Clinical Outcomes for Patients Classified by Fear-Avoidance Beliefs and Centralization Phenomenon

Abstract 

Werneke MW, Hart DL, George SZ, Stratford PW, Matheson JW, Reyes A. Clinical outcomes for patients classified by fear-avoidance beliefs and centralization phenomenon.

Objectives

To (1) determine the prevalence of pain pattern classification subgroups (centralization, noncentralization, and not classified) observed during the initial evaluation of patients experiencing high versus low Fear-Avoidance Beliefs Questionnaire for physical activity (FABQ-PA) scores, (2) examine the association between discharge pain intensity and functional status (FS) outcomes based on FABQ-PA and pain pattern subgroups, and (3) compare minimal clinically important improvement for FS and pain intensity for FABQ-PA and pain pattern classification subgroups.

Design

Observational cohort design.

Setting

Suburban hospital-based outpatient rehabilitation clinic.

Participants

Consecutive patients with low back syndromes (N=238, mean ± SD, 59.1±17.0y; minimum=20, maximum=91).

Interventions

Interventions were designed to match patient classification by fear-avoidance level and pain pattern.

Main Outcome Measures

Two outcome measures were assessed: patient self-reported FS and pain intensity. FS was assessed by using computerized adaptive testing methods. Maximal pain intensity was assessed by using an 11-point numeric pain scale: 0 (no pain) to 10 (worst imaginable pain).

Results

There were no differences (χ₂²=3.7, P=.16) in proportion of patients classified by pain pattern experiencing high or low fear-avoidance beliefs. After controlling for the effect of available risk-adjustment variables, only dual-level classification subgroups, symptom acuity, payer type, and intake FS or pain intensity were associated with discharge FS or pain outcomes. The highest proportion of patients achieving minimal clinically important improvement in pain and FS were reported by the following patient subgroup: centralization and low fear.

Conclusions

Pain pattern and FABQ-PA characteristics impacted rehabilitation outcomes. We recommend that both factors be considered when managing patients with low back pain in an effort to optimize rehabilitation outcomes.

Key Words: Low back pain, Outcome assessment (health care), Rehabilitation

List of Abbreviations: CI, confidence interval, FS, functional status, FABQ, Fear Avoidance Belief Questionnaire, FABQ-PA, Fear Avoidance Belief Questionnaire for Physical Activity, LBP, low back pain