Background and Purpose. Fear-avoidance behavior contributes to chronic low back pain. The purpose of this study was to determine whether patient education on fear-avoidance behavior added to conventional physical therapy would have significant effects on return to work status in contrast to a comparison group with only physical therapy intervention. Return to work status was measured by the length of time from the initial injury to the subject’s return to work on regular duty.

Subjects. Thirty-four workers’ compensation subjects with low back pain who exhibited fear-avoidance behavior, according to their responses to the Fear- Avoidance Beliefs Questionnaire, were alternately assigned either to an educational group or a comparison group.

Methods. Both groups received conventional physical therapy. Subjects in the educational group were also given an educational booklet and received counseling on pain-coping mechanisms from the physical therapist.

Results.Although the difference in time of return to work on regular duty was not statistically significant (p=.06), there was a noticeable difference between the two groups. By 45 days after the date of the initial injury, all of the subjects in the educational group had returned to work on regular duty, whereas one third of the subjects in the comparison group were still either on modified duty or off work entirely. Three subjects in the comparison group had still not returned to regular duty 90 days after the date of the initial injury.

Conclusion and Discussion. The results of this study suggest that the number of patients with chronic low back pain who remain off work 90 days after an initial injury, may be reduced by education on the benefits of staying active.

Key Words: Fear-Avoidance behavior, Low back pain, Patient education, Workers’ Compensation.

LLU Discipline

Physical Therapy


Physical Therapy Sciences


School of Allied Health Professions

First Advisor

Joseph Godges

Second Advisor

Grenith Zimmerman

Third Advisor

Nicceta Davis

Fourth Advisor

Mark Kasow

Degree Name

Doctor of Physical Therapy (DPT)

Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Low Back Pain -- rehabilitation; Patient Education; Behavior Therapy; Fear.



Page Count

v; 25

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives