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The Fear-Avoidance Components Scale (FACS): Responsiveness to Functional Restoration Treatment in a Chronic Musculoskeletal Pain Disorder (CMPD) Population

Neblett, Randy MA, LPC, BCB*; Mayer, Tom G. MD; Williams, Mark J. PhD*; Asih, Sali PhD*,‡; Cuesta-Vargas, Antonio I. PhD§; Hartzell, Meredith M. PhD*; Gatchel, Robert J. PhD, ABPP

doi: 10.1097/AJP.0000000000000501
Original Articles

Objectives: To assess the clinical validity and factor structure of the Fear-Avoidance Components Scale (FACS), a new fear-avoidance measure.

Materials and Methods: In this study, 426 chronic musculoskeletal pain disorder patients were admitted to a Functional Restoration Program (FRP). They were categorized into 5 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 1 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 fear-avoidance–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 1 year later (P≤0.02). A factor analysis identified a 2-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 1 year after discharge. The FACS seems to be a valid and clinically useful measure for predicting attendance, physical performance, distress, and relevant work outcomes in FRP treatment of chronic musculoskeletal pain disorder patients.

*PRIDE Research Foundation

Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas

Department of Psychology, College of Science, The University of Texas at Arlington, Arlington, TX

Department of Clinical Psychology, Faculty of Psychology, Universitas Indonesia, Depok, Jawa Barat, Indonesia

§Department of Physiotherapy of the Faculty of Health Science at the University of Malaga, Spain

The authors declare no conflicts of interest.

Reprints: Tom G. Mayer, MD, 5701 Maple Ave. #100, Dallas, TX 75235 (e-mail:

Received April 20, 2016

Received in revised form January 25, 2017

Accepted February 28, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.