• Kwok-Chung Lee, Thomas T W Chiu, and Tai-Hing Lam.
• Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
• Clin Rehabil. 2007 Sep 1;21(9):812-21.

ObjectivesTo investigate the relationship between fear-avoidance beliefs and future disability and work capacity in patients with neck pain.DesignA prospective observational study.SettingPhysiotherapy outpatient departments.PatientsOne hundred and twenty patients with neck pain intensity sufficient to affect their work capacity.InterventionsPatients participated in either six-week conventional physiotherapy or an exercise training programme to test whether the type of treatment received by the patients together with other outcome measures affected the predictive power of fear-avoidance beliefs.Main Outcome MeasuresPatients underwent examination of the active neck range of movements and neck muscle strength and completed the Fear-Avoidance Beliefs Questionnaire, the Northwick Park Neck Pain Questionnaire, the Medical Outcomes 36-Item Short-Form Health Survey and the 11-point pain numerical rating scale. These were assessed at the beginning and at week 6 of the rehabilitation programme. Patients' work capacity was assessed at week 6 and three months after the six-week rehabilitation programme.ResultsSpearman's correlation coefficients between fear-avoidance beliefs and initial and week 6 disability levels were 0.47 and 0.48, respectively. Regression analysis showed that the fear-avoidance beliefs significantly improved the goodness of fit of the model for predicting week 6 disability levels and return to complete work capacity at week 6 and three months after the rehabilitation programme, even after controlling for the physical impairments, the health status, the pain intensity and the type of treatment received.ConclusionsThe fear-avoidance beliefs factor is an important biopsychosocial variable in predicting future disability level and return to complete work capacity in patients with neck pain.

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