Predictive value of fear avoidance in developing chronic neck pain disability: Consequences for clinical decision making

Nederhand MJ, IJzerman MJ, Hermens HJ, Turk DC, Zilvold G. Predictive value of fear avoidance in developing chronic neck pain disability: consequences for clinical decision making. Arch Phys Med Rehabil 2004;85:496-501. Objective To improve clinical decision making in posttraumatic neck pain by investigating the additional value of fear-avoidance variables in predicting chronic neck pain disability. Design An inception cohort with baseline assessment 1 week posttrauma and outcome assessment 24 weeks posttrauma. Predictive factors include pain intensity, Neck Disability Index (NDI), catastrophizing, fear of movement (Tampa Scale for Kinesiophobia [TSK]), and avoidance muscle behavior. Setting Hospital emergency department of a general hospital. Participants A consecutive sample of 90 people reporting of pain in neck or head region after a motor vehicle collision. Eighty-two subjects (91.1%) of the sample provided 24-week follow-up on the outcome. Interventions Not applicable. Main outcome measure The NDI assessing physical disability of subjects with neck pain. Results By using a combination of the baseline NDI and TSK, it appears to be possible to predict chronic disability with a probability of 54.3% (95% confidence interval [CI], 35.2%-72.3%) after entering the NDI (cutoff, 15) as a first test, and with a probability of 83.3% (95% CI, 70.3%-91.3%) after entering the TSK (cutoff, 40) in a second test. Conclusions A simple rating of baseline neck pain disability within a week of the trauma, separately or in combination with a test for fear of movement, can be used to predict future outcome. Patients showing fear of movement can be offered an intervention that focuses on reduction of this fear.