Clinical course and impact of fear-avoidance beliefs in low back pain - Prospective cohort study of acute and chronic low back pain: II
Clinical course and impact of fear-avoidance beliefs in low back pain - Prospective cohort study of acute and chronic low back pain: II
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DOI：
10.1097/01.brs.0000214878.01709.0e
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发表时间：
2006-04-20
期刊：
影响因子：
3
通讯作者：
Brox, JI
中科院分区：
文献类型：
--
作者：
Grotle, M;Vollestad, NK;Brox, JI
研究设计。前瞻性初始队列研究。比较急性和慢性腰痛患者恐惧-回避信念的临床过程，探讨恐惧-回避信念对预测1年后疼痛和残疾的作用。背景资料摘要。恐惧回避信念与残疾发展有关。在不同的LBP亚群中，对恐惧回避信念的发展知之甚少。急性（n = 123）和慢性（n = 50） LBP患者完成了包括恐惧-回避信念问卷（FABQ）在内的综合评估，并在3、6、9和12个月进行了随访。在基线时，慢性LBP患者的工作fabq评分（FABQ-Work）明显高于急性LBP患者（P < 0.001），并且这种差异在1年内保持不变（P < 0.21）。在基线时，两组的体力活动FABQ-PA评分（FABQ-PA）无统计学差异（P = 0.57）。急性腰痛患者的FABQ-PA评分在随访期间的前4周内显著下降，此后保持不变，而慢性样本的FABQ-PA评分在第一年保持不变（时间效应，P < 0.001；相互作用效应，P < 0.001）。在急性组中，FABQ-Work预测12个月疼痛（P < 0.05）和残疾（P = 0.01）。在慢性样本中，FABQ-PA预测12个月时的残疾（P = 0.03）。在模型中加入痛苦后，FABQ与疼痛/残疾之间的关联消失。慢性腰痛患者比急性腰痛患者对工作有更多的恐惧回避信念。在随访的一年中，除了急性样本的FABQ-PA在第一个月迅速下降外，恐惧回避信念有微小的变化。在调整了社会人口统计学和疼痛变量后，恐惧回避信念预测了12个月后的疼痛和残疾。痛苦是比恐惧回避信念更强的预测因子。
Study Design. Prospective inception cohort study.Objectives. To compare the clinical course of fear-avoidance beliefs in acute and chronic low back pain (LBP) and investigate the contribution of fear-avoidance beliefs to predict pain and disability after 1 year.Summary of Background Data. Fear-avoidance beliefs are involved in disability development. There is little knowledge on the development of fear-avoidance beliefs among different LBP subgroups.Methods. Patients with acute (n = 123) and chronic (n = 50) LBP completed a comprehensive assessment, including the Fear-Avoidance Beliefs Questionnaire (FABQ), and were followed at 3, 6, 9, and 12 months.Results. At baseline, patients with chronic LBP had significantly higher FABQ-scores for work (FABQ-Work) than patients with acute LBP (P < 0.001), and this difference remained unchanged over 1 year (P > 0.21). At baseline, there was no statistical significant difference in FABQ-scores for physical activity (FABQ-PA) between the two groups (P = 0.57). FABQ-PA scores decreased significantly over the first 4 weeks among patients with acute LBP during follow-up and remained unchanged thereafter, whereas in the chronic sample the FABQ-PA scores were unchanged throughout the first year (time effect, P < 0.001; and interaction effect, P < 0.001). In the acute sample, FABQ-Work predicted pain (P < 0.05) and disability at 12 months (P = 0.01). In the chronic sample, FABQ-PA predicted disability at 12 months (P = 0.03). The associations between the FABQ and pain/disability disappeared with distress included in the models.Conclusion. Patients with chronic LBP had more fear-avoidance beliefs for work than patients with acute LBP. There were small changes in fear-avoidance beliefs during the year of follow-up, except for a rapid decrease during the first month in the FABQ-PA in the acute sample. Fear-avoidance beliefs predicted pain and disability at 12 months after adjusting for socio-demographic and pain variables. Distress was a stronger predictor than fear-avoidance beliefs.