Table of Contents
Pain Research and Treatment
Volume 2018, Article ID 8347120, 6 pages
Research Article

Fear Avoidance Beliefs and Risk of Long-Term Sickness Absence: Prospective Cohort Study among Workers with Musculoskeletal Pain

1National Research Centre for the Working Environment, Lersø Parkallé 105, Copenhagen, Denmark
2The Carrick Institute for Graduate studies, Institute of Clinical Neuroscience and Rehabilitation, 8910 Astronaut Blvd, Cape Canaveral, LF 32920, USA
3Departamento de Enfermería y Fisioterapia, Universidad de Lleida, Cataluña, Spain
4Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Spain
5Sport Sciences, Department of Health Science and Technology, Aalborg University, Denmark

Correspondence should be addressed to Lars Louis Andersen; kd.ewcrn@all

Received 11 May 2018; Revised 23 July 2018; Accepted 15 August 2018; Published 2 September 2018

Academic Editor: Sulayman D. Dib-Hajj

Copyright © 2018 Kenneth Jay et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background and Objective. Musculoskeletal pain is common in the population. Negative beliefs about musculoskeletal pain and physical activity may lead to avoidance behavior resulting in absence from work. The present study investigates the influence of fear avoidance beliefs on long-term sickness absence. Methods. Workers of the general working population with musculoskeletal pain (low back, neck/shoulder, and/or arm/hand pain; n = 8319) from the Danish Work Environment Cohort Study were included. Long-term sickness absence data were obtained from the Danish Register for Evaluation and Marginalization (DREAM). Time-to-event analyses (cox regression) controlled for various confounders estimated the association between fear avoidance beliefs (very low, low, moderate [reference category], high, and very high) at baseline and long-term sickness absence (LTSA; ≥6 consecutive weeks) during a 2-year follow-up. Results. During the 2-year follow-up, 10.2% of the workers experienced long-term sickness absence. In the fully adjusted model, very high-level fear avoidance increased the risk of LTSA with hazard ratio (HR) of 1.48 (95% CI 1.15-1.90). Similar results were seen analyses stratified for occupational physical activity, i.e., sedentary workers (HR 1.72 (95% CI 1.04-2.83)) and physically active workers (HR 1.48 (95% CI 1.10-2.01)). Conclusion. A very high level of fear avoidance is a risk factor for long-term sickness absence among workers with musculoskeletal pain regardless of the level of occupational physical activity. Future interventions should target fear avoidance beliefs through information and campaigns about the benefits of staying active when having musculoskeletal pain.