Article

The influence of elevated fear-avoidance beliefs on change in
functional status is unclear. Objective The purpose of this study was to
determine the influence of fear-avoidance on recovery of functional status during
rehabilitation for people with shoulder impairments. Design A retrospective
longitudinal cohort study was conducted. METHODS: /b> Data were collected from
3,362 people with musculoskeletal conditions of the shoulder receiving
rehabilitation. At intake and discharge, upper-extremity function was measured
using the shoulder Computerized Adaptive Test. Pain intensity was measured using
an 11-point numerical rating scale. Completion rate at discharge was 57% for
function and 47% for pain intensity. A single-item screen was used to classify
patients into groups with low versus elevated fear-avoidance beliefs at intake. A
general linear model (GLM) was used to describe how change in function is
affected by fear avoidance in 8 disease categories. This study also accounted for
within-clinic correlation and controlled for other important predictors of
functional change in functional status, including various demographic and
health-related variables. The parameters of the GLM and their standard errors
were estimated with the weighted generalized estimating equations method.
RESULTS: /b> Functional change was predicted by the interaction between fear and
disease categories. On further examination of 8 disease categories using GLM
adjusted for other confounders, improvement in function was greater for the low
fear group than for the elevated fear group among people with muscle, tendon, and
soft tissue disorders (Delta=1.37, P<.01) and those with osteopathies,
chondropathies, and acquired musculoskeletal deformities (Delta=5.52, P<.02).
These differences were below the minimal detectable change. Limitations
Information was not available on whether therapists used information on level of
fear to implement treatment plans. CONCLUSIONS: /b> The influence of
fear-avoidance beliefs on change in functional status varies among specific
shoulder impairments.

Langue : ANGLAIS