title: Fear-avoidance beliefs associated with perceived psychological and social factors at work among patients with neck and back pain: a cross-sectional multicentre study.
abstract: BACKGROUND
  Neck and back pain are common and often account for absenteeism at work. Factors at work as well as fear-avoidance beliefs may influence sick-leave in these patients. The aims of this study were to assess: (1) how sick-listed patients in specialised care perceive demand, control, support, effort, reward, and overcommitment at work compared to a general reference group of workers; (2) if women and men report demand, control, support, effort, reward, and overcommitment differently; and (3) the association between psychological and social factors at work and fear-avoidance beliefs about work.
  
  
  METHODS
  A cross-sectional multicentre study was carried out in 373 patients on sick leave due to neck and back pain. Psychosocial work factors were measured by demand, control, and support, (Nordic Questionnaire for Psychological and Social Factors at Work), and effort, reward and overcommitment (Effort Reward Imbalance Questionnaire). Fear avoidance beliefs about work were measured by the Fear-Avoidance Belief Questionnaire Work subscale (FABQ-W).
  
  
  RESULTS
  Although the patients differed significantly from a reference working group regarding several subscales of demand, control, support, effort, reward, and overcommitment, the magnitude of these differences were small. The study population also reported significantly higher scores for 'demand for physical endurance' than the reference population, and Cohen's d = 0.55 here indicated a medium degree of difference. Female patients reported significantly higher on support, whereas male patients reported significantly higher demand for physical endurance, quantitative demand, effort, and overcommitment. Demand for physical endurance, job control, job support, high reward, and overcommitment were significantly associated with FABQ-W.
  
  
  CONCLUSIONS
  Perceived psychological and social factors at work were strongly associated with fear-avoidance beliefs about work in sick-listed neck and back patients. The demand for physical endurance, control, support, high reward, as well as overcommittment at work outweighed pain and added to the burden of emotional distress and disability regarding fear-avoidance beliefs.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Oslo, Norway. kjersti.myhre@medisin.uio.no.
authors.forename: Kjersti
authors.initials: K
authors.lastname: Myhre
authors.forename: Cecilie
authors.initials: C
authors.lastname: Røe
authors.forename: Gunn Hege
authors.initials: GH
authors.lastname: Marchand
authors.forename: Anne
authors.initials: A
authors.lastname: Keller
authors.forename: Erik
authors.initials: E
authors.lastname: Bautz-Holter
authors.forename: Gunnar
authors.initials: G
authors.lastname: Leivseth
authors.forename: Leiv
authors.initials: L
authors.lastname: Sandvik
authors.forename: Bjørn
authors.initials: B
authors.lastname: Lau
mesh_terms: D000041:Absenteeism; D000328:Adult; D001416:Back Pain / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D003430:Cross-Sectional Studies; D003469:Culture; D004185:Disability Evaluation; D004644:Emotions; D005239:Fear; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007587:Job Description; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D009664:Norway; D010147:Pain Measurement; D010465:Perception; D010807:Physical Endurance; D012201:Reward; D018582:Sick Leave; D012944:Social Support; D011795:Surveys and Questionnaires; D017132:Workplace / Q000523:psychology*