The influence of fear avoidance beliefs on disability and quality of life is sparse in Spanish low back pain patients

Spine (Phila Pa 1976). 2005 Nov 15;30(22):E676-82. doi: 10.1097/01.brs.0000186468.29359.e4.


Study design: Correlation between previously validated questionnaires.

Objectives: To assess the influence of fear avoidance beliefs (FAB) on disability and quality of life in Spanish low back pain (LBP) patients.

Summary of background data: FAB has shown to be a major determinant of disability in LBP patients in Northern European and Anglo-Saxon cultural environments. There are no data on its influence on Latin-Mediterranean patients.

Methods: The study was done in 12 primary care and 9 hospital services from seven different regions of Spain, with 209 patients who were in a potentially active working situation and visited the National Health Service for LBP. None was excluded and the sample was balanced for acute, subacute, and chronic patients. On their first visit and 14 days later, patients were given two independent Visual Analogue Scales (VAS) for LBP and leg pain, as well as the validated Spanish versions of the Fear Avoidance Beliefs (FABQ), Roland-Morris (RMQ), and SF-12 questionnaires.

Results: Correlations between LBP, leg pain, FABQ, disability, and quality of life were moderate on day 1 (r = 0.320-0.564) and stronger on day 15 (r = 0.457-0.637). All of them were statistically highly significant (P = 0.000). Regression models showed that LBP severity explains 33% of disability on day 1 and 20% on day 15, while FAB only explains 6% on day 1 and 2% on day 15. FAB does not explain mental quality of life. It explains only 5% of physical quality of life on day 1 and 4% on day 15. There was no interaction between FAB and chronicity, and FABQ values on day 1 did not predict disability or quality of life at day 15.

Conclusions: As opposed to what has been shown in other cultural settings, FAB have virtually no clinical relevance in Spanish LBP patients who are treated in the National Health Service and who are in a potentially active working situation. The influence of FAB on disability is minimal and much less than that of pain severity, and their contribution to the patient's quality of life is irrelevant. Further studies should explore the potential value of FAB in other Latin-Mediterranean countries.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Avoidance Learning
  • Culture
  • Disabled Persons / psychology*
  • Fear*
  • Female
  • Health Behavior
  • Humans
  • Low Back Pain / ethnology*
  • Low Back Pain / psychology*
  • Male
  • Middle Aged
  • National Health Programs
  • Quality of Life*
  • Spain
  • Surveys and Questionnaires