n South African Journal of Physiotherapy - The prevalence of fear avoidance and pain catastrophising amongst patients with chronic neck pain

Volume 76 Number 1
  • ISSN : 0379-6175
  • E-ISSN: 2410-8219



Background: Cognitive factors impact chronic pain, but the prevalence of fear avoidance (FA) and pain catastrophising (PC) in individuals suffering from chronic neck pain (CNP) has not been investigated in South Africa. Objectives: To determine the prevalence of FA and PC in patients with CNP at private physiotherapy practices in Johannesburg. Method: The Tampa Scale for Kinesiophobia-11 (TSK-11) (α = 0.80) and Pain Catastrophising Scale (α = 0.87) self-report questionnaires were used in a cross-sectional study to determine the prevalence of FA and PC, respectively. Descriptive statistics and correlations using Pearson’s or Spearman’s coefficient were conducted between demographic variables and FA and PC. Non-parametric data were tested using the Wilcoxon rank-sum or Kruskal–Wallis test. Cohen’s d-value or r-value measured strength of associations. Results: A sample of 106 CNP patients with a mean age of 48.7 years (± 14.8) from 25 randomly selected private practices participated in the study. Of the participants, 81% were women (n = 86). Fear avoidance and PC had a prevalence of 25.5% (n = 27) and 15.1% (n = 16), respectively. A positive correlation was found between FA-11-Total and PC-Total (r = 0.684; p = 0.0001) and between FA (TSK-11-Total and TSK-SF (somatic focus)) and PC and its subscales (r ≥ 0.602; p = 0.0001). Participants with a secondary education (26.0 ± 3.4) showed a higher FA than those with tertiary education (21.9 ± 1.5). Effect size was moderate (Cohen’s d = 0.60). Pain intensity correlated positively with both FA (Pearson’s correlation: r = 0.33; p = 0.001) and PC (Spearman’s correlation; r = 0.39; p = 0.0001). Conclusion: FA and PC affect a number of patients with CNP. A lower level of education was associated with FA and a higher pain intensity was associated with higher FA and PC. Clinical implications: Identifying FA and PC in patients with CNP is important to facilitate holistic management.

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