Fear Avoidance Beliefs As a Predictor for Long-term Sick Leave, Disability and Pain in Patients with Chronic Low Back Pain

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2018 Dec 5

PMID 30509231

Citations 29

Authors

Jeanette Sora Trinderup

Annette Fisker

Carsten Bogh Juhl

Tom Petersen

Affiliations

Soon will be listed here.

Abstract

Background: Subgrouping patients with chronic low back pain is recommended prior to selecting treatment strategy, and fear avoidance beliefs is a commonly addressed psychological factor used to help this subgrouping. The results of the predictive value of fear avoidance beliefs in patients with chronic low back pain in prognostic studies are, however, not in concordance. Therefore, the objective of this study was to examine the association between fear avoidance beliefs at baseline and unsuccessful outcome on sick leave, disability and pain at 12-month follow-up in patients with entirely chronic low back pain.

Methods: A secondary analysis of data from a randomised controlled trial. Patients with chronic low back pain (n = 559) completed questionnaires at baseline and after 12 months. Multiple logistic regression analyses were conducted to examine the association between fear avoidance beliefs and the outcomes sick leave, disability and pain.

Results: Higher fear avoidance beliefs about work at baseline were found to be significantly associated with still being on sick leave (OR 1.11; 95% CI 1.02-1.20) and having no reduction in pain (OR 1.04; 95% CI 1.01-1.08) after 12 months and may be associated with having no reduction in disability (OR 1.03; 95% CI 1.00-1.06) after 12 months (lower limit of 95% CI close to 1.00). Fear avoidance beliefs about physical activity were not found to be associated with the three outcomes.

Conclusions: High fear avoidance beliefs about work are associated with continuous sick leave after 1 year in patients with chronic low back pain. This finding might assist clinicians in choosing targeted treatment strategies in subgroups of working patients with chronic low back pain.

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References

George S, Fritz J, Childs J . Investigation of elevated fear-avoidance beliefs for patients with low back pain: a secondary analysis involving patients enrolled in physical therapy clinical trials. J Orthop Sports Phys Ther. 2008; 38(2):50-8. PMC: 2881572. DOI: 10.2519/jospt.2008.2647. View

Kamper S, Apeldoorn A, Chiarotto A, Smeets R, Ostelo R, Guzman J . Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev. 2014; (9):CD000963. PMC: 10945502. DOI: 10.1002/14651858.CD000963.pub3. View

van den Heuvel S, Ariens G, Boshuizen H, Hoogendoorn W, Bongers P . Prognostic factors related to recurrent low-back pain and sickness absence. Scand J Work Environ Health. 2005; 30(6):459-67. DOI: 10.5271/sjweh.835. View

Feitosa A, Lopes J, Bonfa E, Halpern A . A prospective study predicting the outcome of chronic low back pain and physical therapy: the role of fear-avoidance beliefs and extraspinal pain. Rev Bras Reumatol Engl Ed. 2016; 56(5):384-390. DOI: 10.1016/j.rbre.2016.03.002. View

Leeuw M, Goossens M, Linton S, Crombez G, Boersma K, Vlaeyen J . The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2006; 30(1):77-94. DOI: 10.1007/s10865-006-9085-0. View

Gregg C, McIntosh G, Hall H, Hoffman C . Prognostic factors associated with low back pain outcomes. J Prim Health Care. 2014; 6(1):23-30. View

Hill J, Dunn K, Lewis M, Mullis R, Main C, Foster N . A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum. 2008; 59(5):632-41. DOI: 10.1002/art.23563. View

Grotle M, Vollestad N, Brox J . Clinical course and impact of fear-avoidance beliefs in low back pain: prospective cohort study of acute and chronic low back pain: II. Spine (Phila Pa 1976). 2006; 31(9):1038-46. DOI: 10.1097/01.brs.0000214878.01709.0e. View

Royston P, Moons K, Altman D, Vergouwe Y . Prognosis and prognostic research: Developing a prognostic model. BMJ. 2009; 338:b604. DOI: 10.1136/bmj.b604. View

10.

Iversen T, Solberg T, Wilsgaard T, Waterloo K, Brox J, Ingebrigtsen T . Outcome prediction in chronic unilateral lumbar radiculopathy: prospective cohort study. BMC Musculoskelet Disord. 2015; 16:17. PMC: 4326298. DOI: 10.1186/s12891-015-0474-9. View

11.

Heymans M, Anema J, van Buuren S, Knol D, van Mechelen W, de Vet H . Return to work in a cohort of low back pain patients: development and validation of a clinical prediction rule. J Occup Rehabil. 2009; 19(2):155-65. DOI: 10.1007/s10926-009-9166-3. View

12.

Olsen L, Mortensen E, Bech P . The SCL-90 and SCL-90R versions validated by item response models in a Danish community sample. Acta Psychiatr Scand. 2004; 110(3):225-9. DOI: 10.1111/j.1600-0447.2004.00399.x. View

13.

Waddell G, Newton M, Henderson I, Somerville D, Main C . A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993; 52(2):157-168. DOI: 10.1016/0304-3959(93)90127-B. View

14.

Fourney D, Andersson G, Arnold P, Dettori J, Cahana A, Fehlings M . Chronic low back pain: a heterogeneous condition with challenges for an evidence-based approach. Spine (Phila Pa 1976). 2011; 36(21 Suppl):S1-9. DOI: 10.1097/BRS.0b013e31822f0a0d. View

15.

Wertli M, Rasmussen-Barr E, Weiser S, Bachmann L, Brunner F . The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J. 2014; 14(5):816-36.e4. DOI: 10.1016/j.spinee.2013.09.036. View

16.

Manniche C, Asmussen K, Lauritsen B, Vinterberg H, Kreiner S, Jordan A . Low Back Pain Rating scale: validation of a tool for assessment of low back pain. Pain. 1994; 57(3):317-326. DOI: 10.1016/0304-3959(94)90007-8. View

17.

Chapman J, Norvell D, Hermsmeyer J, Bransford R, DeVine J, McGirt M . Evaluating common outcomes for measuring treatment success for chronic low back pain. Spine (Phila Pa 1976). 2011; 36(21 Suppl):S54-68. DOI: 10.1097/BRS.0b013e31822ef74d. View

18.

Steenstra I, Verbeek J, Heymans M, Bongers P . Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature. Occup Environ Med. 2005; 62(12):851-60. PMC: 1740930. DOI: 10.1136/oem.2004.015842. View

19.

Lethem J, Slade P, Troup J, Bentley G . Outline of a Fear-Avoidance Model of exaggerated pain perception--I. Behav Res Ther. 1983; 21(4):401-8. DOI: 10.1016/0005-7967(83)90009-8. View

20.

Hellum C, Johnsen L, Gjertsen O, Berg L, Neckelmann G, Grundnes O . Predictors of outcome after surgery with disc prosthesis and rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up. Eur Spine J. 2012; 21(4):681-90. PMC: 3326124. DOI: 10.1007/s00586-011-2145-3. View