title: Fear-avoidance beliefs, disability, and participation in workers and non-workers with acute low back pain.
abstract: OBJECTIVE
  Fear-avoidance beliefs have been shown to be associated with disability and work status in patients with low back pain. Especially in acute low back pain, much research is needed to increase the knowledge concerning the role of fear-avoidance beliefs and its associated avoidance behavior in the influence on disability and the participation in daily and social life activities. The Fear-Avoidance Beliefs Questionnaire is developed to measure such beliefs and has become increasingly popular for use in primary care practice. The aim of the current study was: 1) to investigate the factor structure of the Fear-Avoidance Beliefs Questionnaire in a population of patients with acute low back pain by means of confirmatory factor analysis; 2) to examine the relationship between fear-avoidance beliefs and perceived disability, as well as participation in daily and social life; and 3) to investigate whether perceived disability mediates the association between pain and participation and between fear-avoidance beliefs and participation.
  
  
  METHODS
  The study has a cross-sectional design and was performed on a sample of 615 patients with acute low back pain in primary care settings in The Netherlands. Patients completed a visual analogue scale for pain, the Roland Disability Questionnaire, the Fear-Avoidance Beliefs Questionnaire, a sociodemographic questionnaire, and 5 participation items.
  
  
  RESULTS
  Confirmatory factor analysis corroborated the 2-factor structure of the Fear-Avoidance Beliefs Questionnaire as found by Waddell et al. Investigation of the association between fear-avoidance beliefs and perceived disability or participation was performed for workers and non-workers separately. The 2 subscales of the Fear-Avoidance Beliefs Questionnaire were significantly associated with perceived disability and participation, although there were differences between the samples. Perceived disability was significantly predicted by pain intensity and fear-avoidance beliefs. Perceived disability significantly predicted participation, and finally, the mediational role of perceived disability was supported.
  
  
  CONCLUSIONS
  In the early stage of low back pain, the reduction of pain and fear-avoidance beliefs might increase the level of activity, which might foster increased participation in daily and social life activities.
authors.affiliation: Practice of Physical Therapy and Manual Therapy, Eindhoven, The Netherlands. swinky@xs4all.nl
authors.forename: Ilse E J
authors.initials: IE
authors.lastname: Swinkels-Meewisse
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Roelofs
authors.forename: André L M
authors.initials: AL
authors.lastname: Verbeek
authors.forename: Rob A B
authors.initials: RA
authors.lastname: Oostendorp
authors.forename: Johan W S
authors.initials: JW
authors.lastname: Vlaeyen
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D001362:Avoidance Learning; D003469:Culture; D004185:Disability Evaluation; D004651:Employment; D005163:Factor Analysis, Statistical; D005239:Fear; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D007398:Interpersonal Relations; D016014:Linear Models; D017116:Low Back Pain / Q000503:physiopathology* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010147:Pain Measurement; D011795:Surveys and Questionnaires