180
L. Aasdahl et al.
Table III. Associations between participants’ fear-avoidance beliefs at baseline and number of work-participation days during 9 months
of follow-up, for musculoskeletal and psychological diagnoses
Number of work-participation days a
Musculoskeletal diagnoses
Psychological diagnoses
Adjusted mean difference
Adjusted mean difference
Baseline n Crude mean difference b (95% CI) b,c n Crude mean difference b (95% CI) b,c
FABQ-Work, per unit
FABQ-Physical activity, per unit 162
176 –1.5
–0.6 106
116 –2.2
–2.9
–1.5 (–2.3 to –0.6)
–0.5 (–1.9 to 1.0)
–2.4 (–3.4 to –1.3)
–2.8 (–4.6 to –1.1)
Estimated from linear regression analyses separately for the 2 main diagnoses groups. As there were so few participants with unspecific diagnoses (chapter A in
ICPC-2) they were not included in these analyses.
a
Estimated from linear regression analyses. b Mean difference: difference in number of days at work as the FABQ score increase by 1 point.
c
Adjusted for age, sex and education level. Analysed with covariates constant at their mean.
FABQ: Fear Avoidance Beliefs Questionnaire; CI: confidence interval.
–52 to 5) than those with consistently low scores, while
those increasing their scores had 54 fewer work days
(95% CI –89 to –18).
For the FABQ-physical activity subscale, there was
a weaker association between changes in FABQ-scores
and work participation during follow-up (Table II).
Participants who reduced their FABQ-scores had 22
fewer work days (95% CI –54 to 11) than those with
consistently low scores, while those increasing their
scores had 15 fewer days (95% CI –46 to 16). Those
with consistently high scores had 41 fewer work days
(95% CI –69 to –12).
The sensitivity analyses including adjustment for
intervention programme in addition to age, sex and
education, showed similar results (results not shown).
FABQ across different diagnoses
Participants with psychological diagnoses had lower
scores than those with musculoskeletal diagnoses on
both FABQ-subscales at baseline (mean 18.7 (SD
10.7) vs 23.1 (SD 11.7) for FABQ-work and mean 5.8
(SD 6.5) vs 11.0 (SD 6.4) for FABQ-physical activity,
respectively). Of participants answering the FABQ at
both baseline and 12 months of follow-up, 74% with
a psychological diagnosis and 63% of those with a
musculoskeletal diagnosis, reduced their FABQ-work
score. For the physical activity subscale, the numbers
were 45% and 67%, respectively. The mean reduction
in fear-avoidance beliefs for work was 7.0 (SD 11.7)
for psychological diagnoses and 4.8 (SD 11.1) for the
musculoskeletal diagnoses. For the physical activity
subscale the numbers were 1.4 (SD 5.6) and 3.0 (SD
5.3), respectively.
FABQ-work scores at baseline were associated
with number of work-participation days during 9
months of follow-up for both musculoskeletal and
psychological diagnoses (Table III). The association
was stronger, and explained variance was larger, for
psychological diagnoses (0.16 vs 0.08). Baseline scores
for the physical activity subscale were associated with
work-participation days for those with psychological
www.medicaljournals.se/jrm
diagnoses, but not for musculoskeletal diagnoses. The
explained variance was small for both groups (< 0.01)
for this subscale.
Participants with missing questionnaires
Participants with missing questionnaires at 12 months
were somewhat younger (mean age 44 years (SD 9.6)
vs 48 years (SD8.2)), and more likely to be men than
women (66% vs 54%). Baseline scores for the 2 FABQ
subscales were similar for those not responding and
those responding (work subscale 22.0 (SD 11.6) vs
20.5 (SD11.3); physical activity subscale 9.4 (SD 6.9)
vs 8.2 (SD 6.6)).
The median number of work-participation days
during follow-up was similar for participants who
answered the FABQ at both the start and the end of
the programmes compared with those answering only
at one time-point, and thus were excluded from the
analyses (work subscale 123 days (IQR 81–182) vs
116 days (IQR 64–178); physical activity subscale
(119 days (IQR 70–180) vs 125 days (IQR 69–178)).
DISCUSSION
There were no differences in fear-avoidance beliefs
about work or physical activity between inpatient
occupational rehabilitation and outpatient cognitive
behavioural therapy during 12 months of follow-up.
The change in FABQ-work during the programmes
was associated with the number of work days during 9
months of follow-up. For FABQ-physical activity, the
association with future work participation was weaker.
The association between fear-avoidance beliefs at
baseline and future work participation was stronger
for those with psychological complaints than for those
with musculoskeletal complaints.
The lack of additional effect of the inpatient pro-
grammes on fear-avoidance beliefs was not in line with
our hypothesis. However, the results are in line with
a previous study comparing effects of work-focused
and standard rehabilitation on FABQ (9). FABQ was