Waddell Gordon, Newton Mary, Henderson Iain, Somerville Douglas, Main Chris J
Orthopaedic Department, Western Infirmary, Glasgow G11 6NT, Scotland UK Salford Behavioural Medicine Unit, Hope Hospital, Salford M6 8HD UK.
Pain. 1993 Feb;52(2):157-168. doi: 10.1016/0304-3959(93)90127-B.
Pilot studies and a literature review suggested that fear-avoidance beliefs about physical activity and work might form specific cognitions intervening between low back pain and disability. A Fear-Avoidance Beliefs Questionnaire (FABQ) was developed, based on theories of fear and avoidance behaviour and focussed specifically on patients' beliefs about how physical activity and work affected their low back pain. Test-retest reproducibility in 26 patients was high. Principal-components analysis of the questionnaire in 210 patients identified 2 factors: fear-avoidance beliefs about work and fear-avoidance beliefs about physical activity with internal consistency (alpha) of 0.88 and 0.77 and accounting for 43.7% and 16.5% of the total variance, respectively. Regression analysis in 184 patients showed that fear-avoidance beliefs about work accounted for 23% of the variance of disability in activities of daily living and 26% of the variance of work loss, even after allowing for severity of pain; fear-avoidance beliefs about physical activity explained an additional 9% of the variance of disability. These results confirm the importance of fear-avoidance beliefs and demonstrate that specific fear-avoidance beliefs about work are strongly related to work loss due to low back pain. These findings are incorporated into a biopsychosocial model of the cognitive, affective and behavioural influences in low back pain and disability. It is recommended that fear-avoidance beliefs should be considered in the medical management of low back pain and disability.
初步研究和文献综述表明，对体育活动和工作的恐惧回避信念可能形成了介于腰痛和残疾之间的特定认知。基于恐惧和回避行为理论开发了一份恐惧回避信念问卷（FABQ），该问卷特别关注患者对体育活动和工作如何影响其腰痛的信念。对26名患者进行的重测信度较高。对210名患者的问卷进行主成分分析，确定了两个因素：对工作的恐惧回避信念和对体育活动的恐惧回避信念，其内部一致性（α）分别为0.88和0.77，分别占总方差的43.7%和16.5%。对184名患者的回归分析表明，即使考虑到疼痛的严重程度，对工作的恐惧回避信念仍占日常生活活动残疾方差的23%和工作损失方差的26%；对体育活动的恐惧回避信念又解释了残疾方差的9%。这些结果证实了恐惧回避信念的重要性，并表明对工作的特定恐惧回避信念与因腰痛导致的工作损失密切相关。这些发现被纳入了一个关于腰痛和残疾的认知、情感和行为影响的生物心理社会模型。建议在腰痛和残疾的医疗管理中考虑恐惧回避信念。
