RELIABILITY, VALIDITY AND RESPONSIVENESS OF THE FEAR-AVOIDANCE BELIEFS QUESTIONNAIRE: METHODOLOGICAL ASPECTS OF THE NORWEGIAN VERSION

Issue: Volume 38, Issue 6, November 2006

Pages: 346-353

DOI: 10.1080/16501970600722403

Abstract:

Objective: To evaluate reliability, validity and responsiveness of the Fear-Avoidance Beliefs Questionnaire (FABQ) for use in Norwegian patients with low back pain.

Design: A prospective cohort study with 2 groups.

Patients: The questionnaire was tested in 123 patients with acute low back pain and 50 patients with chronic low back pain.

Methods: A translation and cross-cultural adaptation was performed. Test-retest reliability was assessed in 28 patients with chronic low back pain. Responsiveness was assessed in acute low back pain.

Results: Two factors for the FABQ were confirmed; fear-avoidance beliefs about work (FABQ–Work) and physical activity (FABQ–PA), accounting for 60% and 54% of the total variance in acute and chronic low back pain, respectively. For FABQ–Work and FABQ–PA internal consistency was 0.90 and 0.79, intra-class correlation coefficients 0.82 and 0.66, minimal detectable changes 12 and 9 points, and coefficients of variation were 16% and 23%. The FABQ correlated weakly to moderately with pain, disability, distress, and clinical variables. Standardized response means were low for FABQ–Work (0.32) and moderate (0.56) for FABQ–PA. Both FABQ subscales showed initially floor and/or ceiling effects.

Conclusion: The Norwegian FABQ version had acceptable factor structure, internal consistency, test-retest reliability and construct validity. The responsiveness of the FABQ–Work was low, and for the FABQ–PA moderate, in the acute sample.

Authors:

Margreth Grotle A1, A2, Jens I Brox A3, Nina K Vøllestad A2
A1 From the National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital
A2 Section for Health Science, University of Oslo
A3 Department of Orthopaedics, Section for Physical Medicine and Rehabilitation, National Hospital, Oslo, Norway

Key words:

low back pain, Fear-Avoidance Beliefs Questionnaire, translation, reliability, minimal detectable change, construct validity, factor analysis, responsiveness

References:

  1. Vlaeyen, JWS and Kole-Snijders, AMJ and Boeren, RGB and van Eek, H. (1995) Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance Pain, 62, pp. 363 - 372.
    [CrossRef]
  2. Pfingsten, M and Kroner-Herwig, B and Leibing, E and Kronshage, U and Hildebrandt, J. (2000) Validation of the German version of the Fear-Avoidance Beliefs Questionnaire (FABQ) Eur J Pain, 4, pp. 259 - 266.
    [CrossRef]
  3. Severeijns, R and Vlaeyen, JW and van den Hout, MA and Weber, WE. (2001) Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment Clin J Pain, 17, pp. 165 - 172.
    [CrossRef]
  4. Chaory, K and Fayad, F and Rannou, F and Lefevre-Colau, MM and Fermanian, J and Revel, M and (2004) Validation of the French Version of the Fear Avoidance Belief Questionnaire Spine, 29, pp. 908 - 913.
  5. Symonds, TL and Burton, AK and Tillotson, KM and Main, CJ. (1996) Do attitudes and beliefs influence work loss due to low back trouble? Occup Med, 46, pp. 25 - 32.
  6. George, SZ and Fritz, JM and Erhard, RE. (2001) A comparison of fear-avoidance beliefs in patients with lumbar spine pain and cervical spine pain Spine, 26, pp. 2139 - 2145.
    [CrossRef]
  7. Swinkels-Meewisse, IE and Roelofs, J and Verbeek, AL and Oostendorp, RA and Vlaeyen, JW. (2003) Fear of movement/(re)injury, disability and participation in acute low back pain Pain, 105, pp. 371 - 379.
    [CrossRef]
  8. Buer, N and Linton, SJ. (2002) Fear-avoidance beliefs and catastrophizing: occurrence and risk factor in back pain and ADL in the general population Pain, 99, pp. 485 - 491.
    [CrossRef]
  9. Burton, AK and Tillotson, KM and Main, CJ and Hollis, S. (1995) Psychosocial predictors of outcome in acute and subchronic low back trouble Spine, 20, pp. 722 - 728.
    [CrossRef]
  10. Linton, SJ and Buer, N and Vlaeyen, JW and Hellsing, AL. (2000) Are fear-avoidance beliefs related to the inception of an episode of back pain? A prospective study Psychol Health, 14, pp. 1051 - 1059.
  11. Picavet, HSJ and Vlaeyen, JWS and Schouten, JSAG. (2002) Pain catastrophizing and kinesiophobia: Predictors of chronic low back pain Am J Epidemiol, 156, pp. 1028 - 1034.
    [CrossRef]
  12. Klenerman, L and Slade, PD and Stanley, IM and Pennie, B and Reilly, JP and Atchison, LE and (1995) The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting Spine, 20, pp. 478 - 484.
    [CrossRef]
  13. Fritz, JM and George, SZ and Delitto, A. (2001) The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status Pain, 94, pp. 7 - 15.
    [CrossRef]
  14. Waddel, G and Newton, M and Henderson, I and Somerville, D and Main, CJ. (1993) A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability Pain, 52, pp. 157 - 168.
    [CrossRef]
  15. Al Obaidi, SM and Nelson, RM and Al Awadhi, S and Shuwaie, AI. (2000) The role of anticipation and fear of pain in the persistence of avoidance behavior in patients with chronic low back pain Spine, 25, pp. 1126 - 1131.
    [CrossRef]
  16. Holm, I and Friis, A and Storheim, K and Brox, JI. (2003) Measuring self-reported functional status and pain in patients with chronic low back pain by postal questionnaires. A reliability study Spine, 28, pp. 828 - 833.
    [CrossRef]
  17. George, SZ and Fritz, JM and Bialosky, JE and Donald, DA. (2003) The effect of a fear-avoidance-based physical therapy intervention for patients with acute low back pain: results of a randomized clinical trial Spine, 28, pp. 2551 - 2560.
  18. Storheim, K and Brox, JI and Holm, I and Koller, AK and Bø, K. (2003) Intensive group training versus cognitive intervention in sub-acute low back pain: short-term results of a single-blind randomized controlled trial J Rehabil Med, 35, pp. 132 - 140.
    [CrossRef]
  19. Brox, JI and Sorensen, R and Friis, A and Nygaard, O and Indahl, A and Ingebrigtsen, T and (2003) Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration Spine, 28, pp. 1913 - 1921.
  20. Walsh, DA and Radcliffe, JC. (2002) Pain beliefs and perceived physical disability of patients with chronic low back pain Pain, 97, pp. 23 - 31.
    [CrossRef]
  21. Guillemin, F and Bombardier, C and Beaton, D. (1993) Cross-cultural adaptation of health-related quality-of-life measures: literature review and proposed guidelines J Clin Epidemiol, 46, pp. 1417 - 1432.
    [CrossRef]
  22. Jensen, MP and Karoly, P.(1992) Self-report scales and procedures for assessing pain in adults. In Handbook of Pain Assessment1st edn. ( pp. 135 - 151 ).