Self-efficacy, fear avoidance, and pain intensity as predictors of disability in subacute and chronic musculoskeletal pain patients in primary health care

Pain. 2004 Oct;111(3):245-252. doi: 10.1016/j.pain.2004.07.001.


This study examined the relations between disability, as measured by the Pain Disability Index (PDI) and self-efficacy, fear avoidance variables (kinesiophobia and catastrophizing), and pain intensity, using a prospective design. Two primary health care samples (n(1)=210; n(2)=161) of patients with subacute, chronic or recurring musculoskeletal pain completed sets of questionnaires at the beginning of a physiotherapy treatment period. Multiple hierarchial regression analyses showed that self-efficacy explained a considerably larger proportion of the variance in disability scores than the fear avoidance variables in the first sample. This finding was replicated in the second sample. Pain intensity explained a small, but significant proportion of the variance in disability scores in one sample only. Gender, age, and pain duration were not related to disability. These findings suggest that self-efficacy beliefs are more important determinants of disability than fear avoidance beliefs in primary health care patients with musculoskeletal pain. The findings also suggest that pain-related beliefs, such as self-efficacy and fear avoidance, in turn, are more important determinants of disability than pain intensity and pain duration in these patients.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Avoidance Learning / physiology
  • Chronic Disease
  • Disability Evaluation
  • Fear / physiology
  • Fear / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Musculoskeletal Diseases / physiopathology
  • Musculoskeletal Diseases / psychology*
  • Pain / physiopathology
  • Pain / psychology*
  • Pain Measurement / statistics & numerical data
  • Predictive Value of Tests
  • Primary Health Care / statistics & numerical data*
  • Regression Analysis
  • Self Efficacy*