Anxiety Levels, Fear-avoidance Beliefs, and Disability Levels at Baseline and at 1 Year among Subjects with Acute and Chronic Low Back Pain

Objective: To compare anxiety levels, fear-avoidance beliefs, and disability levels over 1 year for patients with acute (≤3 months) and chronic (>3 months) low back pain (LBP). Design: Prospective study with questionnaire measurements. Setting: Tertiary care clinic. Patients: Patients with acute or chronic LBP who resided in a 3-county local area and presented to our clinic for initial evaluation. Methods: Administration of and results analysis from Fear-Avoidance Beliefs Questionnaire, Oswestry Disability Index, Pain and Impairment Relationship Scale, and Spielberger State-Trait Anxiety Inventory at baseline and 12 months. Trait anxiety was measured at baseline only. Main Outcome Measurements: Scores from questionnaires assessing fear-avoidance beliefs and state and trait anxiety, as well as LBP disability levels. Results: In total, 138 patients with acute LBP and 107 with chronic LBP were enrolled. Of these patients, 111 with acute and 86 with chronic LBP completed the study. The 2 groups were statistically indistinguishable at baseline on all measures except trait anxiety scores, which were significantly higher in the group with chronic LBP than in the acute group (P = .01). At 1 year, the acute group had a statistically significant improvement in all outcome measures except state anxiety. The group with chronic LBP had significant improvement in all measures except fear-avoidance beliefs and state anxiety. Overall, the group with acute LBP improved more in all measurement instruments than the chronic LBP group (a statistically significant difference) except state anxiety. Conclusions: The group with chronic LBP exhibited a higher level of trait anxiety at baseline than those with acute LBP and, unlike the acute LBP group, did not have improved fear-avoidance beliefs over 1 year. The relationship between anxiety and chronic LBP is novel. Because anxiety is potentially modifiable, future studies that evaluate the relationship between LBP and anxiety are warranted.