Abstract
Background: Fear-avoidance beliefs and signs specifically non-organics are considered the psychological factors that have been determined in playing a major role in the advancement of prolonged disability. The current study was directed to explore the prevalence of fear-avoidance belief in patients with neck and back pain seeking physiotherapy and identifying the superior level of fear-avoidance beliefs regarding work or bodily performances which causes chronicity and disability in patients.
 Methodology: An observational study was conducted at the Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences, Ojha Campus, Karachi-Pakistan, from 1st Dec 2019 to 29th Feb 2020. Standard Fear Avoidance Belief Questionnaire (FAB-Q) was used to assess the fear level. The queries determined from the questionnaire were distributed into two types; FABQ-work-related and FABQ-physical activity-related. 
 Results: A total of 100 patients were included in the study, with a mean age of 45.76 ± 13.75 years. 39.0% patients reported neck pain, whereas 61.0% reported back pain. The prevalence of fear-avoidance belief related to physical activity was 90% and related to work was 91%. The results also showed a significant association between gender and work-related fear-avoidance belief with a p-value of 0.024 (≤ 0.05).
 Conclusion: It is concluded that neck and backache sufferers show a high prevalence of fear-avoidance behavior of physical pastime and work score, confining their daily activities and not taking part in any bodily activities due to fear.
Highlights
Cervical pain and back pain are the most common type of pain related to musculoskeletal problems[1]
The Fear Avoidance Belief Questionnaire (FAB-Q) was used with 2 subscales, a 4-item FABQ physical activity scale (FABQ-PA, range: 0 to 24) and a 7-item FABQ work scale (FABQ-W, range: 0 to 42)
Since the FABQ-PA & FABQ-W was used in two ways in this study a continuous score, including the mean and standard deviation were reported and a trichotomies category reporting the proportion and frequency of low and high fear related to physical activity and work was determined
Summary
Cervical pain and back pain are the most common type of pain related to musculoskeletal problems[1]. Due to the pain severity, individuals tend to stay away from physical activity and develop avoidance behavior, converting an acute condition to chronic and deteriorates the reconditioning that leads to disability. The current study was directed to explore the prevalence of fear-avoidance belief in patients with neck and back pain seeking physiotherapy and identifying the superior level of fear-avoidance beliefs regarding work or bodily performances which causes chronicity and disability in patients. The prevalence of fear-avoidance belief related to physical activity was 90% and related to work was 91%. Conclusion: It is concluded that neck and backache sufferers show a high prevalence of fear-avoidance behavior of physical pastime and work score, confining their daily activities and not taking part in any bodily activities due to fear
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