Predictive value of fear avoidance in developing chronic neck pain disability: consequences for clinical decision making

Marc J. Nederhand, Maarten J. IJzerman, Hermie J. Hermens, Dennis C. Turk, Gerrit Zilvold

Research output: Contribution to journalArticleAcademicpeer-review

174 Citations (Scopus)
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Objective: To improve clinical decision making in posttraumatic neck pain by investigating the additional value of fear-avoidance variables in predicting chronic neck pain disability.DesignAn inception cohort with baseline assessment 1 week posttrauma and outcome assessment 24 weeks posttrauma. Predictive factors include pain intensity, Neck Disability Index (NDI), catastrophizing, fear of movement (Tampa Scale for Kinesiophobia [TSK]), and avoidance muscle behavior.

Setting: Hospital emergency department of a general hospital.

Participants: A consecutive sample of 90 people reporting of pain in neck or head region after a motor vehicle collision. Eighty-two subjects (91.1%) of the sample provided 24-week follow-up on the outcome.

Interventions: Not applicable.

Main outcome measure: The NDI assessing physical disability of subjects with neck pain.

Results: By using a combination of the baseline NDI and TSK, it appears to be possible to predict chronic disability with a probability of 54.3% (95% confidence interval [CI], 35.2%–72.3%) after entering the NDI (cutoff, 15) as a first test, and with a probability of 83.3% (95% CI, 70.3%–91.3%) after entering the TSK (cutoff, 40) in a second test.

Conclusions: A simple rating of baseline neck pain disability within a week of the trauma, separately or in combination with a test for fear of movement, can be used to predict future outcome. Patients showing fear of movement can be offered an intervention that focuses on reduction of this fear.
Original languageEnglish
Pages (from-to)496-501
JournalArchives of physical medicine and rehabilitation
Issue number3
Publication statusPublished - 2004


  • Fear
  • Muscles
  • Rehabilitation
  • Whiplash injuries


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