The Back Pain Beliefs of Health Care Providers: Are We Fear-Avoidant?
Abstract
The purpose of this study was to survey the level of fear-avoidance beliefs for practicing general practitioners and physical therapists and to relate this to self-reported practice behaviors for patients with back pain. To this end, 60 general practitioners and 71 physical therapists were recruited. These participants completed a questionnaire including 11 items slightly revised from instruments designed to assess fear-avoidance beliefs in patients, and four items about treatment practices. The results indicated that these health care practitioners on the average generally held beliefs that are consistent with the current evidence, but there were also indications that some practitioners held beliefs reflecting fear-avoidance. More than two-thirds reported that they would advise a patient to avoid painful movements, more than one-third believed a reduction in pain is a prerequisite for return-to-work, while more than 25% reported that they believe sick leave is a good treatment for back pain. These beliefs were found to be related to reported practice behavior. Those with high levels of fear-avoidance beliefs were compared to those with low levels. Those with high levels of fear-avoidance belief had an increased risk for believing sick leave to be a good treatment (RR = 2.0; 90%CI = 1.02-3.92), not providing good information about activities (RR = 1.7; 90%CI = 1.19-2.45), and being uncertain about identifying patients at risk for developing persistent pain problems (RR = 1.5; 90%CI = 1.00-2.27). It is concluded that some practitioners hold beliefs reflecting fear-avoidance and that these beliefs may influence treatment practice.
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Such fears might present a barrier for the dissemination of Exposure treatments for CLBP.
“Such fears might present a barrier for the dissemination of Exposure treatments for CLBP”
From Exposure and CBT for chronic back pain: An RCT on differential efficacy and optimal length of treatment (2018) · cites this paper as Linton, Vlaeyen, & Ostelo, 2002
Practitioners scoring high on fear avoidance beliefs were much more likely to report that sick leave was a good treatment for pain.
“Furthermore, those scoring high on fear avoidance beliefs were much more likely to report that sick leave was a good treatment for pain.”
From Psychological aspects of persistent pain: Current state of the science (2004) · cites this paper as [65]
In a survey of 60 general practitioners and 71 physical therapists, a number of practitioners had beliefs consistent with fear avoidance.
“Results indicated that a number of practitioners had beliefs consistent with fear avoidance.”
From Psychological aspects of persistent pain: Current state of the science (2004) · cites this paper as [65]
Taken together, these findings suggest that health care providers might have pain-related fears that affect the way that they practice and respond to patients with back pain.
“Taken together, these findings suggest that health care providers might have pain-related fears that affect the way that they practice and respond to patients with back pain.”
From Psychological aspects of persistent pain: Current state of the science (2004) · cites this paper as [65]
More than two thirds of the surveyed practitioners reported that they would recommend that a patient avoid painful movements.
“More than two thirds of the practitioners reported that they would recommend that a patient avoid painful movements.”
From Psychological aspects of persistent pain: Current state of the science (2004) · cites this paper as [65]
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“Avoidance behaviour refers to behaviour aimed at postponing or preventing a potentially aversive situation from occurring [42] and might be influenced by the beliefs and recommendations of health-care professionals [43].”
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- Authors
- Linton, S. J., Vlaeyen, J., & Ostelo, R.
- Affiliations
- Örebro University (SE)
- Maastricht University (NL)
- Corresponding author
- Linton, Steven J.
- Venue
- Journal of Occupational Rehabilitation
- Published
- 2002-12
- Volume
- 12
- Issue
- 4
- Pages
- 223-232
- ISSN
- 1053-0487 (ISSN-L)
- 1573-3688
- OpenAlex
- W1560747412
- Cited by
- 265
- References
- 2
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 14 · 2023: 7 · 2022: 5 · 2021: 5 · 2020: 7 · 2019: 5 · 2018: 11 · 2017: 9 · 2016: 8 · 2015: 13 · 2014: 15 · 2013: 18 · 2012: 9
- FWCI
- 4.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Journal of Occupational Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- VU Research Portal (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Medicine › Psychiatry and Mental health › Medicine, History, and Philosophy
- Keywords
- fear-avoidance beliefs, back pain, general practitioners, physiotherapists, treatment behavior, sick leave, return to work, activity avoidance, chronic pain, patient information, practitioner beliefs
- MeSH terms
- Attitude of Health Personnel, Avoidance Learning, Disability Evaluation, Family Practice, Female, Humans, Male, Physician-Patient Relations, Practice Patterns, Physicians', Probability, Professional-Patient Relations, Surveys and Questionnaires, Sensitivity and Specificity, Severity of Illness Index, Sweden, Cohort Studies, Treatment Outcome, Low Back Pain, Risk Assessment, Statistics, Nonparametric, Health Care Surveys, Physical Therapy Modalities
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