The use of fear-avoidance beliefs and nonorganic signs in predicting prolonged disability in patients with neck pain

Man Ther. 2008 Jun;13(3):239-48. doi: 10.1016/j.math.2007.01.010. Epub 2007 Mar 26.


Psychological factors, such as fear-avoidance beliefs and nonorganic signs, have been postulated to play a role in the development of prolonged disability. The purpose of this study was to determine if fear-avoidance beliefs and nonorganic behavior are predictive of disability in patients with neck pain. Seventy-nine patients, with neck pain, were recruited from five outpatient physiotherapy clinics. Each of the patients completed a modified Fear-Avoidance Beliefs Questionnaire (FABQ) and was evaluated for the presence of cervical nonorganic signs (CNOS). The FABQ consists of two subscales pertaining to work (FABQ-W) and physical activity (FABQ-PA). The patients also completed the Neck Disability Index (NDI) during the initial examination and 12 weeks later. A 12-week NDI score 15 was operationally defined as prolonged disability. In order to determine the overall predictive ability of the FABQ and CNOS, receiver operator characteristic (ROC) curves were used. The areas under the ROC curve were 0.782 (CNOS), 0.833 (FABQ-Total), 0.782 (FABQ-W) and 0.814 (FABQ-PA). Results from this study suggest that the FABQ and testing for CNOS are both good tools for predicting patients who may develop prolonged disability.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Disability Evaluation
  • Fear / psychology*
  • Female
  • Health Behavior*
  • Humans
  • Male
  • Middle Aged
  • Neck Pain / classification
  • Neck Pain / psychology*
  • ROC Curve
  • Sensitivity and Specificity
  • Surveys and Questionnaires