Cited by 118Musculoskeletal pain and rehabilitationMedical Practices and RehabilitationMyofascial pain diagnosis and treatment

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

George, Steven Z., Stryker, Sandra E.·2011·Journal of Orthopaedic & Sports Physical Therapy

Abstract

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.

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Crossref · 10.2519/jospt.2011.3488

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Authors
George, S. Z., & Stryker, S. E.
Affiliations
University of Florida (US)
Venue
Journal of Orthopaedic & Sports Physical Therapy
Published
2011-04
Volume
41
Issue
4
Pages
249-259
ISSN
  • 0190-6011 (ISSN-L)
  • 1938-1344
OpenAlex
W2151805978
Cited by
118
References
32
Citations by year
2026: 3 · 2025: 6 · 2024: 15 · 2023: 5 · 2022: 9 · 2021: 12 · 2020: 9 · 2019: 10 · 2018: 10 · 2017: 7 · 2016: 9 · 2015: 1 · 2014: 6 · 2013: 6 · 2012: 4
FWCI
4.45
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of Orthopaedic and Sports Physical Therapy (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
Keywords
fear-avoidance beliefs, musculoskeletal pain, outpatient physical therapy, cervical spine pain, lumbar spine pain, upper limb pain, lower limb pain, pain intensity, functional outcome, treatment utility
MeSH terms
Ambulatory Care, Analysis of Variance, Disability Evaluation, Fear, Female, Humans, Male, Middle Aged, Musculoskeletal Diseases, Pain, Pain Measurement, Prospective Studies, Psychometrics, Surveys and Questionnaires, Treatment Outcome, Physical Therapy Modalities

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