Fear-avoidance beliefs and clinical outcomes for patients seeking outpatient physical therapy for musculoskeletal pain conditions

J Orthop Sports Phys Ther. 2011 Apr;41(4):249-59. doi: 10.2519/jospt.2011.3488. Epub 2011 Feb 18.


Study design: Prospective cohort.

Objective: To investigate fear-avoidance beliefs across different anatomical regions for patients with musculoskeletal pain.

Background: Fear-avoidance beliefs were first widely studied in patients with low back pain. The early results of studies involving patients with cervical spine, knee, and shoulder disorders suggest that fear-avoidance beliefs have the potential to influence pain and function in different anatomical regions. However, very few prospective studies of fear-avoidance beliefs involve multiple anatomical regions.

Methods: The sample of this study consisted of 313 patients (mean age, 45.5 years; 115 males, 198 females) seeking outpatient physical therapy for cervical spine (n = 63), upper extremity (n = 58), lumbar spine (n = 79), or lower extremity (n = 113) complaints. During the intake session, patients completed the Fear-Avoidance Beliefs Questionnaire physical activity scale (FABQ-PA), modified for the appropriate anatomical location. Patients also rated pain intensity and function on the Therapeutic Associates Outcomes System (TAOS) Functional Index at intake and discharge. The collection of treatment-related parameters included the number of visits, calendar days of physical therapy, and treatment received. FABQ-PA scores were compared across anatomical regions. Elevated FABQ-PA scores and anatomical regions were also investigated for association with intake pain and function, clinical outcomes, and treatment utility parameters.

Results: Similar FABQ-PA levels were observed across the 4 anatomical regions (P>.05). Number of visits, calendar days of physical therapy, and treatment received did not differ between elevated and lower fear-avoidance belief levels (P>.05). Findings for pain intensity and function were similar for each anatomical region. Patients with elevated fear-avoidance beliefs had higher intake scores (P<.05), larger improvements (P<.05), but similar discharge scores (P>.05), compared to those with lower fear-avoidance beliefs.

Conclusion: These data suggest that, in patients with cervical, upper extremity, lumbar, or lower extremity complaints, fear-avoidance beliefs may have a similar influence on intake and change scores for pain intensity and function. General assessment of fear-avoidance beliefs using the FABQ-PA, especially to predict change scores, may be appropriate for use in patients with various musculoskeletal pain conditions.

MeSH terms

  • Ambulatory Care
  • Analysis of Variance
  • Disability Evaluation
  • Fear / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Musculoskeletal Diseases / psychology*
  • Musculoskeletal Diseases / rehabilitation*
  • Pain / psychology*
  • Pain / rehabilitation*
  • Pain Measurement
  • Physical Therapy Modalities*
  • Prospective Studies
  • Psychometrics
  • Surveys and Questionnaires
  • Treatment Outcome