Fear-Avoidance Beliefs as Measured by the Fear-Avoidance Beliefs Questionnaire: Change in Fear-Avoidance Beliefs Questionnaire Is Predictive of Change in Self-Report of Disability and Pain Intensity for Patients With Acute Low Back Pain

Abstract

The purposes of this study were to investigate the association among measures of fear-avoidance beliefs, pain intensity, and lumbar flexion and to determine if changes in these measures were predictive of treatment outcome following physical therapy for acute low back pain. It was hypothesized that items of the Fear-Avoidance Beliefs Questionnaire would be correlated with concurrent measures of pain intensity and lumbar flexion. In addition, it was hypothesized that changes in fear-avoidance beliefs would be predictive of changes in self-report of pain intensity and disability. Patients underwent a standard examination that included measures of fear-avoidance beliefs, pain intensity, lumbar flexion, and disability from low back pain. Patients were then re-examined after 4 weeks of physical therapy treatment. Sixty-three patients with acute low back pain enrolled in a clinical trial of physical therapy treatment. Fear-Avoidance Beliefs Questionnaire items were consistently correlated with lumbar flexion, but not with measures of pain intensity. Pearson correlations indicated that changes in disability were significantly associated with changes in fear-avoidance beliefs and pain intensity, but not changes in lumbar flexion. Changes in fear-avoidance beliefs explained significant amounts of variance in changes in average pain intensity while controlling for changes in lumbar flexion. Changes in fear-avoidance beliefs explained significant amounts of variance in changes in disability while controlling for changes in average pain intensity. These results suggest that fear-avoidance beliefs have a similar association with pain intensity, physical impairment, and disability for patients with acute and chronic low back pain. This study provides preliminary support for the use of the Fear-Avoidance Beliefs Questionnaire as an outcome measure for patients with acute low back pain.