Swinkels-Meewisse Ilse E J, Roelofs Jeffrey, Verbeek André L M, Oostendorp Rob A B, Vlaeyen Johan W S
Practice of Physical Therapy and Manual Therapy, Eindhoven, The Netherlands.
Clin J Pain. 2006 Jan;22(1):45-54. doi: 10.1097/01.ajp.0000148626.84874.93.
Fear-avoidance beliefs have been shown to be associated with disability and work status in patients with low back pain. Especially in acute low back pain, much research is needed to increase the knowledge concerning the role of fear-avoidance beliefs and its associated avoidance behavior in the influence on disability and the participation in daily and social life activities. The Fear-Avoidance Beliefs Questionnaire is developed to measure such beliefs and has become increasingly popular for use in primary care practice. The aim of the current study was: 1) to investigate the factor structure of the Fear-Avoidance Beliefs Questionnaire in a population of patients with acute low back pain by means of confirmatory factor analysis; 2) to examine the relationship between fear-avoidance beliefs and perceived disability, as well as participation in daily and social life; and 3) to investigate whether perceived disability mediates the association between pain and participation and between fear-avoidance beliefs and participation.
The study has a cross-sectional design and was performed on a sample of 615 patients with acute low back pain in primary care settings in The Netherlands. Patients completed a visual analogue scale for pain, the Roland Disability Questionnaire, the Fear-Avoidance Beliefs Questionnaire, a sociodemographic questionnaire, and 5 participation items.
Confirmatory factor analysis corroborated the 2-factor structure of the Fear-Avoidance Beliefs Questionnaire as found by Waddell et al. Investigation of the association between fear-avoidance beliefs and perceived disability or participation was performed for workers and non-workers separately. The 2 subscales of the Fear-Avoidance Beliefs Questionnaire were significantly associated with perceived disability and participation, although there were differences between the samples. Perceived disability was significantly predicted by pain intensity and fear-avoidance beliefs. Perceived disability significantly predicted participation, and finally, the mediational role of perceived disability was supported.
In the early stage of low back pain, the reduction of pain and fear-avoidance beliefs might increase the level of activity, which might foster increased participation in daily and social life activities.
恐惧回避信念已被证明与腰痛患者的残疾和工作状态相关。尤其是在急性腰痛患者中，需要进行更多研究以增进对恐惧回避信念及其相关回避行为在影响残疾以及参与日常和社会生活活动方面所起作用的了解。恐惧回避信念问卷旨在测量此类信念，在初级保健实践中的应用越来越广泛。本研究的目的是：1）通过验证性因素分析，在急性腰痛患者群体中探究恐惧回避信念问卷的因素结构；2）检验恐惧回避信念与感知残疾以及参与日常和社会生活之间的关系；3）研究感知残疾是否在疼痛与参与之间以及恐惧回避信念与参与之间的关联中起中介作用。
本研究采用横断面设计，对荷兰初级保健机构中的615例急性腰痛患者进行了抽样调查。患者完成了疼痛视觉模拟量表、罗兰残疾问卷、恐惧回避信念问卷、社会人口学问卷以及5项参与度项目。
验证性因素分析证实了Waddell等人发现的恐惧回避信念问卷的两因素结构。分别对在职和非在职人员进行了恐惧回避信念与感知残疾或参与之间关联的调查。恐惧回避信念问卷的两个分量表与感知残疾和参与均显著相关，尽管不同样本之间存在差异。疼痛强度和恐惧回避信念可显著预测感知残疾。感知残疾可显著预测参与度，最后，感知残疾的中介作用得到了支持。
在腰痛的早期阶段，减轻疼痛和恐惧回避信念可能会提高活动水平，这可能有助于增加对日常和社会生活活动的参与度。
