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J Acupunct Res > Volume 32(1); 2015 > Article
Lee, Kim, Lee, Lim, Jung, Lee, and Lee: A Correlation Analysis of Neck Pain, Neck Disability Index and Fear-avoidance Beliefs in Patients with Neck Pain Caused by Traffic Accidents
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This study aimed to investigate the correlation between fear-avoidance beliefs and neck pain / neck disability caused by traffic accidents.


We surveyed 52 patients who were injured in traffic accidents. The patients completed baseline measures of pain, disability, fear-avoidance beliefs according to the visual analogue scale(VAS), neck disability index(NDI) and a fear-avoidance beliefs questionnaire (FABQ). At the end of medical treatment, VAS and NDI were reassessed. In order to determine the relationship between FABQ(including its subscales), change of VAS and NDI, Pearson correlation coefficients were used. To examine the accuracy of previously reported cut-off scores, we classified the patients into low and high groups and analyzed the change of VAS and NDI. The relationship was measured by Mann-Whitney U-test and a student’s T-test.


FABQ and its subscales(total, physical activity and work) were significantly correlated with final VAS and NDI. FABQ-T showed low significant negative correlation with change of NDI. Previously reported cut-off scores did not show a statistical significance in this study Conclusions: This study suggests that screening for fear-avoidance beliefs may be useful for identifying patients at risk of prolonged pain after traffic accidents.

Table 1.
General Characteristics of the Subject (N=52)
Male Female p-value
N(%) 25(43.9) 27(47.4)
Age 35.2±11.4 43.7±13.7 0.018*
VAS 5.4±1.2 5.9±1.0 0.122
NDI 18.4±6.7 21.0±6.7 0.165
FABQ-PA 12.8±5.2 13.2±4.8 0.784
FABQ-W 21.1±8.7 20.3±10.5 0.749
FABQ-T 34.0±11.9 33.5±13.8 0.895

Values are means ± SD.

Statistical significance was evaluated by Student’s t-test.

VAS: visual analogue scale. NDI: neck disability index.

FABQ: fear-avoidance beliefs questionnaire, PA-physical activity, W-work, T-total.

* p <0.05.

Table 2.
Pearson Correlation Coefficients Examining the Relationships between FABQ-PA, FABQ-W, FABQ-total Scores, Initial and Final VAS, NDI and Change in VAS, NDI for Patients
FABQ-PA FABQ-W FABQ-T Initial VAS Initial NDI Final VAS Final NDI Change in VAS Change in NDI
FABQ-PA(0~24) .520** .772** .240 .171 .214 .382** .076 −.236
FABQ-W(0~42) .944** .038 .110 .203 .338* −.136 −.266
FABQ-T(0~66) .121 .148 .234 .398** −.072 −.289*
Initial VAS .500** .508** .473** .654** .110
Initial NDI .352* .720** .240 .503**
Final VAS .565** −.319* −.211
Final NDI .024 −.238
Change in VAS .307*
Change in NDI

Values are means ± SD. Statistical significance was evaluated by Pearson correlation coefficients, VAS: visual analogue scale. NDI: neck disability index.

FABQ: fear-avoidance beliefs questionnaire, PA-physical activity, W-work, T-total.

* p <0.05.

** p <0.01.

Table 3.
The Comparison on VAS and NDI Decrement between Two Groups which Classified with Cut-off Score Reported by Landers et al8).
Numbers 3 49 29 23 23 29
VAS decrement 0.7±0.6 1.7±1.0 1.5±1.0 1.78±1.0 1.7±1.1 1.5±1.0
p-value = 0.084 p-value = 0.303 p-value = 0.447
NDI decrement 2.7±7.6 5.6±4.6 6.3±5.3 4.3±4.0 6.7±5.1 4.4±4.4
p-value = 0.306 p-value = 0.136 p-value = 0.078

Values are means ± SD.

Statistical significance was evaluated by Mann-Whitney U-test in FABQ-T and Student’s t-test in FABQ-PA, W.

VAS: visual analogue scale. NDI: neck disability index.

FABQ: fear-avoidance beliefs questionnaire, PA-physical activity, W-work, T-total.



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