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

Clin Rehabil. 2007 Sep;21(9):812-21. doi: 10.1177/0269215507077800.


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.

Publication types

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

MeSH terms

  • Adult
  • Attitude to Health*
  • Disabled Persons / classification*
  • Disabled Persons / psychology
  • Employment / psychology*
  • Fear*
  • Female
  • Hong Kong
  • Humans
  • Male
  • Middle Aged
  • Neck Pain / psychology*
  • Neck Pain / rehabilitation
  • Pain / classification
  • Pain / psychology*
  • Physical Therapy Modalities
  • Surveys and Questionnaires