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

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.

Psychometric properties of the Fear-Avoidance Beliefs Questionnaire in patients with neck pain.

OBJECTIVES: To translate the Fear-Avoidance Beliefs Questionnaire and investigate the validity and reliability of the Chinese version of the questionnaire in patients with neck pain. DESIGN: Observational cross-sectional and prospective study. SETTING: Physiotherapy outpatient departments. SUBJECTS: Four samples with 476 consecutive adult patients with neck pain from four physiotherapy centres. METHODS: The original questionnaire was translated into Chinese by forward and backward translation and reviewed by a panel of experts. The subjects completed the Chinese version of the fear-avoidance questionnaire, Northwick Park Neck Pain Questionnaire, Medical Outcomes 36-Item Short-Form Health Survey and their pain intensity was measured using an 11-point pain numerical rating scale. They were observed and measured at the beginning of physiotherapy, at week 3 and at week 6 after treatment began. RESULTS: The questionnaire had very good content validity and test-retest reliability with an intraclass correlation coefficient of 0.81 and Cronbach's alpha coefficient of 0.90. Spearman's correlation coefficients between fear-avoidance and the neck pain questionnaire, the health survey (physical), health survey (mental) and pain scale were 0.56, 0.45, 0.36 and 0.34, respectively. The standard response mean and effect size at week 6 were 0.38 and 0.32, respectively. Factor analysis yielded three factors which accounted for 61.6% of the total variance of the questionnaire. CONCLUSION: 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 and internal consistency, good construct validity and medium responsiveness.

Correlation between generic health status and region-specific functional measures on patients with neck pain.

This is a cross-sectional and prospective study to examine the correlation between the Northwick Park Neck Pain Questionnaire and the Medical Outcomes 36-Item Short-Form Health Survey on patients with neck pain in the course of physiotherapy. A total of 359 consecutive adult patients with neck pain, from three physiotherapy outpatient departments, who completed the Northwick Park Neck Pain Questionnaire and Medical Outcomes 36-Item Short-Form Health Survey, were observed and measured at different intervals - at the beginning of physiotherapy, at week 3, week 6 and upon discharge from physiotherapy. The results showed that both the Northwick Park Neck Pain Questionnaire and the Medical Outcomes 36-Item Short-Form Health Survey were able to differentiate patients with neck pain in health and diseased states. The Spearman's correlation coefficients between the Northwick Park Neck Pain Questionnaire and the 36-Item Short-Form Health Survey physical and mental component summary scores at entry of physiotherapy were -0.64 with the physical component summary score and -0.44 with the mental component summary score, and, at discharge from physiotherapy, were -0.75 with the physical component summary score and -0.46 with the mental component summary score. The Northwick Park Neck Pain Questionnaire has psychometric properties with both physical and mental dimensions of measurement of pain in patients with neck pain.