low back pain ( lbp ) is a common clinical problem and the lifetime prevalence of back pain is 6080% . lbp has become a major medical , social and economic problem ( waddell , 1993 ) . the main causes of lbp has the spinal structures including inter - vertebral discs , facet joints , vertebral bodies , ligaments , or muscles could be an origin of back pain , biomechanical factors because decrease of functions of the musculoskeletal system ( graves et al . , 1990 ) and psychological factors such as fear , anxiety , depression , and a sense of helplessness often contribute to the development and maintenance of chronic pain and associated disability ( samwel et al . , 2006 ) . pain is one of the most powerful aversive drives in animals and humans , is closely allied to fear . pain has been described using a variety of conceptual definitions among which pain - related fear , fear of movement , and kinesophobia are the most commonly used ( lundberg et al . , 2011 ) . in a subset of patients with low back pain , development of fear resulted in avoidance of actual or perceived pain - generating physical activities and led to worsening performance and recovery after injury ( waddell et al . , the fear of pain is an important aspect in patients disability , which needs to be addressed in order to achieve a successful outcome ( lundberg et al . , 2011 ) . pain - related fear is part of the fear - avoidance model ( lethem et al . , 1983 ) . the fear - avoidance model has been used to explain the development of unfavorable pain experiences and behaviors ( vlaeyen et al . , 1999 ) . troup et al . ( 1987 ) outlined the most specific  fear - avoidance model of exaggerated pain perception  in chronic low back pain . fear - avoidance beliefs of lbp patients predicted disability in daily or occupational activity , treatment outcome , and patients return to work after a functional restoration program ( pfinqsten et al . high scores on the fear - avoidance beliefs questionnaire ( fabq ) ( waddell et al . , 1993 ) , a validated two - part questionnaire , which examines the role of fear in physical activity and work , have been attributed to the maintenance of both chronic pain and pain - related disability ( basler et al . , 2008 ) . therefore , the purpose of this study was to determine the relationship among fear - avoidance beliefs , pain and disability index in patients with low back pain as well as to identify factors having an influence on fear - avoidance beliefs , pain and disability index . a total of 55 patients with low back pain were included as subjects in this study . the subjects were provided with a full explanation of the experimental procedure and all subjects provided written consent signifying voluntary participation . the subjects were inpatients at k hospital in seoul city in korea , from may to september in 2012 . exclusion criteria were : 1 ) neurological problem such as stroke , 2 ) rheumatoid arthritis , 3 ) cancer , 4 ) pregnant , and 5 ) hypertension . fear - avoidance beliefs were measured using a modified form of the fabq , a 16-item , self- report scale , which focuses specifically on patient s beliefs about how physical activity and work affects their pain . the fabq physical activity ( fabq - p ) assessed attitudes and beliefs related to general physical activities ( four items , range 024 ) and the fabq work ( fabq - w ) assessed attitudes and beliefs related to occupational activities ( seven items , range 042 ) . each item is scored from 0 ,  do not at all agree  to 6 completely for both subscales , a low score indicates low fear - avoidance beliefs , and a score of 14 or more on the fabq phys indicates strong fear - avoidance beliefs ( waddell et al . , 1993 ) . the intensity of lbp was usually evaluated using a visual analogue scale ( vas ) . a 10 cm horizontal line ranged from no pain to severe pain , and numbered from 0 to 10 ( 0=no pain , 5=moderate pain , 10=worst pain ) . the patient marked the point that he felt represented his perception of his current state . the disability index of lbp was evaluated using the roland morris disability questionnaire ( rmdq ) and the oswestry disability index ( odi ) . the rmdq is a measure used in assessment of self - reported disability due to low back pain . the scores range from 0 , indicating no disability , to 24 indicating severe disability ( roland and fairbank , 2000 ) . the modified odi is a 10-question condition specific measurement of pain and disability for individuals with lbp . each question is scored from 0 to 5 and summed for determination of total score , which is multiplied by 2 and expressed as a percentage ( fairbank et al . , 1980 ) . the general characteristics and characteristics of low back pain are presented as the frequency and percentage , and the average and standard deviation are also provided . the t - test was used for analysis of the difference in the fabq , pain and disability index . the pearson s correlation coefficient was used to examine the correlation among fabq , pain and disability index . a total of 55 patients with low back pain were included as subjects in this study . the subjects were provided with a full explanation of the experimental procedure and all subjects provided written consent signifying voluntary participation . the subjects were inpatients at k hospital in seoul city in korea , from may to september in 2012 . exclusion criteria were : 1 ) neurological problem such as stroke , 2 ) rheumatoid arthritis , 3 ) cancer , 4 ) pregnant , and 5 ) hypertension . fear - avoidance beliefs were measured using a modified form of the fabq , a 16-item , self- report scale , which focuses specifically on patient s beliefs about how physical activity and work affects their pain . the fabq physical activity ( fabq - p ) assessed attitudes and beliefs related to general physical activities ( four items , range 024 ) and the fabq work ( fabq - w ) assessed attitudes and beliefs related to occupational activities ( seven items , range 042 ) . each item is scored from 0 ,  do not at all agree  to 6 completely for both subscales , a low score indicates low fear - avoidance beliefs , and a score of 14 or more on the fabq phys indicates strong fear - avoidance beliefs ( waddell et al . , 1993 ) . the intensity of lbp was usually evaluated using a visual analogue scale ( vas ) . a 10 cm horizontal line ranged from no pain to severe pain , and numbered from 0 to 10 ( 0=no pain , 5=moderate pain , 10=worst pain ) . the patient marked the point that he felt represented his perception of his current state . the disability index of lbp was evaluated using the roland morris disability questionnaire ( rmdq ) and the oswestry disability index ( odi ) . the rmdq is a measure used in assessment of self - reported disability due to low back pain . the scores range from 0 , indicating no disability , to 24 indicating severe disability ( roland and fairbank , 2000 ) . the modified odi is a 10-question condition specific measurement of pain and disability for individuals with lbp . each question is scored from 0 to 5 and summed for determination of total score , which is multiplied by 2 and expressed as a percentage ( fairbank et al . , 1980 ) . the general characteristics and characteristics of low back pain are presented as the frequency and percentage , and the average and standard deviation are also provided . the t - test was used for analysis of the difference in the fabq , pain and disability index . the pearson s correlation coefficient was used to examine the correlation among fabq , pain and disability index . table 1 lists the general characteristics of the subjects . there were 32 ( 58.2% ) males and 23 ( 41.8% ) females . the averages for age , height and weight were 46.4 yr , 166.7 cm , and 66.6 kg , respectively . table 2 lists the low back pain characteristics of the subjects . in recurrence , 33 ( 60.0% ) subjects thirty seven ( 67.3% ) subjects had radiating pain and 18 ( 32.7% ) subjects did not . twenty two ( 40.0% ) subjects had pain of unknown cause , 20 ( 36.4% ) subjects had accidents , six ( 10.9% ) subjects had disease , and seven ( 12.7% ) subjects had other , respectively . fifteen ( 27.3% ) subjects underwent one more surgery and none surgery was 40 ( 72.7% ) subjects . thirty three ( 60.0% ) subjects were taking medication and 22 ( 40.0% ) subjects were not taking medication . regarding duration , nine ( 16.4% ) subjects were acute ( within six weeks ) , 10 ( 18.2% ) subjects were sub - acute ( 612 weeks ) , and 36 ( 65.5% ) subjects were chronic ( more than 12 weeks ) . table 3 lists the descriptive characteristics of subjects for measures fabq , vas , rmdq , and odi . the average scores for fabq - p , fabq - w , vas , rmdq , and odi were 15.6 , 24.1 , 5.7 , 10.7 , and 32.5 , respectively . fabq - w ( r=0.496 , p=0.000 ) , fabq - total ( r=0.794 , p= 0.000 ) , vas ( r=0.320 , p=0.017 ) , and rmdq ( r=0.372 , p= 0.005 ) showed significant correlation with fabq - p . fabq - total ( r=0.918 , p=0.000 ) , vas ( r=0.292 , p=0.031 ) , rmdq ( r= 0.433 , p=0.001 ) , and odi ( r=0.376 , p=0.005 ) showed significant correlation with fabq - w . vas ( r=0.338 , p=0.012 ) , rmdq ( r=0.455 , p=0.000 ) , and odi ( r=0.338 , p=0.001 ) showed significant correlation with fabq - total . rmdq ( r=0.530 , p= 0.000 ) and odi ( r=0.494 , p=0.000 ) showed significant correlation with vas . pain and pain disability are not only influenced by organic pathology , if found , but also by biological , psychological and social factors . avoidance refers to  the performance of a behavior which postpones or averts the presentation of an aversive event  . in the case of pain , a patient may no longer perform certain activities because he / she anticipates that these activities increase pain and suffering . the concept of fear - avoidance has offered an enticing model which appears to account for why some people develop dysfunctional pain problems ( linton et al . , 2000 ) . the purpose of this study was to determine the relationship among fear - avoidance beliefs , pain and disability index in patients with low back pain as well as to identify factors having an influence on fear - avoidance beliefs , pain and disability index . in this study , fear - avoidance beliefs were measured using a modified form of the fabq and the intensity of lbp was usually evaluated using a vas . ( 1999 ) suggested that an individual s experimental pain threshold is associated with baseline functional status and caused pain . ( 2006 ) reported that fear - avoidance beliefs about work and temporal summation of evoked thermal pain had a significant influence on pain related disability . these factors should be considered as potential outcome predictors for patients with work - related low back pain . in this study , fabq - p appeared to show significant correlation with fabq - w ( r=0.496 , p=0.000 ) , fabq - total ( r=0.794 , p=0.000 ) , vas ( r=0.320 , p= 0.017 ) , and rmdq ( r=0.372 , p=0.005 ) . fabq - w , fabq - total , vas , and rmdq variables showed significant correlation with each other . ( 2007 ) who studied correlates of self - reported disability using modq ( modified oswestry low back pain disability questionnaire ) in patients with low back pain , reported that modq score in patients with low back pain showed significantly correlation with pain intensity ( p=0.000 ) and fabq - w ( p=0.007 ) . however , the modq score did not show significant correlation with fabq - p ( p=0.37 ) . in this study , the odi score showed significant correlation with fabq - w ( r=0.376 , p=0.005 ) , fabq - total ( r=0.338 , p=0.011 ) , vas ( r=0.494 , p=0.000 ) , and rmdq ( r=0.592 , p=0.000 ) . however , the odq score did not show significant correlation with fabq - p ( r=0.199 , p=0.146 ) . basler et al . ( 2008 ) studied fear - avoidance beliefs , physical activity and disability in elderly individuals with chronic low back pain and healthy control subjects . in the patient group , fear - avoidance beliefs , pain intensity and age predicted functional capacity and patients were more fear - avoidant and reported more disability . 2012 ) reported a significant association of fear - avoidance beliefs ( p<0.0001 ) and mcgill pain questionnaire ( p<0.0001 ) in older adults with chronic low back pain with the rmdq . in this study , the rmdq showed significant correlation with fabq - p ( r=0.372 , p=0.005 ) , fabq - w ( r=0.433 , p=0.001 ) , fabq - total ( r=0.455 , p=0.000 ) , vas ( r=0.530 , p=0.000 ) , and odi ( r=0.592 , p=0.000 ) . ( 2012 ) reported significant correlation of baseline rmdq scores with function test scores , except for the sock test ( p<0.05 ) . these results show that because of pain , patients have increased pain intensity and limited physical activity . this limitation of physical activity had high self - reported disability index and increased fear - avoidance beliefs by fear of pain , psychological distress , and anxiety . findings of this study suggest that screening for fear - avoidance beliefs may be useful for identification of patients at risk of psychosocial problems as well as pain intensity and physical impairment .
this study was conducted in order to determine the relationship among fear - avoidance beliefs , pain and disability index in patients with low back pain as well as to identify factors having an influence on fear - avoidance beliefs , pain and disability index . 
 the subjects used in this study were 55 patients with low back pain . 
 all subjects completed a fear - avoidance beliefs questionnaire ( fabq ) which was divided into two subscales , fabq for physical activity ( fabq - p ) and fabq for work ( fabq - w ) , visual analog scale ( vas ) , oswestry disability index ( odi ) and roland morris disability questionnaire ( rmdq ) . in correlation analysis 
 , fabq - p appeared to show significant correlation with fabq - w , fabq - total , vas and rmdq , and all variables showed significant correlation with each other . 
 findings of this study suggest that screening for fear - avoidance beliefs may be useful for identification of patients at risk of psychosocial problems as well as pain intensity and physical impairment .