Is the fear-avoidance model also relevant for chronic disability after traumatic brain injury?

Melloney Wijenberg, Amelia Hicks, Marina Downing, Caroline Heugten, Sven Stapert, Jennie Ponsford*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Previous studies convincingly suggests that the biopsychosocial fear-avoidance model (FAM) may be of added value to understand chronic disability after traumatic brain injury (TBI). Within this model, persistent symptoms occur as a result of catastrophizing and fear-avoidance regarding initial symptoms, leading to depression, reduced mental activity, and greater disability in daily functioning. This study examined the FAM in a large English-speaking TBI sample. A cross-sectional study was conducted in 117 individuals with complicated mild, moderate, or severe TBI at 1-5 years post-injury. Participants completed questionnaires assessing personal, injury-related, and psychological characteristics. Reliability, correlational, and regression analyses were performed. Main outcomes measures of chronic disability were depression, disuse (e.g. less mental activities), and functional disability. The results revealed that all correlations suggested by the FAM were significant. Catastrophizing thoughts were positively associated with TBI-related symptoms and fear-avoidance thoughts. Main outcome measures were positively associated with fear-avoidance thoughts and TBI-related symptoms. Furthermore, variables in the FAM were of additive value to personal, injury-related, and psychological variables in understanding unfavorable chronic disability after TBI. The separate regression analyses for depression, less mental activities, and disability revealed 'fear-avoidance thoughts' as the only consistent variable. In conclusion, this study shows the associations of the FAM with chronic disability after TBI, which has implications for assessment and future management of the FAM in TBI in English-speaking countries. Longitudinal studies are warranted to further investigate and refine the model.

Original languageEnglish
Number of pages30
JournalJournal of Neurotrauma
Publication statusE-pub ahead of print - 25 Aug 2020

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