Fear avoidance beliefs as a predictor for long-term sick leave, disability and pain in patients with chronic low back pain

Abstract

BackgroundSubgrouping patients with chronic low back pain is recommended prior to selecting treatment strategy, and fear avoidance beliefs is a commonly addressed psychological factor used to help this subgrouping. The results of the predictive value of fear avoidance beliefs in patients with chronic low back pain in prognostic studies are, however, not in concordance. Therefore, the objective of this study was to examine the association between fear avoidance beliefs at baseline and unsuccessful outcome on sick leave, disability and pain at 12-month follow-up in patients with entirely chronic low back pain.MethodsA secondary analysis of data from a randomised controlled trial. Patients with chronic low back pain (n = 559) completed questionnaires at baseline and after 12 months. Multiple logistic regression analyses were conducted to examine the association between fear avoidance beliefs and the outcomes sick leave, disability and pain.ResultsHigher fear avoidance beliefs about work at baseline were found to be significantly associated with still being on sick leave (OR 1.11; 95% CI 1.02–1.20) and having no reduction in pain (OR 1.04; 95% CI 1.01–1.08) after 12 months and may be associated with having no reduction in disability (OR 1.03; 95% CI 1.00–1.06) after 12 months (lower limit of 95% CI close to 1.00). Fear avoidance beliefs about physical activity were not found to be associated with the three outcomes.ConclusionsHigh fear avoidance beliefs about work are associated with continuous sick leave after 1 year in patients with chronic low back pain. This finding might assist clinicians in choosing targeted treatment strategies in subgroups of working patients with chronic low back pain.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2351-9) contains supplementary material, which is available to authorized users.

Fear-Avoidance Behavior and Sickness Absence in Patients with Work-Related Musculoskeletal Disorders

“…The values of the fear-avoidance behavior obtained are similar to other studies both in acute [38,39] and in chronic pain patients [40]. These data are also consistent with other observational studies in the same line [19,33,41,42], giving meaning to the fear avoidance model, according to which the perception of pain in the short term could lead to movement avoidance behavior, reinforcing this attitude in the long term and providing negative characteristics to movement after a work accident [42].…”

“…The ability of the fear-avoidance questionnaire to predict sickness absence status and time to return to work has previously been shown to be questionable [32]. However, other authors have pointed out that high levels of fear-avoidance attitudes in the work dimension were related to long term sickness absence and no improvement in disability and pain in patients with LBP [33]. The results presented, in this study, are based on data collected at the beginning of the sickness absence process and on the follow-up of the duration of the absence.…”

Effectiveness of stratified treatment for back pain in Danish primary care: A randomized controlled trial

“…The subgroup classification of the SBT reflects items clinicians usually use to assess LBP (Hill et al., 2008 ), and although Kent et al., ( 2009 ) found wide variability in the assessment of non‐specific LBP (Kent et al., 2009 ), clinicians primarily use physical examination findings to support clinical decision making. Although other decision tools are well known in physiotherapy to support treatment plans or determine severity (Brazier et al., 1992 ; Foster et al., 2013 ; Freynhagen et al., 2006 ), recent studies and guidelines indicate that multiple factors play an important predictive role (Beneciuk et al., 2013 ; Stochkendahl et al., 2018 ; Trinderup et al., 2018 ). The findings of this study indicate that SBT subgroup classification seems useful and can support clinicians in reducing the number of treatment sessions for some patients, without affecting overall satisfaction with the quality of care.…”

Understanding Contextual Factors Effects and Their Implications for Italian Physiotherapists: Findings from a National Cross-Sectional Study

“…In situations where a patient desires a treatment whose efficacy lacks available scientific evidence, half of the respondents suggest a different treatment that is more suitable for the clinical picture. This specific question underlines a hotly debated topic: providing the best therapy in terms of scientific evidence without forgetting internal elements (i.e., expectations and previous experiences) that may have a significant effect [2,9,11,24,25]. As suggested by the current literature, physiotherapists who decide to advise a different treatment, regardless of the patient's demands, should carefully balance the positive characteristics of medical treatment with the negative ones of the other [26].…”