Kovacs Francisco M, Muriel Alfonso, Abriaira Victor, Medina Jose Maria, Castillo Sanchez Maria Dolores, Olabe Javier
Departamento Científico, Fundación Kovacs, Palma de Mallorca, Spain.
Spine (Phila Pa 1976). 2005 Nov 15;30(22):E676-82. doi: 10.1097/01.brs.0000186468.29359.e4.
STUDY DESIGN: Correlation between previously validated questionnaires. OBJECTIVES: To assess the influence of fear avoidance beliefs (FAB) on disability and quality of life in Spanish low back pain (LBP) patients. SUMMARY OF BACKGROUND DATA: FAB has shown to be a major determinant of disability in LBP patients in Northern European and Anglo-Saxon cultural environments. There are no data on its influence on Latin-Mediterranean patients. METHODS: The study was done in 12 primary care and 9 hospital services from seven different regions of Spain, with 209 patients who were in a potentially active working situation and visited the National Health Service for LBP. None was excluded and the sample was balanced for acute, subacute, and chronic patients. On their first visit and 14 days later, patients were given two independent Visual Analogue Scales (VAS) for LBP and leg pain, as well as the validated Spanish versions of the Fear Avoidance Beliefs (FABQ), Roland-Morris (RMQ), and SF-12 questionnaires. RESULTS: Correlations between LBP, leg pain, FABQ, disability, and quality of life were moderate on day 1 (r = 0.320-0.564) and stronger on day 15 (r = 0.457-0.637). All of them were statistically highly significant (P = 0.000). Regression models showed that LBP severity explains 33% of disability on day 1 and 20% on day 15, while FAB only explains 6% on day 1 and 2% on day 15. FAB does not explain mental quality of life. It explains only 5% of physical quality of life on day 1 and 4% on day 15. There was no interaction between FAB and chronicity, and FABQ values on day 1 did not predict disability or quality of life at day 15. CONCLUSIONS: As opposed to what has been shown in other cultural settings, FAB have virtually no clinical relevance in Spanish LBP patients who are treated in the National Health Service and who are in a potentially active working situation. The influence of FAB on disability is minimal and much less than that of pain severity, and their contribution to the patient's quality of life is irrelevant. Further studies should explore the potential value of FAB in other Latin-Mediterranean countries.
研究设计：先前验证过的问卷之间的相关性。 目的：评估恐惧回避信念（FAB）对西班牙下腰痛（LBP）患者残疾和生活质量的影响。 背景数据总结：在北欧和盎格鲁-撒克逊文化环境中，FAB已被证明是LBP患者残疾的主要决定因素。尚无关于其对拉丁-地中海患者影响的数据。 方法：该研究在西班牙七个不同地区的12个初级保健机构和9个医院服务机构进行，研究对象为209名处于潜在工作状态且因LBP就诊于国家医疗服务体系的患者。无一例被排除，样本在急性、亚急性和慢性患者中保持平衡。在首次就诊时和14天后，患者接受了两个独立的用于评估下腰痛和腿痛的视觉模拟量表（VAS），以及经过验证的西班牙语版恐惧回避信念问卷（FABQ）、罗兰-莫里斯问卷（RMQ）和SF-12问卷。 结果：第1天时，下腰痛、腿痛、FABQ、残疾和生活质量之间的相关性为中等（r = 0.320 - 0.564），第15天时更强（r = 0.457 - 0.637）。所有这些相关性在统计学上均具有高度显著性（P = 0.000）。回归模型显示，下腰痛严重程度在第1天可解释33%的残疾情况，在第15天可解释20%；而FAB在第1天仅能解释6%，在第15天仅能解释2%。FAB无法解释心理生活质量。它在第1天仅能解释5%的身体生活质量，在第15天仅能解释4%。FAB与慢性程度之间不存在相互作用，第1天的FABQ值无法预测第15天的残疾或生活质量。 结论：与其他文化背景下的情况相反，在西班牙国家医疗服务体系中接受治疗且处于潜在工作状态的LBP患者中，FAB几乎没有临床相关性。FAB对残疾的影响微乎其微，远小于疼痛严重程度的影响，且它们对患者生活质量的贡献微不足道。进一步的研究应探索FAB在其他拉丁-地中海国家的潜在价值。
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