title: Assessing fear-avoidance beliefs in patients with whiplash-associated disorders: a comparison of 2 measures.
abstract: OBJECTIVE
  To examine the development of fear avoidance behaviours following whiplash injury using two different measures of fear avoidance, the Pictorial Fear of Activities Scale-Cervical (PFActS-C), and the Tampa Scale of Kinesiophobia (TSK-17). Secondarily we assessed the capacity of these measures to predict recovery status at long term follow up and initial cervical range of movement (ROM).
  
  
  METHODS
  Ninety-eight patients with acute WAD were recruited and completed measures of pain and disability (NDI), fear avoidance beliefs and cervical ROM at baseline (<4 weeks), 3 and 6 months post injury. Participants were grouped based on NDI scores at 6 months follow up as either recovered (NDI <10), mild (NDI 10-28) or moderate/severe (NDI ≤ 30).
  
  
  RESULTS
  Repeated measures, linear mixed model analysis showed a significant main effect for time and group for both TSK-17 and PFActS-C scores (P ≤ 0.001). On both measures the moderate/severe group scored significantly higher than the mild and recovered groups. TSK-17 scores, age and initial pain intensity at baseline significantly predicted NDI scores at 6 months (P = 0.002). PFActS-C scores, age and initial pain intensity at baseline significantly predicted initial cervical extension and rotation ROM (P = 0.001).
  
  
  CONCLUSIONS
  Fear avoidance beliefs and behaviours develop quickly following whiplash injury and influence both the initial physical presentation and long term outcome of patients with WAD. The PFActS-C may provide a measure of fear of movement which is more specific to the cervical spine in patients with WAD in comparison to the TSK-17.
authors.affiliation: *Centre for National Research on Disability and Rehabilitation Medicine, The University of Queensland, Herston, Qld, Australia.
authors.forename: Ashley
authors.initials: A
authors.lastname: Pedler
authors.forename: Michele
authors.initials: M
authors.lastname: Sterling
mesh_terms: D000328:Adult; D001362:Avoidance Learning; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000523:psychology*; D010698:Phobic Disorders / Q000523:psychology*; D011446:Prospective Studies; D011594:Psychometrics / Q000379:methods*; D016059:Range of Motion, Articular / Q000502:physiology; D012044:Regression Analysis; D015203:Reproducibility of Results; D014911:Whiplash Injuries / Q000523:psychology*; D055815:Young Adult