• Thilo O Kromer, Judith M Sieben, Rob A de Bie, and Caroline H G Bastiaenen.
• T.O. Kromer, PhD, Department of Physiotherapy, School of Therapeutic Sciences, SRH University Heidelberg, Maria-Probst-Strasse 3, 69123 Heidelberg, Germany, and CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands. ThiloOliver.Kromer@hochschule-heidelberg.de Thilo.Kromer@maastrichtuniversity.nl.
• Phys Ther. 2014 Dec 1;94(12):1775-84.

BackgroundLittle information exists about the role of fear-avoidance beliefs and catastrophizing in subacromial pain syndrome.ObjectiveThe purpose of this study was to investigate the associations among pain, catastrophizing, fear, and disability and the contribution of fear-avoidance beliefs to disability at baseline and at 3-month follow-up.DesignA cross-sectional and longitudinal analysis was conducted.MethodsBaseline demographic and clinical data, including fear-avoidance beliefs and catastrophizing, of 90 patients were assessed for this analysis. Disability was measured with the Shoulder Pain and Disability Index at baseline and at 3-month follow-up. First, bivariate and partial correlations were calculated among pain, fear-avoidance beliefs, catastrophizing, and disability, based on the fear-avoidance model. Second, the contribution of fear-avoidance beliefs to disability at baseline and at 3-month follow-up was examined with hierarchical regression analyses.ResultsCorrelations between clinical variables and disability were largely in line with the fear-avoidance model. Regression analyses identified a significant contribution of fear-avoidance beliefs to baseline disability but not to disability at 3 months.LimitationsPatients with subacromial pain syndrome were studied; therefore, the results should be transferred with caution to other diagnoses. A modified version of the Fear-Avoidance Beliefs Questionnaire was used, which was not validated for this patient group.ConclusionsFear-avoidance beliefs contribute significantly to baseline disability but not to disability change scores after 3-month follow-up. Duration of complaints and baseline disability were the main factors influencing disability change scores. Although the results help to improve understanding of the role of fear-avoidance beliefs, further studies are needed to fully understand the influence of psychological and clinical factors on the development of disability in patients with subacromial shoulder pain.© 2014 American Physical Therapy Association.

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