redictive Value of Fear Avoidance in Developing Chronic eck Pain Disability: Consequences for Clinical Decision aking

Objective: To improve clinical decision making in posttrauatic neck pain by investigating the additional value of fearvoidance variables in predicting chronic neck pain disability. Design: An inception cohort with baseline assessment 1 eek posttrauma and outcome assessment 24 weeks postrauma. Predictive factors include pain intensity, Neck Disabilty Index (NDI), catastrophizing, fear of movement (Tampa cale for Kinesiophobia [TSK]), and avoidance muscle behavor. Setting: Hospital emergency department of a general hosital. Participants: A consecutive sample of 90 people reporting f pain in neck or head region after a motor vehicle collision. ighty-two subjects (91.1%) of the sample provided 24-week ollow-up on the outcome. Interventions: Not applicable. Main Outcome Measure: The NDI assessing physical disbility of subjects with neck pain. Results: By using a combination of the baseline NDI and SK, it appears to be possible to predict chronic disability with probability of 54.3% (95% confidence interval [CI], 35.2%– 2.3%) after entering the NDI (cutoff, 15) as a first test, and ith a probability of 83.3% (95% CI, 70.3%–91.3%) after ntering the TSK (cutoff, 40) in a second test. Conclusions: A simple rating of baseline neck pain disabilty within a week of the trauma, separately or in combination ith a test for fear of movement, can be used to predict future utcome. Patients showing fear of movement can be offered an ntervention that focuses on reduction of this fear.