Correlates of self-reported disability in patients with low back pain: the role of fear-avoidance beliefs

Ann Acad Med Singap. 2007 Dec;36(12):1013-20.


Introduction: The purpose of the study was to examine the determinants of self-reported disability - MODQ (Modified Oswestry Low Back Pain Disability Questionnaire) in patients with low back pain (LBP); and to examine the level of FABQ (Fear-Avoidance Belief Questionnaires) scores in an ambulatory clinical population referred to physiotherapy management. We believe that identifying potentially modifiable determinants of disability in patients with LBP provides an opportunity to broaden the strategies to reduce its socioeconomic burden.

Materials and methods: A retrospective study was designed to be conducted in the physiotherapy department of a local hospital. The data were taken from standard examination of patients [n = 162, female 15.4%, male 84.6%, age mean = 30.6 years [standard deviation (SD), 11.4; range, 17 to 68)] presenting to the department with acute or chronic LBP. The data included physical examination of back, self-reported disability by MODQ, fear-avoidance beliefs by FABQ, pain intensity and demographic information.

Results: The final model generated by hierarchical regression analysis revealed that MODQ scores included self-reported symptom aggravation with all movements, pain medication usage, average straight leg raise (SLR), pain intensity, and Fear-Avoidance Belief Questionnaire-Work (FABQ-W). Overall, these variables account for approximately 40% of variance. The mediational analysis indicated that the relationship between the FABQ-W and MODQ scores may be partially mediated by pain intensity, average SLR values and pain medication usage.

Conclusion: In this correlational study of physical impairments, psychosocial factors and self-reported disability, disability was driven primarily by measures of pain and fear-avoidance beliefs. Because the FABQ is a simple and useful clinical tool, we suggest that physicians and physiotherapists alike should make it a routine attempt to characterise the fear-avoidance beliefs of patients with LBP.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Disability Evaluation
  • Fear / psychology*
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Health Status Indicators
  • Health Surveys
  • Humans
  • Low Back Pain / physiopathology*
  • Low Back Pain / psychology
  • Male
  • Middle Aged
  • Pain Measurement
  • Retrospective Studies
  • Surveys and Questionnaires
  • Work Capacity Evaluation