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The Role of the Fear-avoidance Model in Female Workers With Neck-shoulder Pain related to Computer Work

Huis 't Veld, Rianne M. H. A. in MSc*; Vollenbroek-Hutten, Miriam M. R. PhD*; Groothuis-Oudshoorn, Karin C. G. M. PhD*; Hermens, Hermie J. PhD* †

The Clinical Journal of Pain: January 2007 - Volume 23 - Issue 1 - p 28-34
doi: 10.1097/01.ajp.0000210943.88933.f3
Original Articles

Objective This study explores the fear-avoidance model in a sample of women with neck-shoulder pain related to computer work who were still functioning at the workplace. Exploring this model in this population could produce starting points for new treatment approaches in occupational health.

Methods Fifty-eight women with work-related neck-shoulder pain and 45 healthy controls were included. Differences in components of the fear-avoidance model between cases and controls were computed using t tests. In addition, correlations were calculated and structural equation modeling techniques were performed to investigate the fear-avoidance model in the case group.

Results In line with the fear-avoidance model, cases had lower performance levels and felt significantly more disabled compared with their controls but showed, in contrast to the model, significantly lower levels of catastrophizing thoughts. Of the fear-avoidance beliefs measures, all correlations were significant except, between catastrophizing and fear of movement. Fear-avoidance beliefs about work seem to play an important role in disability levels of work-related neck-shoulder pain patients as illustrated by the high(est) association with disabilities. The results of the present study also showed that the original fear-avoidance model proposed in people with work-related neck-shoulder pain who are still functioning at the workplace could only be confirmed by 1 of the 3 fit indices. Interestingly, adding an extrapath between fear-avoidance beliefs and disability in the original model approached good model fit as shown by all 3 fit indices.

Discussion In line with the fear-avoidance model, the current results addressed the importance of pain-related fear in people with neck-shoulder pain disability related to computer work. Interestingly, and not in accordance with the fear-avoidance model, fear-avoidance beliefs directly influence disability levels in the current sample; regardless of lower levels of performance that is, physical impairment.

*Roessingh Research and Development B.V., Enschede

Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands

Reprints: Rianne Huis in 't Veld, MSc, Roessingh Research and Development B.V., Roessinghbleekweg 33b, 7522 AH Enschede, The Netherlands (e-mail:

Received for publication October 21, 2005; accepted August 21, 2006

The present study was performed within the framework of the European project “Neuromuscular Assessment in the Elderly Worker” (NEW).

© 2007 Lippincott Williams & Wilkins, Inc.