Predictive validity of initial fear avoidance beliefs in patients with low back pain receiving physical therapy: is the FABQ a useful screening tool for identifying patients at risk for a poor recovery?

Abstract

Several prospective studies examining patients receiving physical therapy support the predictive validity of FABQ subscale scores. This has lead to the proposition that the FABQ would be a useful screening tool, permitting early identification of patients at risk for a poor outcome with an opportunity to modify the treatment accordingly. However, the predictive validity of the FABQ within physical therapy practice has yet to be examined. Predictive validity was analyzed between the FABQ-PA, FABQ-W using both disability and pain as the dependent variables using Pearson correlation coefficients and stepwise hierarchical linear regression modeling controlling for baseline variables. Separate analyses were run for patients with private health insurance and those receiving workers' compensation. Further analysis of predictive validity was performed by dichotomizing the outcome of physical therapy. Patients were coded as having a poor outcome if they failed to achieve a minimum clinically important change in disability over the course of treatment. The accuracy of previously reported cut-off scales for both the FABQ-W and FABQ-PA were examined for both payor types. Results of the hierarchical linear regression analyses for patients with private insurance showed neither the FABQ-PA nor the FABQ-W score significantly improved the explained variance in change in pain or disability. For patients receiving workers' compensation, only the FABQ-W subscale score significantly contributed to the model after controlling for the other baseline variables for both changes in disability and pain. Only the FABQ-W subscale was predictive of poor outcome and this was only identified in the worker's compensation group. The results suggest that the work subscale of the FABQ might be an appropriate screening tool to identify patients with work-related LBP who are at risk for a poor outcome with routine physical therapy. Neither FABQ subscale was predictive of outcome for patients with private insurance, and the use of the FABQ, as a screening tool for patients with non-workrelated LBP was not supported.

Fear-Avoidance Beliefs and Clinical Outcomes for Patients Seeking Outpatient Physical Therapy for Musculoskeletal Pain Conditions

“…These findings are in contrast to those of other studies in physical therapy settings, in which higher fear-avoidance scores predicted poorer outcomes. 8,11 These results are, however, similar to those of a cohort study which found that initial FABQ-PA score levels were not predictive of discharge pain or disability in patients with low back pain, 4 and to those of a randomized trial which reported better treatment outcomes for participants with elevated fear-avoidance beliefs who received graded exercise. 10 In the current study, the elevated fear-avoidance group was not put into a specific treatment group but received a patient-centered plan of care tailored towards their elevated fearavoidance beliefs.…”

The predictive and external validity of the STarT Back Tool in Danish primary care

“…Previous studies have tested the predictive validity of questionnaires using a variety of methods [19,20]. In the current study, the predictive validity and external validity of the SBT met the criteria proposed by Justice et al [10] for comparing cohorts across countries and at a different outcome time points than from that previously studied (in our case, 3 months in the current study and 6 months in the original SBT study in the UK).…”

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

“…Some may consider this a weakness of the current study, as fear of work activities is associated with FS outcomes in other studies 4,11,12,14,16,36,68 and can be screened efficiently. 29 However, the effect of type of payer on fear-avoidance beliefs of work items has not been studied.…”

“…There is evidence that identifying patients with elevated fearavoidance beliefs and managing them accordingly may reduce fear and improve outcomes. [3][4][5][10][11][12][13][14][15][16][17][18][19][20]36,40,41,56,68 The purpose of this study was to determine the effect of adding a single-item screening variable that classified patients with elevated versus not elevated fearavoidance beliefs of physical activities on a model that predicts risk-adjusted FS outcomes.…”