Clinical course and impact of fear-avoidance beliefs in low back pain: prospective cohort study of acute and chronic low back pain: II.
METHODS
Prospective inception cohort study.


OBJECTIVE
To compare the clinical course of fear-avoidance beliefs in acute and chronic low back pain (LBP) and investigate the contribution of fear-avoidance beliefs to predict pain and disability after 1 year.


BACKGROUND
Fear-avoidance beliefs are involved in disability development. There is little knowledge on the development of fear-avoidance beliefs among different LBP subgroups.


METHODS
Patients with acute (n = 123) and chronic (n = 50) LBP completed a comprehensive assessment, including the Fear-Avoidance Beliefs Questionnaire (FABQ), and were followed at 3, 6, 9, and 12 months.


RESULTS
At baseline, patients with chronic LBP had significantly higher FABQ-scores for work (FABQ-Work) than patients with acute LBP (P < 0.001), and this difference remained unchanged over 1 year (P > 0.21). At baseline, there was no statistical significant difference in FABQ-scores for physical activity (FABQ-PA) between the two groups (P = 0.57). FABQ-PA scores decreased significantly over the first 4 weeks among patients with acute LBP during follow-up and remained unchanged thereafter, whereas in the chronic sample the FABQ-PA scores were unchanged throughout the first year (time effect, P < 0.001; and interaction effect, P < 0.001). In the acute sample, FABQ-Work predicted pain (P < 0.05) and disability at 12 months (P = 0.01). In the chronic sample, FABQ-PA predicted disability at 12 months (P = 0.03). The associations between the FABQ and pain/disability disappeared with distress included in the models.


CONCLUSIONS
Patients with chronic LBP had more fear-avoidance beliefs for work than patients with acute LBP. There were small changes in fear-avoidance beliefs during the year of follow-up, except for a rapid decrease during the first month in the FABQ-PA in the acute sample. Fear-avoidance beliefs predicted pain and disability at 12 months after adjusting for socio-demographic and pain variables. Distress was a stronger predictor than fear-avoidance beliefs.
Grotle
Margreth
M
National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. margreth.grotle@medisin.uio.no
Vøllestad
Nina K
NK
Brox
Jens I
JI
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000342:Affective Symptoms / Q000523:psychology*; D001362:Avoidance Learning; D002908:Chronic Disease; D003469:Culture; D004185:Disability Evaluation; D004651:Employment; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012044:Regression Analysis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires