Neblett Randy, Mayer Tom G, Williams Mark J, Asih Sali, Cuesta-Vargas Antonio I, Hartzell Meredith M, Gatchel Robert J
*PRIDE Research Foundation †Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas ∥Department of Psychology, College of Science, The University of Texas at Arlington, Arlington, TX ‡Department of Clinical Psychology, Faculty of Psychology, Universitas Indonesia, Depok, Jawa Barat, Indonesia §Department of Physiotherapy of the Faculty of Health Science at the University of Malaga, Spain.
Clin J Pain. 2017 Dec;33(12):1088-1099. doi: 10.1097/AJP.0000000000000501.
To assess the clinical validity and factor structure of the Fear-Avoidance Components Scale (FACS), a new fear-avoidance measure.
In this study, 426 chronic musculoskeletal pain disorder patients were admitted to a Functional Restoration Program (FRP). They were categorized into 5 FACS severity levels, from subclinical to extreme, at admission, and again at discharge. Associations with objective lifting performance and other patient-reported psychosocial measures were determined at admission and discharge, and objective work outcomes for this predominantly disabled cohort, were assessed 1 year later.
Those patients in the severe and extreme FACS severity groups at admission were more likely to "drop out" of treatment than those in the lower severity groups (P=0.05). At both admission and discharge, the FACS severity groups were highly and inversely correlated with objective lifting performance and patient-reported fear-avoidance-related psychosocial variables, including kinesiophobia, pain intensity, depressive symptoms, perceived disability, perceived injustice, and insomnia (Ps<0.001). All variables showed improvement at FRP discharge. Patients in the extreme FACS severity group at discharge were less likely to return to, or retain, work 1 year later (P≤0.02). A factor analysis identified a 2-factor solution.
Strong associations were found among FACS scores and other patient-reported psychosocial and objective lifting performance variables at both admission and discharge. High discharge-FACS scores were associated with worse work outcomes 1 year after discharge. The FACS seems to be a valid and clinically useful measure for predicting attendance, physical performance, distress, and relevant work outcomes in FRP treatment of chronic musculoskeletal pain disorder patients.
评估一种新的恐惧回避测量工具——恐惧回避成分量表（FACS）的临床效度和因子结构。
在本研究中，426名慢性肌肉骨骼疼痛障碍患者被纳入功能恢复计划（FRP）。入院时及出院时，他们被分为从亚临床到极端的5个FACS严重程度等级。在入院和出院时确定与客观提举能力及其他患者报告的心理社会测量指标之间的关联，并在1年后评估这个以残疾为主的队列的客观工作结果。
入院时处于严重和极端FACS严重程度组的患者比低严重程度组的患者更有可能“退出”治疗（P = 0.05）。在入院和出院时，FACS严重程度组与客观提举能力以及患者报告的与恐惧回避相关的心理社会变量高度负相关，这些变量包括运动恐惧症、疼痛强度、抑郁症状、感知到的残疾、感知到的不公正和失眠（P < 0.001）。所有变量在FRP出院时均有改善。出院时处于极端FACS严重程度组的患者在1年后重返工作岗位或保住工作的可能性较小（P≤0.02）。因子分析确定了一个双因子解决方案。
在入院和出院时，FACS评分与其他患者报告的心理社会及客观提举能力变量之间均存在强关联。出院时FACS高分与出院1年后较差的工作结果相关。FACS似乎是一种有效的临床测量工具，可以预测慢性肌肉骨骼疼痛障碍患者在FRP治疗中的就诊率、身体表现、痛苦程度和相关工作结果。
