Journal of Rehabilitation Medicine 51-3 | Page 29

J Rehabil Med 2019; 51: 175–182 ORIGINAL REPORT CHANGES IN FEAR-AVOIDANCE BELIEFS AND WORK PARTICIPATION AFTER OCCUPATIONAL REHABILITATION FOR MUSCULOSKELETAL- AND COMMON MENTAL DISORDERS: SECONDARY OUTCOMES OF TWO RANDOMIZED CLINICAL TRIALS Lene AASDAHL, MD, PhD 1,2 , Sigmund Østgård GISMERVIK, MD 1,3, Gunn Hege MARCHAND, MD, PhD 3,4 , Ottar VASSELJEN, PhD 1 , Roar JOHNSEN, Dr.Med 1 and Marius Steiro FIMLAND, PhD 1,2,3,4 From the 1 Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, 2 Unicare Helsefort Rehabilitation Centre, Rissa, 3 Department of Physical Medicine and Rehabilitation, St Olavs Hospital, Trondheim University Hospital and 4 Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway Objectives: To assess: (i) whether changes in the Fear-Avoidance Beliefs Questionnaire (FABQ) were greater for multicomponent inpatient rehabilitation vs outpatient cognitive behavioural therapy, and (ii) whether baseline scores and changes (pre- to post- intervention) in FABQ were associated with future work-participation. Methods: Individuals sick-listed for 2–12 months were randomized to inpatient multicomponent re­ habilitation (3.5 weeks or 4+4 days) or outpatient cognitive behavioural therapy (6 sessions/6 weeks). Results: A total of 334 subjects were included. There were no significant differences on FABQ between the in- and out-patient programmes during follow- up. Participants with consistently low scores on the work subscale had more work-participation days, followed by those who reduced their scores. Parti­ cipants who increased, or had consistently high sco­ res had the least workdays. For the physical activity subscale, the associations were weaker. FABQ-work scores at baseline were associated with number of work-participation days for both musculoskeletal and psychological diagnoses, and more strongly for the latter group. Conclusion: This study suggests that FABQ could be a useful prognostic tool for individuals on sick leave due to musculoskeletal or psychological disorders. There was no evidence that inpatient occupational rehabilitation reduces FABQ scores more than out­ patient cognitive behavioural therapy. Key words: return to work; sick leave; musculoskeletal di- seases; mental health. Accepted Jan 15, 2019: Epub ahead of print Feb 5, 2019 J Rehabil Med 2019; 51: 175–182 Correspondence address: Lene Aasdahl, Norwegian University of Sci- ence and Technology, NTNU, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Postboks 8905, MTFS, 7491 Trondheim, Norway. E-mail: [email protected] P sychological factors are important in prevention of disability and promotion of return to work (RTW) (1). One model to explain how psychological factors influence disability in patients with low-back pain is the LAY ABSTRACT Psychological factors are important in sick-listed wor- kers’ return to work process. The fear-avoidance mo- del suggests that negative beliefs about pain and its consequences may lead to catastrophizing thoughts and avoidance of activities believed to be harmful or to worsen the pain. This study evaluated whether the Fear-Avoidance Beliefs Questionnaire (FABQ), was as- sociated with future work outcomes for sick-listed wor- kers in occupational rehabilitation. FABQ is traditionally used for individuals with low-back pain, but this study also used it for individuals with common mental health disorders. The results suggest that the FABQ could be a useful prognostic tool for individuals on sick leave due to both musculoskeletal and psychological disorders. fear-avoidance model (2, 3). This model describes how negative beliefs about pain and its consequences may lead to catastrophizing and avoidance of activities be- lieved to be harmful or to worsen the pain, which again may lead to inactivity and reduced functioning (3). One of several questionnaires developed to measure fear-avoidance beliefs is the Fear-Avoidance Beliefs Questionnaire (FABQ) (4), consisting of 2 subscales: work and physical activity. High fear-avoidance beliefs have repeatedly been associated with lower RTW rates (5–7). However, few studies have evaluated whether RTW interventions reduce fear-avoidance beliefs (8). A recent study of patients with neck or back pain participating in a multidisciplinary intervention found no difference in FABQ scores within 4 months follow-up between interventions with added work-focus vs conventional rehabilitation (9). However, with reduced FABQ-work scores (12 points or more) the odds for RTW increased at 12 months of follow-up. The FABQ was developed for patients with low-back pain. However, avoidance of activities believed to be harmful by the patient, as described in the fear-avoidan- ce model, is not specific for low-back pain. Hence, the physiological responses seen in patients with back pain have common features with responses seen in anxiety This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2520