The Role of Fear Avoidance Beliefs as a Prognostic Factor for Outcome in Patients with Non-Specific Low Back Pain

Post on October 21, 2013 by André Broussard, D.C.

A Systematic Review
Maria M. Wertli, M.D.

Abstract
Background context
Psychological factors including fear avoidance beliefs are believed to influence the development of chronic low back pain.

Purpose
To determine the prognostic importance of fear avoidance beliefs as assessed by the Fear Avoidance Beliefs Questionnaire (FABQ) and the Tampa Scale of Kinesiophobia (TSK), for clinically relevant outcomes in patients with non-specific low back pain (LBP).

Design / Setting
Systematic Review.

Methods
In October 2011, the following databases were searched: BIOSIS, CINAHL, Cochrane Library, Embase, OTSeeker, PeDRO, PsycInfo, PubMed/Medline, Scopus, and Web of Science. To ensure the completeness of the search, a hand search and a search of bibliographies was conducted and all relevant references included. A total of 2,031 references were retrieved, leaving 566 references after the removal of duplicates. For 53 references, the full-text was assessed and finally 21 studies were included in the analysis. This study was not funded and the authors have no conflict of interest to declare.

Results
The most convincing evidence was found supporting fear avoidance beliefs to be a prognostic factor for work-related outcomes in sub-acute LBP patients (i.e. four weeks to three months LBP). Four cohort studies, conducted by disability insurance companies in the U.S.A., Canada, and Belgium, included 258 to 1,068 patients mostly with non-specific LBP. These researchers found an increased risk for work-related outcomes (not returning to work, sick days) with elevated FABQ-scores. The Odds Ratio (OR) ranged from 1.05 (95% CI 1.02, 1.09) to 4.64 (95% CI 1.57, 13.71). The highest OR was found when applying a high cut-off for FABQ-W scores. This may indicate that the use of cut-off values increases the likelihood of positive findings. This question requires further study. fear avoidance beliefs in very acute LBP ( 3 months) was mostly not predictive.

Conclusions
Evidence suggests that fear avoidance beliefs are prognostic for poor outcome in sub-acute LBP and thus early treatment, including interventions to reduce fear avoidance beliefs, may avoid delayed recovery and chronicity.

Journal Abstract:  http://www.sciencedirect.com/science/article/pii/S1529943013015763

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