To investigate the effects of the fear-avoidance beliefs on Chinese patients with neck pain

xxi, 219 leaves : ill. (chiefly col.) ; 30 cm.PolyU Library Call No.: [THS] LG51 .H577P RS 2007 LeeThere is increasing evidence to suggest that psychosocial variables play an important role in the development of chronic pain and disability. Among the psychosocial factors, the fear-avoidance beliefs as set out in the Fear-Avoidance Beliefs Model developed by Lethem et al (1983) have been hypothesized to be among the most important variables in predicting disability, work return and treatment outcome in patients with low back pain. Previous studies have shown that the fear-avoidance model is limited not only to patients with lower back pain but also it is present in a wide range of patients with chronic pain conditions. However, our literature search showed that there is no information available on how fear-avoidance beliefs play a role in affecting Chinese patients with neck pain. We have hypothesized that, among the psychosocial factors, the fear-avoidance beliefs in patients with neck pain might also play an important role in affecting their disability and their ability to work normally. This study is the first attempt to examine the effects of fear-avoidance beliefs in Chinese patients with neck pain. This was a prospective study consisting of two phases. Phase I involved translation and validation of the Fear-Avoidance Beliefs Questionnaire (FABQ), and recruitment of a total of 476 patients with neck pain. The patients were asked to complete the Chinese version of the FABQ, the Northwick Park Neck Pain Questionnaire (NPQ) and the Medical Outcomes 36-Item Short-Form Health Survey (SF-36). Their pain intensity was measured using the 11-point pain numerical rating scale (NRS). They were observed and measured three times: at the beginning of physiotherapy, at week 3 after treatment began, and at week 6. The validity of the translated FABQ was verified by investigating its content validity, test-retest reliability, construct validity, factor structure and responsiveness.Phase II of the study involved 120 patients with neck pain and incomplete work capacity. They underwent examination of the active range of neck movements and neck muscle strength and they then 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. They were then randomized into either a 6-week individualized exercise training programme or a 6-week conventional outpatient physiotherapy programme. Participants' work status was assessed at week 6 and again at week 18, three months after the 6-week programs. Regression analysis was performed to investigate the relationship between the fear-avoidance beliefs and the initial and future disability and work status. The results of the study indicated that the Chinese version of FABQ had very good content validity and test-retest reliability, with an intraclass correlation coefficient of 0.81 and a Cronbach's alpha coefficient of 0.90. Spearman's correlation coefficients between FABQ and the NPQ, the SF-36 (Physical), SF-36 (Mental) and NRS were 0.56, 0.45, 0.36 and 0.34 respectively at the start of physiotherapy. The standard response mean and effect size at week 6 of treatment were 0.38 and 0.32, respectively. Factor analysis yielded three factors which accounted for 61.6% of the total variance of the questionnaire. The Spearman's correlation coefficients between fear-avoidance beliefs and initial and 6-week 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 in predicting 6-week disability and return to complete work capacity at 6 weeks and 18 weeks, even after controlling for pain intensity, physical impairments, general health measures, initial disability level and type of treatment. Therefore, the Chinese version of the Fear-avoidance Beliefs Questionnaire is a valid and reliable tool for patients with neck pain. It has been shown to demonstrate very good content validity, a high degree of test-retest reliability, internal consistency, good construct validity and medium responsiveness. Moreover, the level of future disability and, more importantly, the likelihood of return to complete work capacity could be predicted at an early phase of rehabilitation. Therefore, the fear-avoidance beliefs factor is an important biopsychosocial variable in predicting future disability level and return to complete work capacity. It is recommended that this factor should be addressed in the early stage of management of neck pain so that patients who are at risk of long-term disability and work loss can be identified earlier and appropriate interventions can be designed and implemented. This will prevent unnecessary medical costs and, more importantly, alleviate suffering in the patients.Department of Rehabilitation SciencesPh.D., Dept. of Rehabilitation Sciences, The Hong Kong Polytechnic University, 2007