title: Influence of fear-avoidance beliefs on disability in patients with subacromial shoulder pain in primary care: a secondary analysis.
abstract: BACKGROUND
  Little information exists about the role of fear-avoidance beliefs and catastrophizing in subacromial pain syndrome.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the associations among pain, catastrophizing, fear, and disability and the contribution of fear-avoidance beliefs to disability at baseline and at 3-month follow-up.
  
  
  METHODS
  A cross-sectional and longitudinal analysis was conducted.
  
  
  METHODS
  Baseline demographic and clinical data, including fear-avoidance beliefs and catastrophizing, of 90 patients were assessed for this analysis. Disability was measured with the Shoulder Pain and Disability Index at baseline and at 3-month follow-up. First, bivariate and partial correlations were calculated among pain, fear-avoidance beliefs, catastrophizing, and disability, based on the fear-avoidance model. Second, the contribution of fear-avoidance beliefs to disability at baseline and at 3-month follow-up was examined with hierarchical regression analyses.
  
  
  RESULTS
  Correlations between clinical variables and disability were largely in line with the fear-avoidance model. Regression analyses identified a significant contribution of fear-avoidance beliefs to baseline disability but not to disability at 3 months.
  
  
  CONCLUSIONS
  Patients with subacromial pain syndrome were studied; therefore, the results should be transferred with caution to other diagnoses. A modified version of the Fear-Avoidance Beliefs Questionnaire was used, which was not validated for this patient group.
  
  
  CONCLUSIONS
  Fear-avoidance beliefs contribute significantly to baseline disability but not to disability change scores after 3-month follow-up. Duration of complaints and baseline disability were the main factors influencing disability change scores. Although the results help to improve understanding of the role of fear-avoidance beliefs, further studies are needed to fully understand the influence of psychological and clinical factors on the development of disability in patients with subacromial shoulder pain.
authors: T.O. Kromer, PhD, Department of Physiotherapy, School of Therapeutic Sciences, SRH University Heidelberg, Maria-Probst-Strasse 3, 69123 Heidelberg, Germany, and CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands. ThiloOliver.Kromer@hochschule-heidelberg.de Thilo.Kromer@maastrichtuniversity.nl.
authors: Thilo O
authors: TO
authors: Kromer
authors: J.M. Sieben, PhD, CAPHRI School for Public Health and Primary Care, Maastricht University; Centre for Evidence-Based Physiotherapy (CEBP), Maastricht University; and Department of Anatomy and Embryology, Maastricht University.
authors: Judith M
authors: JM
authors: Sieben
authors: R.A. de Bie, PhD, Department of Epidemiology, Maastricht University; CAPHRI School for Public Health and Primary Care, Maastricht University; and CEBP, Maastricht University.
authors: Rob A
authors: RA
authors: de Bie
authors: C.H.G. Bastiaenen, PhD, Department of Epidemiology, Maastricht University; CAPHRI School for Public Health and Primary Care, Maastricht University; and CEBP, Maastricht University.
authors: Caroline H G
authors: CH
authors: Bastiaenen
mesh_terms: D000203:Activities of Daily Living; D001362:Avoidance Learning; D058443:Catastrophization; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000523:psychology*; D005239:Fear; D006801:Humans; D010147:Pain Measurement; D011320:Primary Health Care; D012044:Regression Analysis; D019534:Shoulder Impingement Syndrome / Q000523:psychology*