Importance of fear-avoidance belief questionnaire in non-specific chronic low back pain: a case review

A fear avoidance belief questionnaire is widely used to discover the patient beliefs about how physical activity and work affect back pain. Also it has moderate to good correlation with disability recovery rate. The aim of this case review is to describe the role of fear avoidance belief questionnaire during examination and management of chronic non-specific low back pain. A 24 year-old female was referred for physiotherapy with a chronic history of low back pain. Thorough musculoskeletal examination was undertaken with Oswestry Disability Questionnaire and fear avoidance belief questionnaire as outcome measures. Subjective examination showed strong positive signs of psychological illness and there were no red signs. Physical examination showed painful guarded movement patterns in the lumbo-pelvic region, which made it difficult to indicate specific examination. Based on current findings and ongoing clinical reasoning, the patient was educated in terms of cognitive reconstruction regarding the nature of her low back pain and its relation with present disabilities. After cognitive reconstruction we requested her to perform functional activities. Interestingly, she was able to achieve smooth movement patterns in the spine, with minimal abnormalities. Following this, we were able to progress with further specific physical examination involving muscle power test, spine accessory movements and motor control tests without the help of further radiological evaluation. The patient was treated using a specific biopsychosocial approach. There were positive results for considering a fear avoidance belief questionnaire as a useful and highly economical diagnostic tool for evaluation and management of low back pain patients.