Work-related fear-avoidance beliefs and risk of low-back pain: Prospective cohort study among healthcare workers

Abstract

PURPOSE Low-back pain (LBP) is a prevalent condition among healthcare workers, negatively affecting well-being and work ability. Research has identified fear-avoidance beliefs, i.e. the belief that physical activities worsen or prolong pain, as a key psychological factor in LBP. Given the physical demands of healthcare work, understanding the link between fear-avoidance and LBP is crucial for effective prevention and management strategies. This study investigated the prospective association between fear-avoidance beliefs and risk of increased LBP intensity and duration in hospital workers. METHODS Fear-avoidance beliefs and LBP were assessed in 1,933 healthcare workers from 389 departments at 19 hospitals at baseline and 1-year follow-up. Associations between baseline work-related fear-avoidance beliefs (FABW) and LBP intensity and duration at follow-up were analyzed using cumulative logistic regression, adjusting for various factors including age, sex, baseline LBP, education, seniority, patient transfers, psychosocial work environment, and lifestyle. RESULTS Moderate and high FABW was associated with higher odds of increased pain intensity (OR: 1.37 [95% CI: 1.09–1.73] and 1.85 [95% CI: 1.18–2.88], respectively) and prolonged pain duration (OR: 1.37 [95% CI: 1.05–1.78] and 2.27 [95% CI: 1.50–3.44], respectively). A sensitivity analysis including only female nurses showed similar results, with the high FABW group having significantly higher odds of increased pain intensity (OR 2.95, 95% CI: 1.84–4.72) and duration (OR 2.64, 95% CI: 1.55–4.49). CONCLUSIONS Fear-avoidance beliefs increase the risk of LBP intensity and duration among healthcare workers, emphasizing the need for interventions dealing with psychological aspects of LBP.