.

PURPOSE: The fear-avoidance model suggests that patients with an exaggerated fear of pain will avoid physical activities that are anticipated to increase pain. This avoidance of physical activity and behavior, which is conditioned by underlying psychological factors, is thought to influence the duration of disability during the subsequent course of recovery. The purpose of this study was to investigate the relationship between fear-avoidance beliefs and functional limitation in a cohort of patients with neck pain. SUBJECTS: Eighty-four consecutive patients (5 acute, 21 subacute, and 58 chronic) experiencing neck pain at four outpatient physical therapy clinics were recruited to participate in this study. Patients were classified into four groups based on the potential for secondary gain: no gain (56 patients), worker’s compensation (15 patients), litigation involving a motor vehicle accident (9 patients), and other gain (4 patients). METHODS: Each of the patients completed a modified Fear-Avoidance Beliefs Questionnaire (FABQ) (‘low back’ wording changed to ‘neck’) and the Neck Disability Index (NDI) during the initial examination. The Neck Disability Index was then completed again 12 weeks after the initial evaluation. Physical therapy intervention and medical management were left to the discretion of the treating physical therapist and referring physician. ANALYSIS: Correlational coefficients (Spearman’s rho) were used to quantify the relationships for the following variables: FABQ (total score and two subscales, work (FABQ1) and activity (FABQ2)), initial NDI, 12-week NDI, and secondary gain. RESULTS: Moderate negative correlations (r = .544 - .643) were significant at p < .01 for the initial and 12-week NDI scores with the total FABQ and the two subscales, FABQ1 and FABQ2. Low, but significant negative correlations were found for secondary gain to the FABQ, FABQ1 and FABQ2. The strongest of these correlations was an r of -.398 with the FABQ1. CONCLUSION: These observed moderate correlations provide evidence that fear avoidance beliefs are inversely related to function. That is, subjects who had high initial FABQ scores reported more functional limitation after 12 weeks than those who had low initial FABQ scores. These results lend support to the notion that fear-avoidance beliefs may play a role in chronicity of symptoms and the development of abnormal illness behavior. FUNDING SOURCE: None.

Copyright 2004 by the American Physical Therapy Association

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