title: A longitudinal study on the predictive validity of the fear-avoidance model in low back pain.
abstract: Recently, fear-avoidance models have been quite influential in understanding the transition from acute to chronic low back pain (LBP). Not only has pain-related fear been found to be associated with disability and increased pain severity, but also treatment focused at reducing pain-related fear has shown to successfully reduce disability levels. In spite of these developments, there is still a lack in well-designed prospective studies examining the role of pain-related fear in acute back pain. The aim of the current study was to prospectively test the assumption that pain-related fear in acute stages successfully predicts future disability. Subjects were primary care acute LBP patients consulting because of a new episode of LBP (<or=3 weeks). They completed questionnaires on background variables, fear-avoidance model variables and LBP outcome (Graded Chronic Pain Scale, GCPS) at baseline, 3, 6, and 12 months follow-up and at the end of the study. Two-hundred and twenty-two acute LBP patients were included, of whom 174 provided full follow-up information (78.4%). A backward ordinal regression analysis showed previous LBP history and pain intensity to be the most important predictors of end of study GCPS. Of the fear-avoidance model variables, only negative affect added to this model. Our results do not really support the longitudinal validity of the fear-avoidance model, but they do feed the discussion on the role of pain-related fear in early stages of LBP.
authors.affiliation: Department of General Practice, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. judith.sieben@hag.unimaas.nl
authors.forename: Judith M
authors.initials: JM
authors.lastname: Sieben
authors.forename: Johan W S
authors.initials: JW
authors.lastname: Vlaeyen
authors.forename: Piet J M
authors.initials: PJ
authors.lastname: Portegijs
authors.forename: Jeanine A
authors.initials: JA
authors.lastname: Verbunt
authors.forename: Sita
authors.initials: S
authors.lastname: van Riet-Rutgers
authors.forename: Arnold D M
authors.initials: AD
authors.lastname: Kester
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
authors.forename: Arnoud
authors.initials: A
authors.lastname: Arntz
authors.forename: J André
authors.initials: JA
authors.lastname: Knottnerus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001362:Avoidance Learning / Q000502:physiology*; D004185:Disability Evaluation; D005239:Fear; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000503:physiopathology* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires