Abstract
Nederhand MJ, IJzerman MJ, Hermens HJ, Turk DC, Zilvold G. Predictive value of fear
avoidance in developing chronic neck pain disability: consequences for clinical decision
making. Arch Phys Med Rehabil 2004;85:496–501.
Objective
To improve clinical decision making in posttraumatic neck pain by investigating the
additional value of fear-avoidance variables in predicting chronic neck pain disability.
Design
An inception cohort with baseline assessment 1 week posttrauma and outcome assessment
24 weeks posttrauma. Predictive factors include pain intensity, Neck Disability Index
(NDI), catastrophizing, fear of movement (Tampa Scale for Kinesiophobia [TSK]), and
avoidance muscle behavior.
Setting
Hospital emergency department of a general hospital.
Participants
A consecutive sample of 90 people reporting of pain in neck or head region after a
motor vehicle collision. Eighty-two subjects (91.1%) of the sample provided 24-week
follow-up on the outcome.
Interventions
Not applicable.
Main outcome measure
The NDI assessing physical disability of subjects with neck pain.
Results
By using a combination of the baseline NDI and TSK, it appears to be possible to predict
chronic disability with a probability of 54.3% (95% confidence interval [CI], 35.2%–72.3%)
after entering the NDI (cutoff, 15) as a first test, and with a probability of 83.3%
(95% CI, 70.3%–91.3%) after entering the TSK (cutoff, 40) in a second test.
Conclusions
A simple rating of baseline neck pain disability within a week of the trauma, separately
or in combination with a test for fear of movement, can be used to predict future
outcome. Patients showing fear of movement can be offered an intervention that focuses
on reduction of this fear.
Keywords
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Article info
Footnotes
☆Supported by the St. Hubertus Foundation and the US National Institute of Arthritis and Musculoskeletal and Skin Diseases.
☆No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.
Identification
Copyright
© 2004 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
