Screening for Fear Avoidance Beliefs/Behaviors

Instructions: Please answer this question according to how you feel or what you have been told by your healthcare
provider:
“I should not do physical activities which might make my pain worse”

□ Yes

□ No

Reference: Hart et al screened 30,858 patients, 34 to 68 year of age, with lower back pain in the United States for
intake and discharge level of fear avoidance beliefs. The base rate in both groups was 41%.

Scoring: A positive test response (“Yes”) increases the likelihood of fear avoidance behaviors/beliefs impacting the
outcome by about 50% (+ LR = 34.88).1

A negative test response (“No”) decreases the likelihood of fear avoidance behaviors/beliefs impacting the
outcome by about -30% (- LR = 0.18).1

Interpretation: Start with your estimated or measured base rate. In this case, we use Hart’s measured base rate of
41% applied to our patient sample. Add the appropriate test result, positive or negative. For example: a “Yes”
response is 41% + 50% = 91%. The patient most likely has elevated fear avoidance beliefs/behaviors.

Documentation: Use this result to justify physical therapy using “…brief psycho-educational strategies that address
the cognitive (thinking) and affective (feeling) processes that motivate pain-related activity avoidance.” 2

1. Hart DL et al. Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted
Functional Outcomes in Patients Treated for a Lumbar Spine Dysfunction. JOSPT. May 2011;41(5):pp.336-
345.

2. Davenport T, Austin A et al. The CAB Model of Pain-Related Activity Avoidance: Description and
Implications for Research and Practice in Physical Therapy. Orthopedic Physical Therapy Practice 2009;
21(4):127-134.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting
© 2008-2011 Tim Richardson, PT
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