Predictive value of fear avoidance in developing chronic neck pain disability: consequences for clinical decision making.
OBJECTIVE
To improve clinical decision making in posttraumatic neck pain by investigating the additional value of fear-avoidance variables in predicting chronic neck pain disability.


METHODS
An inception cohort with baseline assessment 1 week posttrauma and outcome assessment 24 weeks posttrauma. Predictive factors include pain intensity, Neck Disability Index (NDI), catastrophizing, fear of movement (Tampa Scale for Kinesiophobia [TSK]), and avoidance muscle behavior.


METHODS
Hospital emergency department of a general hospital.


METHODS
A consecutive sample of 90 people reporting of pain in neck or head region after a motor vehicle collision. Eighty-two subjects (91.1%) of the sample provided 24-week follow-up on the outcome.


METHODS
Not applicable.


METHODS
The NDI assessing physical disability of subjects with neck pain.


RESULTS
By using a combination of the baseline NDI and TSK, it appears to be possible to predict chronic disability with a probability of 54.3% (95% confidence interval [CI], 35.2%-72.3%) after entering the NDI (cutoff, 15) as a first test, and with a probability of 83.3% (95% CI, 70.3%-91.3%) after entering the TSK (cutoff, 40) in a second test.


CONCLUSIONS
A simple rating of baseline neck pain disability within a week of the trauma, separately or in combination with a test for fear of movement, can be used to predict future outcome. Patients showing fear of movement can be offered an intervention that focuses on reduction of this fear.
Nederhand
Marc J
MJ
Roessingh, Research & Development, Enschede, The Netherlands. m.nederhand@rrd.nl
Ijzerman
Maarten J
MJ
Hermens
Hermie J
HJ
Turk
Dennis C
DC
Zilvold
Gerrit
G
D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D003657:Decision Making; D004185:Disability Evaluation; D005239:Fear; D005260:Female; D019416:Head Movements; D006801:Humans; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000150:complications / Q000534:rehabilitation; D019547:Neck Pain / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D020127:Recovery of Function; D016896:Treatment Outcome