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Fear Avoidance Beliefs Influence Duration of Sick Leave in Spanish Low Back Pain Patients

Kovacs, Francisco M. MD, PhD*; Muriel, Alfonso MSc†; Sánchez, María Dolores Castillo MD‡; Medina, José María MD§; Royuela, Ana BS†; the Spanish Back Pain Research Network

Spine:
doi: 10.1097/BRS.0b013e3180b9f5f7
Health Services Research
Abstract

Study Design. Follow-up study.

Objectives. To estimate the influence of fear avoidance beliefs (FAB) on 1-year low back pain (LBP)-related sick leave.

Summary of Background Data. As opposed to Anglo-Saxon and Northern European subjects, in Spanish LBP patients the influence of FAB on disability and quality of life is virtually irrelevant.

Methods. Twelve primary care and 9 hospital services from 7 different regions of Spain recruited 165 workers who visited the National Health Service for LBP. None was excluded. On their first visit and 14 days later, patients were given 2 independent Visual Analogue Scales (VAS) for LBP and leg pain, as well as the validated Spanish versions of the Fear Avoidance Beliefs (FABQ), Roland-Morris (RMQ), and SF-12 questionnaires. During the following 12-month period, the number of days on sick leave because of LBP was registered.

Results. Differences in sick leave throughout the study period were associated with baseline differences in chronicity, severity of low back (not referred) pain, disability, FAB, physical and mental quality of life, being on sick leave when entering the study, and duration of previous sick leave. Ordinal logistic regression models showed that each additional point in the total FAB baseline score increases by 2.4% the odds of being on sick leave for up to 60 days during the following year and by 7.7% the odds of being sick listed for 61 days or more. Corresponding figures for FAB-Work scores are 4.2% and 11%. No variable modifies the effect of FAB on sick leave.

Conclusion. Although in Spanish patients the influence of FAB on disability and quality of life is irrelevant, baseline FABQ score does influence LBP-related sick leave during the following year. This seems to be a direct effect of FAB, since there is no confounding by any other variable.

In Brief

In Spanish patients, the influence of FAB on disability and quality of life is irrelevant and much lower than that of pain severity. However, FAB influence LBP-related sick leave. Each additional point on the FABQ baseline score increases by 2.4% the odds of being on sick leave for up to 60 days during the following year, and by 7.7% the odds of being sick listed for 61 days or more. This effect of FAB is not being confounded by other variables.

Author Information

From *Departamento Científico, Fundación Kovacs, Palma de Mallorca, Spain; †Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, Madrid, Spain; ‡Delegación Provincial de Asuntos Sociales de Granada, Spain; and §Centro de Salud Gran Capitán, Granada, Spain.

Acknowledgment date: June 23, 2006. First revision date: December 18, 2006. Acceptance date: January 8, 2007.

Supported in part by a grant from Programa de Apoyo a la Investigación, from the Instituto de Salud Carlos III, Madrid, Spain (to A.M.) and by a grant from Fondo de Investigación Sanitaria (PI050966) (to A.R.).

Other members of the Spanish Back Pain Research Network who authored this study are: José Luis Martín Ruíz, Carmen Fernández, Javier Olabe, Patricia Ibáñez Gómez, Víctor Abraira, Lourdes Ortigosa, Antonio López Bermejo, Mateo Seguí Díaz, Pablo Tobajas Ruber, Mariano Ortega, Luis González Luján, Luis Cuesta Villa, Violeta González Urzelai, Monserrat Cañellas Arsegol, Guillermo Ripoll Estela, Monserrat Núñez, Juan Femenías Rosselló, Manel Carro Presedo, Luis Alvarez Galovich, Elena Rodríguez Bohorquez, Ma Angeles Usero Martín, Ma Teresa León Espinosa de los Monteros, Agustín Martín Martín, Montserrat Calatayud, Jordi Troy Ferrarons, Loreto Palacio Elua, Catalina Mateu Serrra, Jaime Ripoll, Angels Sanjuan Castillo, Mario Gestoso, Margarita Martín Pino, Nicole Mufraggi Vechierinni, María Teresa Gil del Real, Jenny Moix, and Javier Zamora.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Foundation funds were received from a commercial party related directly or indirectly to the subject of this manuscript. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Supported by the Kovacs Foundation.

Address correspondence and reprint requests to Francisco M. Kovacs, MD, PhD, Departamento Científico, Fundación Kovacs, Paseo de Mallorca 36, E-07012 Palma de Mallorca, Spain; E-mail: kovacs@kovacs.org

© 2007 Lippincott Williams & Wilkins, Inc.