The role of fear-avoidance beliefs in patients with neck pain: Relationships with current and future disability and work capacity

Abstract

Objectives: To investigate the relationship between fear-avoidance beliefs and future disability and work capacity in patients with neck pain. Design: A prospective observational study. Setting: Physiotherapy outpatient departments. Patients: One hundred and twenty patients with neck pain intensity sufficient to affect their work capacity. Interventions: Patients participated in either six-week conventional physiotherapy or an exercise training programme to test whether the type of treatment received by the patients together with other outcome measures affected the predictive power of fear-avoidance beliefs. Main outcome measures: Patients underwent examination of the active neck range of movements and neck muscle strength and completed the Fear-Avoidance Beliefs Questionnaire, the Northwick Park Neck Pain Questionnaire, the Medical Outcomes 36-Item Short-Form Health Survey and the 11-point pain numerical rating scale. These were assessed at the beginning and at week 6 of the rehabilitation programme. Patients' work capacity was assessed at week 6 and three months after the six-week rehabilitation programme. Results: Spearman's correlation coefficients between fear-avoidance beliefs and initial and week 6 disability levels were 0.47 and 0.48, respectively. Regression analysis showed that the fear-avoidance beliefs significantly improved the goodness of fit of the model for predicting week 6 disability levels and return to complete work capacity at week 6 and three months after the rehabilitation programme, even after controlling for the physical impairments, the health status, the pain intensity and the type of treatment received. Conclusions: The fear-avoidance beliefs factor is an important biopsychosocial variable in predicting future disability level and return to complete work capacity in patients with neck pain. © SAGE Publications 2007.