PMID- 18349490
OWN - NLM
STAT- MEDLINE
DCOM- 20080718
LR  - 20220318
IS  - 0190-6011 (Print)
IS  - 0190-6011 (Linking)
VI  - 38
IP  - 2
DP  - 2008 Feb
TI  - Investigation of elevated fear-avoidance beliefs for patients with low back pain: 
      a secondary analysis involving patients enrolled in physical therapy clinical 
      trials.
PG  - 50-8
LID - 10.2519/jospt.2008.2647 [doi]
AB  - STUDY DESIGN: Secondary analysis. OBJECTIVE: To investigate the Fear-Avoidance 
      Beliefs Questionnaire (FABQ) for its ability to predict 6-month outcomes for 
      patients with low back pain (LBP) participating in physical therapy clinical 
      trials. BACKGROUND: Consistent evidence suggests that fear-avoidance beliefs are 
      predictive of short-term outcomes for patients with LBP. However, proposed 
      cut-off scores have not been widely investigated for longer-term outcomes in 
      samples of patients receiving physical therapy. METHODS AND MEASURES: Subjects (n 
      = 160) were participants in 2 separate randomized trials that used standard 
      methodology and investigated the efficacy of physical therapy interventions for 
      LBP. Subjects completed baseline measures of pain, disability, fear-avoidance 
      beliefs, and physical impairment. They completed 4 weeks of randomly assigned 
      physical therapy and were reassessed at 6 months with standard examination 
      techniques. The accuracy of previously proposed cut-offs for elevated FABQ scores 
      were determined by independent t tests and chi-square analysis on raw 6-month 
      Oswestry Disability Questionnaire (ODQ) scores, 6-month ODQ change scores, and 
      minimally clinical important difference (MCID) in ODQ scores (6 points). Next, a 
      hierarchical regression model determined which FABQ scale better predicted 
      6-month ODQ scores after controlling for previously reported prognostic factors 
      and relevant treatment parameters. Last, receiver operating characteristic curve 
      analyses were planned to generate a range of FABQ cut-off scores that predicted 
      6-month MCID in the ODQ. RESULTS: The previously reported cut-off score for the 
      FABQ physical activity scale (>14) resulted in 111 (69.4%) of 160 patients being 
      classified as having elevated baseline scores, while the previously reported 
      cut-off score for the FABQ work scale (>29) resulted in 19 (11.9%) of 160 
      patients being classified as having elevated baseline scores. Patients with 
      elevated FABQ physical activity scale scores (>14) had no significant differences 
      in 6-month ODQ outcomes. Patients with elevated FABQ work scale (>29) scores 
      reported higher 6-month ODQ scores and were more likely to have reported no 
      improvement in ODQ score. The final regression model explained 24.4% of the 
      variance in 6-month ODQ scores, with only manipulation and exercise and the FABQ 
      work scale as unique predictors. Fifteen of the subjects (12.7%) had a 6-month 
      change in ODQ that indicated no improvement. The area under the receiver 
      operating characteristic curve for the FABQ physical activity scale predicting 
      this outcome was 0.562 (95% CI: 0.415-0.710) and for the FABQ work scale was 
      0.694 (95% CI: 0.542-0.846). Cut-off scores were explored for the FABQ work scale 
      only, with positive likelihood ratios that ranged from 1.19 to 5.15 and negative 
      likelihood ratios that ranged from 0.30 to 0.83. CONCLUSIONS: The FABQ work scale 
      was the better predictor of self-report of disability in this sample of patients 
      participating in physical therapy clinical trials. Future studies are necessary 
      to further test and refine the FABQ work scale as a screening tool alone, and in 
      combination with other examination findings.
FAU - George, Steven Z
AU  - George SZ
AD  - Department of Physical Therapy, Brooks Center for Rehabilitation Studies, 
      University of Florida, Gainesville, FL 32611-0154, USA. szgeorge@phhp.ufl.edu
FAU - Fritz, Julie M
AU  - Fritz JM
FAU - Childs, John D
AU  - Childs JD
LA  - eng
GR  - R03 AR051128/AR/NIAMS NIH HHS/United States
GR  - R03 AR051128-01A2/AR/NIAMS NIH HHS/United States
GR  - R-03 AR051128-01/AR/NIAMS NIH HHS/United States
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20080122
PL  - United States
TA  - J Orthop Sports Phys Ther
JT  - The Journal of orthopaedic and sports physical therapy
JID - 7908150
SB  - IM
MH  - Adult
MH  - Chronic Disease
MH  - Disability Evaluation
MH  - Exercise Therapy
MH  - Fear/*psychology
MH  - Female
MH  - Health Status Indicators
MH  - Health Surveys
MH  - Humans
MH  - Low Back Pain/*psychology/rehabilitation
MH  - Male
MH  - Musculoskeletal Manipulations
MH  - *Physical Therapy Modalities
MH  - Prospective Studies
MH  - Regression Analysis
MH  - Surveys and Questionnaires
MH  - Treatment Outcome
PMC - PMC2881572
MID - NIHMS100854
EDAT- 2008/03/20 09:00
MHDA- 2008/07/19 09:00
PMCR- 2010/06/07
CRDT- 2008/03/20 09:00
PHST- 2008/03/20 09:00 [pubmed]
PHST- 2008/07/19 09:00 [medline]
PHST- 2008/03/20 09:00 [entrez]
PHST- 2010/06/07 00:00 [pmc-release]
AID - 1382 [pii]
AID - 10.2519/jospt.2008.2647 [doi]
PST - ppublish
SO  - J Orthop Sports Phys Ther. 2008 Feb;38(2):50-8. doi: 10.2519/jospt.2008.2647. 
      Epub 2008 Jan 22.