Objectives: To assess the clinical validity and factor structure of the Fear-Avoidance Components Scale (FACS), a new fear-avoidance (FA) measure.
Methods: In this study, 426 chronic musculoskeletal pain disorder (CMPD) patients were admitted to a functional restoration program (FRP). They were categorized into five 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 one-year later.
Results: 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 FA-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 one-year later (P<=0.02). The factor analysis identified a two-factor solution.
Discussion: 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 one-year after discharge. The FACS appears to be a valid and clinically useful measure for predicting attendance, physical performance, distress and relevant work outcomes in FRP treatment of CMPD patients.
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