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The Back Pain Beliefs of Health Care Providers: Are We Fear-Avoidant?

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Abstract

The purpose of this study was to survey the level of fear-avoidance beliefs for practicing general practitioners and physical therapists and to relate this to self-reported practice behaviors for patients with back pain. To this end, 60 general practitioners and 71 physical therapists were recruited. These participants completed a questionnaire including 11 items slightly revised from instruments designed to assess fear-avoidance beliefs in patients, and four items about treatment practices. The results indicated that these health care practitioners on the average generally held beliefs that are consistent with the current evidence, but there were also indications that some practitioners held beliefs reflecting fear-avoidance. More than two-thirds reported that they would advise a patient to avoid painful movements, more than one-third believed a reduction in pain is a prerequisite for return-to-work, while more than 25% reported that they believe sick leave is a good treatment for back pain. These beliefs were found to be related to reported practice behavior. Those with high levels of fear-avoidance beliefs were compared to those with low levels. Those with high levels of fear-avoidance belief had an increased risk for believing sick leave to be a good treatment (RR = 2.0; 90%CI = 1.02–3.92), not providing good information about activities (RR = 1.7; CI = 1.19–2.45), and being uncertain about identifying patients at risk for developing persistent pain problems (RR = 1.5; 90%CI = 1.00–2.27). It is concluded that some practitioners hold beliefs reflecting fear-avoidance and that these beliefs may influence treatment practice.

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REFERENCES

  1. Burton AK, Waddell G, Tillotson KM, Summerton N. Information and advice to patients with back pain can have a positive effect: A randomized controlled trial of a novel educational booklet in primary care. Spine 1999; 24(23): 2484-2491.

    Google Scholar 

  2. Riley JF, Ahern DK, Follick MJ. Chronic pain and functional impairment: Assessing beliefs about their relationship. Arch Phys Med Rehab 1988; 59: 579-582.

    Google Scholar 

  3. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low-back pain and disability. Pain 1993; 52: 157-168.

    Google Scholar 

  4. Linton SJ. Applied relaxation as a method of coping with chronic pain: A therapist's guide. Scand J Behav Ther 1982; 11: 161-174.

    Google Scholar 

  5. Linton SJ, Buer N, Vlaeyen J, Hellsing AL. Are fear-avoidance beliefs related to a new episode of back pain? A prospective study. Psychology and Health 2000; 14: 1051-1059.

    Google Scholar 

  6. Linton SJ, Halldén K. Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Clin J Pain 1998; 14(3): 209-215.

    Google Scholar 

  7. Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain 2000; 85: 317-332.

    Google Scholar 

  8. Vlaeyen JWS, Kole-Snijders AMJ, Rotteveel A, Ruesink R, Heuts PHTG. The role of fear of movement/(re)injury in pain disability. J Occup Rehabil 1995; 5: 235-252.

    Google Scholar 

  9. Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low-back pain and its relation to behavioral performance. Pain 1995; 62: 363-372.

    Google Scholar 

  10. Linton SJ. Psychologic risk factors for neck and back pain. In: Nachemsom A, Jonsson E, eds. Neck and back pain: The scientific evidence of causes, diagnosis, and treatment. Philadelphia: Lippincott Williams & Wilkins, 2000, pp. 57-78.

    Google Scholar 

  11. Nachemson A, Jonsson E. Neck and back pain: The scientific evidence of causes, diagnosis, and treatment. Philadelphia: Lippincott Williams & Wilkins, 2000, p. 495.

    Google Scholar 

  12. Haldorsen EM, Brage S, Johannesen TS, Tellnes G, Ursin H. Musculoskeletal pain: Concepts of disease, illness, and sickness certification in health professionals in Norway. Scand J Rheumatol 1996; 25(4): 224-232

    Google Scholar 

  13. Englund L: Sick-listing: Attitudes and doctor's practice, Doctoral Dissertation. Uppsala University, Sweden, 2000.

    Google Scholar 

  14. Cherkin D, Deyo RA, Wheeler K, Ciol MA. Physicians views about treating low-back pain: The results of a national survey. Spine 1995; 20(1): 1-9.

    Google Scholar 

  15. Waddell G, Feder G, Lewis M. Systematic reviews of bed rest and advice to stay active for acute low-back pain. Br J Gen Pract 1997; 47: 647-652.

    Google Scholar 

  16. Von Korff M, Moore JE, Lorig K, Cherkin, DC, Saunders K, González VM, Laurent D, Rutter C, Commite F. A crandomized trial of a lay-led self-management group intervention for back pain patients in primary care. Spine 1998; 23: 2608-2615.

    Google Scholar 

  17. Waddell G. The back pain revolution. Edinburgh: Churchill Livingstone, 1998.

    Google Scholar 

  18. Main CJ, Spanswick CC. Pain management: An interdisciplinary approach. Edinburgh: Churchill Livingstone, 2000.

    Google Scholar 

  19. Von Korff M, Barlow W, Cherkin D, Deyo RA. Effects of practice style in managing back pain. Ann Int Med 1994; 121(3): 187-195.

    Google Scholar 

  20. Turner J, LeResche L, von Korff M, Ehrlich K. Primary care back pain patient characteristics, visit content, and short-term outcomes. Spine 1998; 23: 463-469.

    Google Scholar 

  21. Rainville J, Carlson N, Polatin P, Gatchel RJ, Indahl A. Exploration of physicians' recommendations for activities in chronic low-back pain. Spine 2000; 25(17): 2210-2220.

    Google Scholar 

  22. Miller RP, Kori SH, Todd DD. The Tampa Scale for Kinesiophobia. Tampa, FL, unpublished manuscript, 1991.

  23. Englund L, Svärdsudd K. Sick-listing habits among general practitioners in a Swedish county. Scand J Prim Health Care 2000; 18: 81-86.

    Google Scholar 

  24. Koes BW, van Tulder MW, Ostelo R, Burton AK, Waddell G. Clinical guidelines for the management of low-back pain in primary care. Spine 2001; 26(22): 2504-2514.

    Google Scholar 

  25. Linton SJ. A review of psychological risk factors in back and neck pain. Spine 2000; 25(9): 1148-1156.

    Google Scholar 

  26. von Korff M. Pain management in primary care: An individualized stepped/care approach. In: Gatchel RJ, Turk DC, eds. Psychosocial factors in pain, 1st ed. New York: Guilford Press, 1999, 360-373.

    Google Scholar 

  27. Kendall N. Screening and early interventions: The New Zealand experience. Vienna, Austria: International Association for the Study of Pain, 1999.

    Google Scholar 

  28. Gatchel RJ, Polatin PB, Kinney RK. Predicting outcome of chronic back pain using clinical predictors of psychopathology: A prospective analysis. Health Psychology 1995; 14(5): 415-420.

    Google Scholar 

  29. Hazard RG, Haugh LD, Reid S, Preble JB, MacDonald L. Early prediction of chronic disability after occupational low back injury. Spine 1996; 21(8): 945-951.

    Google Scholar 

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Authors and Affiliations

  1. Department of Occupational and Environmental Medicine, Örebro Medical Center, 701 85, Örebro, Sweden

    Steven J. Linton

  2. Department of Medical, Clinical, and Experimental Psychology, University of Maastrict, The Netherlands

    Johan Vlaeyen & Raymond Ostelo

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  1. Steven J. Linton
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  2. Johan Vlaeyen
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  3. Raymond Ostelo
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Correspondence to Steven J. Linton.

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Linton, S.J., Vlaeyen, J. & Ostelo, R. The Back Pain Beliefs of Health Care Providers: Are We Fear-Avoidant?. J Occup Rehabil 12, 223–232 (2002). https://doi.org/10.1023/A:1020218422974

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