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Clinical Rehabilitation, Vol. 21, No. 9, 812-821 (2007)
DOI: 10.1177/0269215507077800

The role of fear-avoidance beliefs in patients with neck pain: relationships with current and future disability and work capacity

Kwok-Chung Lee

Department of Rehabilitation Sciences, The Hong Kong Polytechnic University

Thomas T.W. Chiu

Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, rstchiu{at}polyu.edu.hk

Tai-Hing Lam

Department of Community Medicine and Unit for Behavioral Sciences, The University of Hong Kong, Hong Kong

Objectives: To investigate the relationship between fear-avoidance beliefs and future disability and work capacity in patients with neck pain.

Design: A prospective observational study.

Setting: Physiotherapy outpatient departments.

Patients: One hundred and twenty patients with neck pain intensity sufficient

to affect their work capacity.

Interventions: Patients participated in either six-week conventional physiotherapy or an exercise training programme to test whether the type of treatment received by the patients together with other outcome measures affected the predictive power of fear-avoidance beliefs.

Main outcome measures: Patients underwent examination of the active neck range of movements and neck muscle strength and completed the Fear-Avoidance Beliefs Questionnaire, the Northwick Park Neck Pain Questionnaire, the Medical Outcomes 36-Item Short-Form Health Survey and the 11-point pain numerical rating scale. These were assessed at the beginning and at week 6 of the rehabilitation programme. Patients' work capacity was assessed at week 6 and three months after the six-week rehabilitation programme.

Results: Spearman's correlation coefficients between fear-avoidance beliefs and initial and week 6 disability levels were 0.47 and 0.48, respectively. Regression analysis showed that the fear-avoidance beliefs significantly improved the goodness of fit of the model for predicting week 6 disability levels and return to complete work capacity at week 6 and three months after the rehabilitation programme, even after controlling for the physical impairments, the health status, the pain intensity and the type of treatment received.

Conclusions: The fear-avoidance beliefs factor is an important biopsychosocial variable in predicting future disability level and return to complete work capacity in patients with neck pain.


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