Sunday, February 17, 2008

FABQ and physical therapy

Another study on the FABQ (fear avoidance behavior questionnaire) in physical therapy was published in this month's JOSPT. The purpose of the study was to more specifically delineate the significance of the 2 portions of the test, look at predictive ability of each, and determine the score at which the test became predictive. Very exciting, I know.

The FABQ was developed by Gordon Waddell, of biopsychosocial model fame, and is as a test to determine the fear based pain behavior of patients. It is built on the premise that people in pain exist on a spectrum from "confronters" to "avoiders" when it comes to pain. Avoiders are more likely to continue to be in pain. It has been shown to be one of the better tools at identifying who is more and less likely to have their pain become long standing.

What I find missing from these studies, and this one is no different, is a lack of a description of what this actually means. Why would a person avoid pain and another confront it? The descriptions are usually left under the vague nature of "psychological issues."

One need only look toward Lorimer Moseley and Dr. Waddell for more. Dr. Moseley has shown us that beliefs about the nature of pain were discriminative in a group of people with experimentally induced pain of whose pain would continue. This adds to his research showing that educating the patient on pain physiology and thus giving them a more accurate understanding of pain, decreased their pain.

Waddell has shown that even the explanatory model of the clinician plays a role the persistence of pain.

Bottom line, change the belief about pain and you change the way a person behaves in response to pain. Change the behavior in response to pain and you can change the pain itself.

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