Anxiety Levels, Fear-avoidance Beliefs, and Disability Levels at Baseline and at 1 Year among Subjects with Acute and Chronic Low Back Pain

Randy A. Shelerud,Dirk R. Larson,Brianna J. Crawford,Kristin S. Vickers Douglas,Karen L. Newcomer

doi:10.1016/j.pmrj.2010.03.034

Abstract

To compare anxiety levels, fear-avoidance beliefs, and disability levels over 1 year for patients with acute (< or =3 months) and chronic (>3 months) low back pain (LBP). Prospective study with questionnaire measurements. Tertiary care clinic. Patients with acute or chronic LBP who resided in a 3-county local area and presented to our clinic for initial evaluation. Administration of and results analysis from Fear-Avoidance Beliefs Questionnaire, Oswestry Disability Index, Pain and Impairment Relationship Scale, and Spielberger State-Trait Anxiety Inventory at baseline and 12 months. Trait anxiety was measured at baseline only. Scores from questionnaires assessing fear-avoidance beliefs and state and trait anxiety, as well as LBP disability levels. In total, 138 patients with acute LBP and 107 with chronic LBP were enrolled. Of these patients, 111 with acute and 86 with chronic LBP completed the study. The 2 groups were statistically indistinguishable at baseline on all measures except trait anxiety scores, which were significantly higher in the group with chronic LBP than in the acute group (P = .01). At 1 year, the acute group had a statistically significant improvement in all outcome measures except state anxiety. The group with chronic LBP had significant improvement in all measures except fear-avoidance beliefs and state anxiety. Overall, the group with acute LBP improved more in all measurement instruments than the chronic LBP group (a statistically significant difference) except state anxiety. The group with chronic LBP exhibited a higher level of trait anxiety at baseline than those with acute LBP and, unlike the acute LBP group, did not have improved fear-avoidance beliefs over 1 year. The relationship between anxiety and chronic LBP is novel. Because anxiety is potentially modifiable, future studies that evaluate the relationship between LBP and anxiety are warranted.

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