Influence Of Fear Avoidance Beliefs Research Articles

Influence of fear-avoidance beliefs and catastrophizing in the result of facet radiofrequency denervation in patients with chronic low back pain

Influence of fear-avoidance beliefs and catastrophizing in the result of facet radiofrequency denervation in patients with chronic low back pain

Fear Avoidance Beliefs and Outcome After Surgery for Degenerative Lumbar Spine.

This was a prospective cohort study. The aim of this study is to question the influence of fear avoidance beliefs on functional outcome following surgery for degenerative lumbar spine. Fear avoidance beliefs are well-studied modifiers of low back pain. Nonetheless, the influence of fear avoidance beliefs on the outcome of spinal surgery remains controversial. We conducted a prospective cohort study including patients undergoing surgery for degenerative lumbar discopathy, spondylolisthesis, and stenosis. Patients completed a preoperative questionnaire including the Fear Avoidance Beliefs Questionnaire (FABQ) as well as Visual Analog Scales for radicular and lumbar pain (VAS-R/L), Oswestry Disability Index (ODI), and Short-Form 36 health survey (SF36). Functional outcome was measured at least 6 months after surgery using ODI. Sixty-three patients with a mean follow-up of 254 days (8.5 mo, minimum=179 d, maximum=534 d) were included in the study. Women showed stronger work-related fear avoidance beliefs but there was no other difference in baseline characteristics and functional outcome between patients with low or high (>75th percentile) baseline FABQ-P or FABQ-W scores. Individual variables associated with whether patients reached minimal clinically important difference for ODI were: working status [odds ratio (OR)=0.13; 95% confidence interval (95% CI), 0.03-0.62; P =0.01], American Society of Anesthesiologists classification score (OR=0.32; 95% CI, 0.11-0.92; P =0.03), preoperative duration of symptoms (OR=0.94; 95% CI, 0.89-0.99; P =0.03), and preoperative ODI (OR=1.03; 95% CI, 1.00-1.07; P =0.05). Neither physical nor work-related preoperative FABQ scores were predictors of functional results. In our study, the FABQ was not associated with functional outcome following surgery for degenerative lumbar spine. Other psychological patient-reported measures are needed to refine selection of patients undergoing spine surgery in order to ensure better outcomes.

Fear Avoidance Beliefs and Risk of Long-Term Sickness Absence: Prospective Cohort Study among Workers with Musculoskeletal Pain.

Background and Objective Musculoskeletal pain is common in the population. Negative beliefs about musculoskeletal pain and physical activity may lead to avoidance behavior resulting in absence from work. The present study investigates the influence of fear avoidance beliefs on long-term sickness absence. Methods Workers of the general working population with musculoskeletal pain (low back, neck/shoulder, and/or arm/hand pain; n = 8319) from the Danish Work Environment Cohort Study were included. Long-term sickness absence data were obtained from the Danish Register for Evaluation and Marginalization (DREAM). Time-to-event analyses (cox regression) controlled for various confounders estimated the association between fear avoidance beliefs (very low, low, moderate [reference category], high, and very high) at baseline and long-term sickness absence (LTSA; ≥6 consecutive weeks) during a 2-year follow-up. Results During the 2-year follow-up, 10.2% of the workers experienced long-term sickness absence. In the fully adjusted model, very high-level fear avoidance increased the risk of LTSA with hazard ratio (HR) of 1.48 (95% CI 1.15-1.90). Similar results were seen analyses stratified for occupational physical activity, i.e., sedentary workers (HR 1.72 (95% CI 1.04-2.83)) and physically active workers (HR 1.48 (95% CI 1.10-2.01)). Conclusion A very high level of fear avoidance is a risk factor for long-term sickness absence among workers with musculoskeletal pain regardless of the level of occupational physical activity. Future interventions should target fear avoidance beliefs through information and campaigns about the benefits of staying active when having musculoskeletal pain.

Influence of fear-avoidance beliefs on disability in patients with subacromial shoulder pain in primary care: a secondary analysis.

Little information exists about the role of fear-avoidance beliefs and catastrophizing in subacromial pain syndrome. The purpose of this study was to investigate the associations among pain, catastrophizing, fear, and disability and the contribution of fear-avoidance beliefs to disability at baseline and at 3-month follow-up. A cross-sectional and longitudinal analysis was conducted. Baseline demographic and clinical data, including fear-avoidance beliefs and catastrophizing, of 90 patients were assessed for this analysis. Disability was measured with the Shoulder Pain and Disability Index at baseline and at 3-month follow-up. First, bivariate and partial correlations were calculated among pain, fear-avoidance beliefs, catastrophizing, and disability, based on the fear-avoidance model. Second, the contribution of fear-avoidance beliefs to disability at baseline and at 3-month follow-up was examined with hierarchical regression analyses. Correlations between clinical variables and disability were largely in line with the fear-avoidance model. Regression analyses identified a significant contribution of fear-avoidance beliefs to baseline disability but not to disability at 3 months. Patients with subacromial pain syndrome were studied; therefore, the results should be transferred with caution to other diagnoses. A modified version of the Fear-Avoidance Beliefs Questionnaire was used, which was not validated for this patient group. Fear-avoidance beliefs contribute significantly to baseline disability but not to disability change scores after 3-month follow-up. Duration of complaints and baseline disability were the main factors influencing disability change scores. Although the results help to improve understanding of the role of fear-avoidance beliefs, further studies are needed to fully understand the influence of psychological and clinical factors on the development of disability in patients with subacromial shoulder pain.

Influence of Fear-Avoidance Beliefs on Functional Status Outcomes for People With Musculoskeletal Conditions of the Shoulder

The influence of elevated fear-avoidance beliefs on change in functional status is unclear. The purpose of this study was to determine the influence of fear-avoidance on recovery of functional status during rehabilitation for people with shoulder impairments. A retrospective longitudinal cohort study was conducted. Data were collected from 3,362 people with musculoskeletal conditions of the shoulder receiving rehabilitation. At intake and discharge, upper-extremity function was measured using the shoulder Computerized Adaptive Test. Pain intensity was measured using an 11-point numerical rating scale. Completion rate at discharge was 57% for function and 47% for pain intensity. A single-item screen was used to classify patients into groups with low versus elevated fear-avoidance beliefs at intake. A general linear model (GLM) was used to describe how change in function is affected by fear avoidance in 8 disease categories. This study also accounted for within-clinic correlation and controlled for other important predictors of functional change in functional status, including various demographic and health-related variables. The parameters of the GLM and their standard errors were estimated with the weighted generalized estimating equations method. Functional change was predicted by the interaction between fear and disease categories. On further examination of 8 disease categories using GLM adjusted for other confounders, improvement in function was greater for the low fear group than for the elevated fear group among people with muscle, tendon, and soft tissue disorders (Δ=1.37, P<.01) and those with osteopathies, chondropathies, and acquired musculoskeletal deformities (Δ=5.52, P<.02). These differences were below the minimal detectable change. Limitations Information was not available on whether therapists used information on level of fear to implement treatment plans. The influence of fear-avoidance beliefs on change in functional status varies among specific shoulder impairments.

The Correlation Between Pain, Catastrophizing, and Disability in Subacute and Chronic Low Back Pain

Correlation between variables measured with previously validated instruments. To explore the association between catastrophizing and disability in patients treated for subacute or chronic low back pain (LBP) within routine clinical practice in Spain. The influence of psychological variables on LBP-related disability in Southern Europe is different to the one in the Anglo-Saxon and Northern European cultural environments. In Spanish LBP patients, the influence of fear avoidance beliefs on disability is negligible, and catastrophizing does not mediate the improvement of disability caused by active education. The association between catastrophizing and dis-ability is unknown. Thirty-three clinicians working for the Spanish National Health Service in 6 primary care and 8 specialty centers, recruited 1461 patients seeking care for subacute and chronic LBP. Patients were assessed only once. A linear regression model was developed to assess the percentage of the variance of disability explained by gender, age, chronicity status, severity of LBP, severity of referred pain (referred pain down to the leg), catastrophizing, eligible for workers' compensation (yes/no), failed back surgery (yes/no), radiologic findings, and treatments. Correlations among LBP, referred pain down to the leg, disability, and catastrophizing were moderate, but significant. The strongest one was between disability and catastrophizing (r ∇ 0.520). Catastrophizing explained 28% of disability, whereas severity of LBP only 3%. Global adjusted R of the model was 0.387. There was an association between some radiologic findings and treatments, and slightly higher levels of disability. In Southern European subacute and chronic LBP patients, catastrophizing correlates with dis-ability and explains approximately one-fourth of its variance. Further studies should assess its value as a prognostic factor in subacute and chronic patients.

The Influence of Psychological Factors on Low Back Pain-Related Disability in Community Dwelling Older Persons

To assess the influence of fear avoidance beliefs (FAB) and catastrophizing on low back pain (LBP)-related disability in Spanish community dwelling retirees. Correlation between variables measured with previously validated instruments. Majorca, Spain. 1,044 community dwelling subjects attending conferences for retired persons. Visual analog scales for LBP and pain referred to the leg (LP), Roland Morris Questionnaire (RMQ) for disability, FAB-Phys questionnaire (FABQ) for FAB, and the Coping Strategies Questionnaire (CSQ) for catastrophizing. In subjects without clinically relevant LBP, FAB correlated moderately with catastrophizing (r = 0.535) and disability (r = 0.390), and weakly with LP (r = 0.119) and LBP (r = 0.197). In subjects with LBP, FAB correlated moderately with catastrophizing (r = 0.418) and disability (r = 0.408), and weakly with LP (0.152), but not with LBP. Correlations among CSQ, FABQ, and RMQ were similar in subjects with and without current LBP. In regression models, the coefficient for effect of FAB on disability was 0.14 for participants with no LBP, and 0.28 for those with pain. Corresponding values for catastrophizing were 0.17 and 0.19. In Spanish community dwelling retirees, the influence of FAB and catastrophizing on LBP-related disability is clinically small.

Fear Avoidance Beliefs Do Not Influence Disability and Quality of Life in Spanish Elderly Subjects With Low Back Pain

Correlation between previously validated questionnaires. To assess the association of fear avoidance beliefs (FAB) with disability and quality of life in elderly Spanish subjects. As opposed to Anglo-Saxon and Northern European patients, in Spanish low back pain (LBP) patients of working age, the influence of FAB on disability and quality of life is sparse and much less than that of pain. The influence of FAB on LBP-related disability and quality of life in the elderly is unknown. A visual analogue scale (VAS), the Roland Morris Questionnaire (RMQ), the FAB-Phys questionnaire (FABQ), and the SF-12 questionnaire were used to assess LBP, disability, fear avoidance beliefs, and quality of life in 661 institutionalized elderly in Spain, 439 of whom had LBP. In all subjects, FAB correlated with LBP (r = 0.477), disability (r = 0.458), the Physical Component Summary of SF-12 (PCS SF-12) (r = -0.389), and the Mental Component Summary of SF-12 (MCS SF-12) (r = -0.165). In subjects with LBP, FABs only correlated weakly with disability (r = -0.110). The stronger correlations were found between LBP and disability, both in all subjects (r = 0.803) and LBP patients (r = 0.445). Regression models including all the participants showed that the influence of FABs on physical quality of life was sparse and that FABs were not associated with either disability or mental quality of life. In elderly subjects with LBP, FABs were not associated with either disability or quality of life. In Spanish institutionalized elderly subjects, FABs only have a minor influence on physical quality of life, and none on disability or mental quality of life. In elderly subjects with LBP, differences in FABs are not associated with differences in disability or quality of life. Further studies should explore the potential value of FABs in the elderly in other settings.

Fear Avoidance Beliefs Influence Duration of Sick Leave in Spanish Low Back Pain Patients

Follow-up study. To estimate the influence of fear avoidance beliefs (FAB) on 1-year low back pain (LBP)-related sick leave. As opposed to Anglo-Saxon and Northern European subjects, in Spanish LBP patients the influence of FAB on disability and quality of life is virtually irrelevant. Twelve primary care and 9 hospital services from 7 different regions of Spain recruited 165 workers who visited the National Health Service for LBP. None was excluded. On their first visit and 14 days later, patients were given 2 independent Visual Analogue Scales (VAS) for LBP and leg pain, as well as the validated Spanish versions of the Fear Avoidance Beliefs (FABQ), Roland-Morris (RMQ), and SF-12 questionnaires. During the following 12-month period, the number of days on sick leave because of LBP was registered. Differences in sick leave throughout the study period were associated with baseline differences in chronicity, severity of low back (not referred) pain, disability, FAB, physical and mental quality of life, being on sick leave when entering the study, and duration of previous sick leave. Ordinal logistic regression models showed that each additional point in the total FAB baseline score increases by 2.4% the odds of being on sick leave for up to 60 days during the following year and by 7.7% the odds of being sick listed for 61 days or more. Corresponding figures for FAB-Work scores are 4.2% and 11%. No variable modifies the effect of FAB on sick leave. Although in Spanish patients the influence of FAB on disability and quality of life is irrelevant, baseline FABQ score does influence LBP-related sick leave during the following year. This seems to be a direct effect of FAB, since there is no confounding by any other variable.

The Influence of Fear Avoidance Beliefs on Disability and Quality of Life is Sparse in Spanish Low Back Pain Patients

Correlation between previously validated questionnaires. To assess the influence of fear avoidance beliefs (FAB) on disability and quality of life in Spanish low back pain (LBP) patients. FAB has shown to be a major determinant of disability in LBP patients in Northern European and Anglo-Saxon cultural environments. There are no data on its influence on Latin-Mediterranean patients. The study was done in 12 primary care and 9 hospital services from seven different regions of Spain, with 209 patients who were in a potentially active working situation and visited the National Health Service for LBP. None was excluded and the sample was balanced for acute, subacute, and chronic patients. On their first visit and 14 days later, patients were given two independent Visual Analogue Scales (VAS) for LBP and leg pain, as well as the validated Spanish versions of the Fear Avoidance Beliefs (FABQ), Roland-Morris (RMQ), and SF-12 questionnaires. Correlations between LBP, leg pain, FABQ, disability, and quality of life were moderate on day 1 (r = 0.320-0.564) and stronger on day 15 (r = 0.457-0.637). All of them were statistically highly significant (P = 0.000). Regression models showed that LBP severity explains 33% of disability on day 1 and 20% on day 15, while FAB only explains 6% on day 1 and 2% on day 15. FAB does not explain mental quality of life. It explains only 5% of physical quality of life on day 1 and 4% on day 15. There was no interaction between FAB and chronicity, and FABQ values on day 1 did not predict disability or quality of life at day 15. As opposed to what has been shown in other cultural settings, FAB have virtually no clinical relevance in Spanish LBP patients who are treated in the National Health Service and who are in a potentially active working situation. The influence of FAB on disability is minimal and much less than that of pain severity, and their contribution to the patient's quality of life is irrelevant. Further studies should explore the potential value of FAB in other Latin-Mediterranean countries.