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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.



1. Ministry of Land Infrastructure Transport. Current status of vehicle registration. [cited 2014 Sep 3] Available from: URL:

2. Korean National Police Agency. Current status of traffic accidents(death, injury). [cited 2014 July 14] Available from: URL:

3. Choi ES, Jang HG, Kwon OG, Woo CH, An HD. The change of cervical curvature in whiplash injury patients after oriental medicine treatment. J Oriental Rehab Med. 2002;19(3):107–21.

4. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52(2):157–68.
crossref pmid
5. Fritza JM, Georgeb SZ, Delitto A. The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status. Pain. 2001;94(1):7–15.
crossref pmid
6. Joo MK, Kim TY, Kim JT, Kim SY. Reliability and validity of the Korean version of the fear-avoidance beliefs questionnaire. PTK. 2009;16(2):24–30.

7. Song KJ, Choi BW, Kim SJ, Yoon SJ. Cross-cultural adaptation and validation of the Korean version of the neck disability index. J Korean Orthop Assoc. 2009;44(3):350–9.
8. Landers MR, Creger RV, Baker CV, Stutelberg KS. The use of fear-avoidance beliefs and nonorganic signs in predicting prolonged disability in patients with neck pain. Manual Therapy. 2008;13(3):239–48.
crossref pmid
9. Korean Statistical Information Serivce. Current status of hospital management. 2004–2011. Available from: URL:

10. Hush JM, Michaleff Z, Maher CG, Refshauqe K. Individual, physical and psychological risk factors for neck pain in Australian office workers: a 1-year longitudinal study. Eur Spine J. 2009;18(10):1532–40.
crossref pmid pmc
11. Lethem J, Slade PD, Troup JD, Bentley G. Outline of a fear-avoidance model of exaggerated pain perception-I. Behav Res Ther. 1983;21(4):401–8.
crossref pmid
12. George SZ, Fritz JM, Erhard RE. A comparison of fear-avoidance beliefs in patients with lumbar spine pain and cervical spine pain. Spine. 2001;26(19):2139–45.
crossref pmid
13. George SZ, Fritz JM. Investigation of elevated fear-avoidance beliefs for patients with low back pain: a secondary analysis involving patients enrolled in physical therapy. Journal of Orthopaedic & Sports Physical Therapy. 2008;38(2):50–8.
crossref pmid pmc
14. Jang HJ, Kim SY, Jeon JG, Shin EJ. The association between neck pain/disability and upper limb disability in patients with non-specific neck pain. Journal of the Korea Academia-Industrial-cooperation Society. 2013;14(6):2862–8.
15. Kim SS, Chung EJ, Lee JS, Lee BH. A study of the relationship between fear-avoidance beliefs, pain and neck disability index in patients with neck pain. J Oriental Rehab Med. 2012;22(4):123–33.

16. Choi HS, Kim MY, Kim JS, et al. The correlation analysis of low back pain, stress by event, and fear-avoidance beliefs caused by traffic accidents. J oriental Rehab Med. 2013;23(4):203–12.

17. Cleland JA, Fritz JM. Predictive validity of initial fear avoidance beliefs in patients with low back pain receiving physical therapy: is the FABQ a useful screening tool for identifying patients at risk for a poor recovery? Eur Spine J. 2008;17(1):70–9.
crossref pmid

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