Clinical Outcomes for Patients Classified by Fear-Avoidance Beliefs and Centralization Phenomenon
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OBJECTIVES: To (1) determine the prevalence of pain pattern classification subgroups (centralization, noncentralization, and not classified) observed during the initial evaluation of patients experiencing high versus low Fear-Avoidance Beliefs Questionnaire for physical activity (FABQ-PA) scores, (2) examine the association between discharge pain intensity and functional status (FS) outcomes based on FABQ-PA and pain pattern subgroups, and (3) compare minimal clinically important improvement for FS and pain intensity for FABQ-PA and pain pattern classification subgroups. DESIGN: Observational cohort design. SETTING: Suburban hospital-based outpatient rehabilitation clinic. PARTICIPANTS: Consecutive patients with low back syndromes (N=238, mean +/- SD, 59.1+/-17.0y; minimum=20, maximum=91). INTERVENTIONS: Interventions were designed to match patient classification by fear-avoidance level and pain pattern. MAIN OUTCOME MEASURES: Two outcome measures were assessed: patient self-reported FS and pain intensity. FS was assessed by using computerized adaptive testing methods. Maximal pain intensity was assessed by using an 11-point numeric pain scale: 0 (no pain) to 10 (worst imaginable pain). RESULTS: There were no differences (chi(2)(2)=3.7, P=.16) in proportion of patients classified by pain pattern experiencing high or low fear-avoidance beliefs. After controlling for the effect of available risk-adjustment variables, only dual-level classification subgroups, symptom acuity, payer type, and intake FS or pain intensity were associated with discharge FS or pain outcomes. The highest proportion of patients achieving minimal clinically important improvement in pain and FS were reported by the following patient subgroup: centralization and low fear. CONCLUSIONS: Pain pattern and FABQ-PA characteristics impacted rehabilitation outcomes. We recommend that both factors be considered when managing patients with low back pain in an effort to optimize rehabilitation outcomes.
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