Fear-avoidance Beliefs In Patients Research Articles

A comparison of kinesiophobia, pain-activity patterns and fear-avoidance beliefs in patients with chronic low back pain

Chronic pain affects individuals’ activity levels. Three activity patterns are observed among individuals with chronic pain: avoidance, overdoing, and regularization. According to fear - avoidance models, kinesiophobia is related to pain severity and disability. Kinesiophobia is a psychological factor that attracts attention in people with persistent pain, is related to the severity and persistence of pain. The aim of this study was to compare demographic and clinical characteristics of individuals with chronic inflammatory low back pain (ILBP) and mechanical low back pain (MLBP), in relation to kinesiophobia, fear-avoidance beliefs, and pain/activity patterns. A total of 89 people (45 MLBP, 44 ILBP) aged 18-65 were included in this cross-sectional study. A Visual Analog Scale (VAS) was used to inquire about for the duration of axial spondylarthritis diagnosis, duration of LBP, duration of morning stiffness, general pain, pain during movement, and night pain. Patients' fear of movement due to pain was assessed with the Tampa Kinesiophobia Scale (TKS), pattern changes in daily activities were assessed with the Pain-Activity Pattern Scale (PAPS), and fear-avoidance was assessed with the Fear-Avoidance Beliefs Questionnaire (FABQ). The scores obtained were compared. There was no statistically significant difference between the MLBP and ILBP groups in terms of age (p=0.202), BMI (p=0.124), gender (0.459), education level (p=0.082) and pain duration (p=0.018), VAS-movement (p=0.071), FABQ score (0.277), PAPSa (p=0.454), PAPSe (0.596), PAPSs (p=0.247), and TKS score (p=0167). Whereas a statistically significant difference was found between the duration of morning stiffness (p=0.001), VAS resting (p=0.001), and VAS night (p=0.001) score. It was observed that high resting and night VAS scores in the ILBP group were not associated with fear-avoidance and kinesiophobia behaviors any more than in the MLBP group. The fear- avoidance and kinesiophobia behaviors of both groups were affected to a similar extent, even though the pain type was different.

Impact of Specific Training for Fear Avoidance Beliefs Training on Patients with Non-Specific Chronic Low Back Pain

Background: Fear-avoidance beliefs (FAB) are related to disability, postural stability, and chronicity of low back pain. The aim of this study is to investigate the impact of specific training for FAB on postural stability, disability, pain, abdominal and back muscle endurance, and FAB in patients with non-specific chronic low back pain (NCLBP).

"Myths and Facts" Education Is Comparable to "Facts Only" for Recall of Back Pain Information but May Improve Fear-Avoidance Beliefs: An Embedded Randomized Trial.

To assess the effectiveness of patient education with "myths and facts" versus "facts only" on recall of back pain information and fear-avoidance beliefs in patients with chronic low back pain (LBP). Randomized Study Within A Trial. One hundred fifty-two participants with chronic LBP were included. Participants allocated to the "facts only" group received an information sheet with 6 LBP facts, whereas those allocated to the "myths and facts" group received the same information sheet, with each myth refuted by its respective fact. The primary outcome was a correct recall of back pain facts, and the secondary outcome was the physical activity component of the Fear-Avoidance Beliefs Questionnaire (FABQ-PA), 2 weeks after the provision of the information sheet. There was no evidence of a difference in the proportion of participants with a correct recall between the "myths and facts" and "facts only" groups (odds ratio = 0.98; 95% confidence interval [CI]: 0.48, 1.99) and no significant difference in FABQ-PA mean scores between groups (-1.58; 95% CI: -3.77, 0.61). Sensitivity analyses adjusted for prognostic factors showed no difference in information recall but a larger difference in FABQ-PA scores (-2.3; 95% CI: -4.56, -0.04). We found no overall difference in the recall of back pain information for patients provided with "myths and facts" compared with that for patients provided with "facts only" and a slight reduction in fear-avoidance beliefs for physical activity using "myths and facts" compared with that using "facts only," but the meaningfulness of this result is uncertain. J Orthop Sports Phys Ther 2022;52(9):586-594. Epub: 9 July 2022. doi:10.2519/jospt.2022.10989.

Fear avoidance beliefs as a predictor for long-term sick leave, disability and pain in patients with chronic low back pain

BackgroundSubgrouping 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.MethodsA 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.ResultsHigher 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.ConclusionsHigh 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.

Myofascial release improves pain and disability in non-specific chronic low back pain: A randomized clinical trial

Introduction: Despite its high prevalence, the etiology and the nature of chronic low back pain (CLBP) have not yet been fully understood. It has been suggested that soft tissues such as thoracolumbar fascia (Langevin et al 2011; Schleip & Klingler 2008) and other lumbar muscles might be related to LBP (Borg-Stein & Wilkins 2006; DeFranca & Levine 1991). Myofascial Release (MFR) is a form of manual treatment widely used by physiotherapists in the management of different musculoskeletal pathologies (Barnes 1990). No previous studies have reported the effects of an isolated MFR treatment in patients with CLBP. The purpose of this study is to investigate the effects of an isolated MFR protocol on pain, disability, and fear-avoidance beliefs in patients with CLBP.

Translation and validation of Marathi version of Fear-Avoidance and Belief Questionnaire in patients with chronic low back pain

Background: Fear-Avoidance Beliefs Questionnaire (FABQ) is widely used to assess the fear-avoidance beliefs in patients with low back pain (LBP). However, English serves as a barrier to the population of the state where Marathi is the prime language. Hence, the FABQ needs to be translated into Marathi for the ease of its use. Materials and Methods: FABQ was successfully translated in Marathi using forward-backward translation using recommended guidelines. The final version of FABQ-Marathi version (FABQ-M) was used on 100 patients with chronic nonspecific LBP to assess its reliability and validity. Reliability was assessed by measuring the internal consistency of FABQ-M and its subscales and by checking the test-retest reliability on day 1 and day 2. For the determination of construct validity, convergent and divergent validity was assessed. The floor and ceiling effects were studied. Results: Reliability-internal consistency-Cronbach's alpha for FABQ-M was 0.860 and test–retest: correlation between FABQ-M on day 1 and day 2 were highly significant. The intraclass coefficient was 0.976. There was a high internal consistency between the FABQ-M and its subscales. On assessing convergent validity, there was moderate correlation found between FABQ-M and TSK (r = 0.52, P = 0.00). Divergent validity showed moderate correlation between FABQ-M and NRS (r = 0.48, P = 0.00) and between FABQ-M and RMDQ (r = 0.59, P = 0.00). Conclusion: The translated FABQ-M proved to be acceptable. The results suggest it is a validated, an easy to comprehend, reliable, and valid instrument for the measurement of the fear and avoidance beliefs caused by back disorders in the Marathi-speaking population.

High Disease Activity May Increase Fear-Avoidance Beliefs in Rheumatoid Arthritis

This study aims to compare fear-avoidance (FA) beliefs of rheumatoid arthritis (RA) patients with osteoarthritis (OA) of hand patients and fibromyalgia (FM) patients and evaluate its relationship with RA activity and duration. The study included 206 patients with RA (34 males, 172 females; mean age 49 years; range 20 to 72 years), 57 patients with FM (57 females; mean age 48 years; range 20 to 71 years), and 50 patients with OA of hand (4 males, 46 females; mean age 43 years; range 43 to 77 years). FA beliefs were assessed with modified Fear-Avoidance Belief Questionnaire (mFABQ). RA patients were dichotomized according to disease activity and disease duration separately; cutoff values were disease activity score 28 of 3.2 and six months of disease activity, respectively. Modified Fear-Avoidance Belief Questionnaire scores were similar in patients with RA, OA of hand, and FM. RA patients in non-remission group had higher mFABQ scores. Moreover, mFABQ scores were similar in RA patients with early and established disease groups. Fear-avoidance beliefs of patients with RA were similar with OA of hand patients and FM patients. However, higher disease activity in RA was related with escalated FA beliefs. Further studies focusing on pathophysiology of FA beliefs in patients with RA are warranted for effective pain management of RA.

A Preliminary Study of the Objective Measurement of Compliance Rates for Semirigid Lumbar-Support Use in Patients with Chronic Nonspecific Low Back Pain: How Important Is the Compliance Rate?

Study DesignClinical pilot study.PurposeTo objectively evaluate the compliance rate of lumbar-support use in patients with chronic nonspecific low back pain, as well as to assess low back pain intensity, disability, and fear-avoidance beliefs.Overview of LiteratureWearing time is an important factor in the assessment of the efficacy of lumbar-support use in patients with chronic nonspecific low back pain. Previous studies have measured lumbar-support wearing time based on subjective assessment, and these evaluations are not easily verifiable and are usually overestimated by subjects.MethodsTwelve subjects with chronic nonspecific low back pain who had been wearing semirigid lumbar supports for 6 weeks were evaluated. Compliance was objectively monitored using temperature sensors integrated into the semirigid lumbar supports. Subjects wore their lumbar supports for 8 hour/day on workdays and 3 hour/day on holidays during the first 3 weeks. During the next 3 weeks, subjects were gradually weaned off the lumbar supports. Pain intensity was measured using a numerical rating scale. The Oswestry disability index was used to assess the subjects' disability. Fear-avoidance behavior was evaluated using a fear-avoidance beliefs questionnaire.ResultsThe mean compliance rate of the subjects was 78.16%±13.9%. Pain intensity was significantly lower in patients with a higher compliance rate (p=0.001). Disability index and fear-avoidance beliefs (functional outcomes) significantly improved during the second 3-weeks period of the treatment (p<0.001, p=0.02, respectively).ConclusionsThe compliance rate of patients wearing lumbar supports is a determining factor in chronic low back pain management. Wearing semirigid lumbar supports, as advised, was associated with decreased pain intensity, improved disability index scores, and improved fear-avoidance beliefs in patients with chronic nonspecific low back pain.

Effects of Myofascial Release in Nonspecific Chronic Low Back Pain: A Randomized Clinical Trial.

Double-blind, randomized parallel sham-controlled trial with concealed allocation and intention-to treat analysis. To investigate the effects of an isolate myofascial release (MFR) protocol on pain, disability, and fear-avoidance beliefs in patients with chronic low back pain (CLBP). MFR is a form of manual medicine widely used by physiotherapists in the management of different musculoskeletal pathologies. Up to this moment, no previous studies have reported the effects of an isolated MFR treatment in patients with CLBP. Fifty-four participants, with nonspecific CLBP, were randomized to MFR group (n = 27) receiving four sessions of myofascial treatment, each lasting 40 minutes, and to control group (n = 27) receiving a sham MFR. Variables studied were pain measured by means Short Form McGill Pain Questionnaire (SF-MPQ) and visual analog scale (VAS), disability measured with Roland Morris Questionnaire, and fear-avoidance beliefs measured with Fear-Avoidance Beliefs Questionnaire. Subjects receiving MFR displayed significant improvements in pain (SF-MPQ) (mean difference -7.8; 95% confidence interval [CI]: -14.5 to -1.1, P = 0.023) and sensory SF-MPQ subscale (mean difference -6.1; 95% CI: -10.8 to -1.5, P = 0.011) compared to the sham group, but no differences were found in VAS between groups. Disability and the Fear-Avoidance Beliefs Questionnaire score also displayed a significant decrease in the MFR group (P < 0.05) as compared to sham MFR. MFR therapy produced a significant improvement in both pain and disability. Because the minimal clinically important differences in pain and disability are, however, included in the 95% CI, we cannot know whether this improvement is clinically relevant. 2.

The relationship between physical capacity and fear avoidance beliefs in patients with chronic low back pain.

[Purpose] The aim of this study was to investigate the relationship between physical capacity and fear avoidance beliefs in patients with chronic low back pain. [Subjects and Methods] This cross sectional study included 131 male university students with chronic low back pain. All the patients completed a fear avoidance beliefs questionnaire. Each participant performed a physical capacity test, which included hand grip force, leg strength, abdominal muscle endurance, flexibility, and cardiopulmonary endurance testing. [Results] Negative correlation was observed between physical capacity (leg strength, abdominal muscle endurance) and fear avoidance beliefs regarding work. Physical capacity (hand grip force, leg strength, cardiopulmonary endurance) showed a negative correlation with fear avoidance beliefs about physical activity. Abdominal muscle endurance and cardiopulmonary endurance were predictors of fear avoidance beliefs. [Conclusion] Physical capacity showed a negative correlation with fear avoidance beliefs in patients with chronic low back pain. The results of this study suggest that physical capacity is an important factor for predicting fear avoidance beliefs in patients with chronic low back pain.

Effects of neck stabilization and dynamic exercises on pain, disability and fear avoidance beliefs in patients with non-specific neck pain; a randomized clinical trial

Effects of neck stabilization and dynamic exercises on pain, disability and fear avoidance beliefs in patients with non-specific neck pain; a randomized clinical trial

Effect of neck stabilization and dynamic exercises on pain, disability and fear avoidance beliefs in patients with non-specific neck pain

clinimetric information available for any of these laboratory tests of ARs. Implications: Further research is required to clearly define ARs and develop a dynamic, clinically feasible measure of the ARs that occur during gait in people with stroke or TBI.

A Correlation Analysis of Neck Pain, Neck Disability Index and Fear-avoidance Beliefs in Patients with Neck Pain Caused by Traffic Accidents

Objectives : This study aimed to investigate the correlation between fear-avoidance beliefs and neck pain / neck disability caused by traffic accidents. Methods : We surveyed 52 patients who were injured in traffic accidents. The patients completed baseline measures of pain, disability, fear-avoidance beliefs according to the visual analogue scale(VAS), neck disability index(NDI) and a fear-avoidance beliefs questionnaire (FABQ). At the end of medical treatment, VAS and NDI were reassessed. In order to determine the relationship between FABQ(including its subscales), change of VAS and NDI, Pearson correlation coefficients were used. To examine the accuracy of previously reported cut-off scores, we classified the patients into low and high groups and analyzed the change of VAS and NDI. The relationship was measured by Mann-Whitney U-test and a student's T-test. Results : FABQ and its subscales(total, physical activity and work) were significantly correlated with final VAS and NDI. FABQ-T showed low significant negative correlation with change of NDI. Previously reported cut-off scores did not show a statistical significance in this study Conclusions : This study suggests that screening for fear-avoidance beliefs may be useful for identifying patients at risk of prolonged pain after traffic accidents.

Reliability and validity of the Persian versions of the fear avoidance beliefs questionnaire and Tampa Scale of Kinesiophobia in patients with neck pain.

Validation of 2 self-report questionnaires. To evaluate the internal consistency, reliability, and construct validity of the Persian versions of the fear avoidance beliefs questionnaire (FABQ) and the Tampa Scale of Kinesiophobia (TSK) in patients with acute and chronic neck pain. The FABQ and TSK are 2 important measures to evaluate fear of pain and fear avoidance beliefs in patients with spinal pain. To date, the psychometric properties of these questionnaires have not been demonstrated in Persian-speaking patients with neck pain in Iran. One hundred sixty-six patients with acute and chronic neck pain participated in the study. The construct validity of the questionnaires was evaluated by measuring convergent and known-groups validity. The visual analogue scale measure of pain, neck disability index, hospital anxiety and depression scale, and the physical (PCS-12) and mental (MCS-12) summary scores of the Short Form health survey (SF-12) were used to test construct validity of the Persian FABQ and TSK. In addition, 50 randomly selected patients with chronic neck pain were asked to complete the questionnaires 48 hours later for the second time. Cronbach α coefficient for the FABQ and TSK in patients with acute and chronic pain was in the range from 0.77 to 0.92 and 0.77 to 0.78, respectively. The Persian FABQ and TSK showed satisfactory test-retest reliability with intraclass correlation coefficient of more than 0.80. There were moderate to strong correlations between the Persian FABQ and TSK scores and the neck disability index (r = 0.44-0.55), Depression subscales of the hospital anxiety and depression scale (r = 0.42-0.48), and PCS-12 (r =-0.34 to -0.62). The Persian FABQ and TSK have acceptable reliability and validity for measuring pain related fear and avoidance beliefs among Persian-speaking patients with acute and chronic neck pain. However, considering the study limitations, the findings should be interpreted with caution. 3.

OP0082-HPR Fear-Avoidance Beliefs of Physical Activity in Adults with Rheumatoid Arthritis

BackgroundA minority of people with RA perform maintained health enhancing physical activity (HEPA). Psychosocial factors seem to be the most salient and consistent factors to explain HEPA variation [1]. Furthermore,...

Psychometric properties of the Japanese version of the Fear-Avoidance Beliefs Questionnaire (FABQ)

BackgroundThe Fear-Avoidance Beliefs Questionnaire (FABQ) is useful for measuring fear-avoidance beliefs in patients with low back pain (LBP); however, no psychometrically validated Japanese version is available. The objective of this study was to evaluate reliability and validity of the Japanese version of the FABQ for use with Japanese workers with LBP. MethodsThis was conducted as a web-based survey. Both confirmatory and exploratory factor analysis were performed to examine domain structure of the Japanese version of the FABQ. For reliability, internal consistency was assessed with Cronbach’s alpha coefficient. For concurrent validity, correlation coefficients between the FABQ and the Pain Catastrophizing Scale (PCS) were calculated. For known-group validity, the relationship between FABQ score and clinical variables such as pain and depression was examined. ResultsAnalyses were based on responses of 1,786 adult Japanese workers with LBP. Factor analysis using the principal factor method with promax rotation revealed two factors, work and physical activity, in accordance with the domain structure of the original version of the scale. For reliability, acceptable internal consistency was demonstrated with Cronbach’s alpha coefficient of 0.882 and 0.783 for each subscale. For concurrent validity, significantly moderate correlations were demonstrated between FABQ subscales and PCS subscales (r = 0.30-0.39). For known-group validity, as hypothesized, significantly higher FABQ subscale scores were observed in workers who had stronger pain, who experienced routine work disability with sick leave, who experienced recurrence of LBP, and who had depressed mood. ConclusionsThis analysis showed that the Japanese version of the FABQ is psychometrically reliable and valid to detect fear-avoidance beliefs in Japanese workers with LBP.

Effect of a long-lasting multidisciplinary program on disability and fear-avoidance behaviors in patients with chronic low back pain: results of a randomized controlled trial.

To evaluate the effect on disability, kinesiophobia, pain, and the quality of life of a long-lasting multidisciplinary program based on cognitive-behavioral therapy and targeted against fear-avoidance beliefs in patients with chronic low back pain. parallel-group, randomized, superiority controlled study. Ninety patients were randomly assigned to a multidisciplinary program consisting of cognitive-behavior therapy and exercise training (experimental group, 45 patients) or exercise training alone (control group, 45 patients). Before treatment (T1), 5 weeks later (instructive phase, T2), and 12 (posttreatment analysis, T3) and 24 months after the end of the instructive phase (1-year follow-up, T4), all of the patients completed a booklet containing the Roland-Morris Disability Questionnaire Scale (primary outcome), the Tampa Scale for Kinesiophobia, a pain numerical rating scale, and the Short-Form Health Survey. A linear mixed model for repeated measures was used to analyze each outcome measure, and the reliable change index/clinically significant change method was used to assess the clinical significance of the changes. The linear mixed model analysis showed a remarkable group, time, and interaction effect for group * time in all of the primary and secondary outcomes (P always <0.001). The majority of the patients in the experimental group achieved a reliable and clinically significant improvement, whereas the majority of those in the control group experienced no change. The long-lasting multidisciplinary program was superior to the exercise program in reducing disability, fear-avoidance beliefs and pain, and enhancing the quality of life of patients with chronic low back pain. The effects were clinically tangible and lasted for at least 1 year after the intervention ended.

Short-term therapeutic effects of 890-nanometer light therapy for chronic low back pain: a double-blind randomized placebo-controlled study

We conducted a double-blind randomized placebo-controlled study to investigate the effects of short-term 890-nm light therapy in patients with chronic low back pain in a rehabilitation clinic. Thirty-eight women and 22 men with chronic low back pain (mean age, 60.3years; range, 32-80years) received 40-min sessions of hot-pack therapy combined with active or placebo 890-nm light therapy (wavelength = 890nm, radiant power output = 6.24W, power density = 34.7mW/cm(2) for 40min, total energy = 83.2J/cm(2)) over the lower back three times weekly for 2weeks. Participants were assessed before and after treatment by using a range of motion measurements, a visual analog scale evaluation of pain, the Multidimensional Fatigue Inventory, the Biodex Stability System, the Fear-Avoidance Beliefs Questionnaire, repeated chair-rising times, the Frenchay Activity Index, the Oswestry Disability Questionnaire (ODQ), and the Osteoarthritis Quality of Life Questionnaire. The severity of disability based on the ODQ score was used as the primary clinical outcome measurement. Compared to the baseline measurements, participants in the treatment group reported significant reductions in fear-avoidance beliefs regarding physical activity (P = 0.040) and work (P = 0.007) and in the severity of disability (P = 0.021). Treatment with hot-pack therapy and 890-nm light therapy was associated with reductions in the severity of disability and fear avoidance beliefs in patients with chronic low back pain.

Fear-avoidance beliefs and cardiac rehabilitation in patients with first-time myocardial infarction

The aim of this study was to examine fear-avoidance beliefs in patients after first-time myocardial infarction and to determine how such beliefs change over time. A further aim was to analyse fear-avoidance beliefs and physical activity levels in patients attending exercise-based cardiac rehabilitation led by a registered physiotherapist, compared with a control group. Prospective cohort study. A total of 62 patients after first-time myocardial infarction were consecutively included in the study, mean age 61 years (range 42-73). Thirty-four patients chose exercise-based cardiac rehabilitation and 28 carried out the exercise regime on their own (controls). At follow-up, 57 patients (n = 30 and n = 27, respectively) responded. The Fear-Avoidance Beliefs Questionnaire and the Exercise and Physical Activity questionnaires were completed at 1 and 4 months post-infarction. Clinically relevant fear-avoidance beliefs were seen in 48% of all patients at baseline, compared with 21% at follow-up (p = 0.01). Corresponding baseline values were 62% for the cardiac rehabilitation group and 29% for controls (p = 0.02). At follow-up, 4 months post-infarction, the difference between the groups was no longer seen. The total amount of physical activity increased over time for the cardiac rehabilitation group (p = 0.03), and this was also significant compared with the control group (p = 0.02). Compared with controls, patients attending exercise-based cardiac rehabilitation led by a registered physiotherapist, demonstrated higher levels of fear-avoidance beliefs at baseline, which decreased over time. Furthermore, attendees increased their level of physical activity and exercise over time. Participation in exercise-based cardiac rehabilitation is therefore strongly recommended for patients with myocardial infarction, especially for those with increased fear of movement.

Assessing Fear-Avoidance Beliefs in Patients With Whiplash-associated Disorders

To examine the development of fear avoidance behaviours following whiplash injury using two different measures of fear avoidance, the Pictorial Fear of Activities Scale-Cervical (PFActS-C), and the Tampa Scale of Kinesiophobia (TSK-17). Secondarily we assessed the capacity of these measures to predict recovery status at long term follow up and initial cervical range of movement (ROM). Ninety-eight patients with acute WAD were recruited and completed measures of pain and disability (NDI), fear avoidance beliefs and cervical ROM at baseline (<4 weeks), 3 and 6 months post injury. Participants were grouped based on NDI scores at 6 months follow up as either recovered (NDI <10), mild (NDI 10-28) or moderate/severe (NDI ≤ 30). Repeated measures, linear mixed model analysis showed a significant main effect for time and group for both TSK-17 and PFActS-C scores (P ≤ 0.001). On both measures the moderate/severe group scored significantly higher than the mild and recovered groups. TSK-17 scores, age and initial pain intensity at baseline significantly predicted NDI scores at 6 months (P = 0.002). PFActS-C scores, age and initial pain intensity at baseline significantly predicted initial cervical extension and rotation ROM (P = 0.001). Fear avoidance beliefs and behaviours develop quickly following whiplash injury and influence both the initial physical presentation and long term outcome of patients with WAD. The PFActS-C may provide a measure of fear of movement which is more specific to the cervical spine in patients with WAD in comparison to the TSK-17.