Advertisement

Journal of Occupational Rehabilitation

, Volume 22, Issue 1, pp 59–70 | Cite as

Validity and Reliability of the Fear-Avoidance Beliefs Questionnaire (FABQ) in Workers with Upper Extremity Injuries

  • Taucha Inrig
  • Bev Amey
  • Cheryl Borthwick
  • Dorcas Beaton
Article

Abstract

Introduction Fear Avoidance Beliefs (FAB) have been associated with increased pain, dysfunction and difficulty returning to work in Upper Extremity (UE) injures. The FABQ is used to assess FAB, but its measurement properties have not been established in UE. The purpose of this study is to evaluate the reliability and validity of the FABQ to screen UE compensated injured workers for FAB. Methods Consenting workers attending a specialty clinic completed a modified FABQ, QuickDASH (Disability), SPADI Pain Score and von Korff Chronic Pain Grade (Pain), SF-36v2 (General Health), and Work Instability Scale (Job Instability). A sub-sample of workers (n = 48) completed the FABQ 2 weeks later for test–retest reliability. Results 187 workers; 54.0% male; mean age 45.2 (sd 9.68); 56% were currently working. Mean subscale scores (FABQ-Work [FABQ-W]/FABQ-Physical Activity [FABQ-PA]) were 35/42 and 20/24. Ceiling effects (23%/38%) existed in both subscales. Cronbach’s alphas were 0.75/0.78. Test–retest analysis (ICC(2,1)) was lower than desired (0.52/0.59). Construct validation was supported by a moderate correlation between FABQ-W/FABQ-PA and QuickDASH Work Module (0.51/0.42) and WIS (0.46/0.38) in those currently working. Low correlations were found between the subscales measures of pain (SPADI: 0.24/0.23; Chronic Pain Grade: 0.25/0.25), and SF-36 MCS (−0.25/−0.30). Conclusions Although FAB is an important concept to measure in compensated UE injured workers, the FABQ had limitations in this population as there was a high ceiling effect, and lower than desired reliability for individual discrimination. A priori hypotheses around construct validity were rejected for 16/22 concepts tested.

Keywords

Measurement Reliability and validity Fear avoidance Workers’ compensation 

References

  1. 1.
    Slade PD, Troup JD, Lethem J, Bentley G. The fear-avoidance model of exaggerated pain perception—II. Behav Res Ther. 1983;21(4):409–16.PubMedCrossRefGoogle Scholar
  2. 2.
    Lethem J, Slade PD, Troup JD, Bentley G. Outline of a fear-avoidance model of exaggerated pain perception—I. Behav Res Ther. 1983;21(4):401–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52(2):157–68.PubMedCrossRefGoogle Scholar
  4. 4.
    Crombez G, Vlaeyen JW, Heuts PH, Lysens R. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain. 1999;80(1–2):329–39.PubMedCrossRefGoogle Scholar
  5. 5.
    Boersma K, Linton SJ. Psychological processes underlying the development of a chronic pain problem: a prospective study of the relationship between profiles of psychological variables in the fear-avoidance model and disability. Clin J Pain. 2006;22(2):160–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Fritz JM, George SZ, Delitto A. The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status. Pain. 2001;94(1):7–15.PubMedCrossRefGoogle Scholar
  7. 7.
    Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlaeyen JWS. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007;30(1):77–94.PubMedCrossRefGoogle Scholar
  8. 8.
    Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85(3):317–32.PubMedCrossRefGoogle Scholar
  9. 9.
    Ciccone DS, Just N. Pain expectancy and work disability in patients with acute and chronic pain: a test of the fear avoidance hypothesis. J Pain. 2001;2(3):181–94.PubMedCrossRefGoogle Scholar
  10. 10.
    Cleland JA, Fritz JM, Brennan GP. Predictive validity of initial fear avoidance beliefs in patients with low back pain receiving physical therapy: is the FABQ a useful screening tool for identifying patients at risk for a poor recovery? Eur Spine J. 2008;17(1):70–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Fritz JM, George SZ. Identifying psychosocial variables in patients with acute work-related low back pain: the importance of fear-avoidance beliefs. Phys Ther. 2002;82(10):973–83.PubMedGoogle Scholar
  12. 12.
    George SZ, Fritz JM, Erhard RE. A comparison of fear-avoidance beliefs in patients with lumbar spine pain and cervical spine pain. Spine. 2001;26(19):2139–45.PubMedCrossRefGoogle Scholar
  13. 13.
    Grotle M, Vollestad NK, Veierod MB, Brox JI. Fear-avoidance beliefs and distress in relation to disability in acute and chronic low back pain. Pain. 2004;112(3):343–52.PubMedCrossRefGoogle Scholar
  14. 14.
    Lotters F, Franche RL, Hogg-Johnson S, Burdorf A, Pole JD. The prognostic value of depressive symptoms, fear-avoidance, and self-efficacy for duration of lost-time benefits in workers with musculoskeletal disorders. Occup Environ Med. 2006;63(12):794–801.PubMedCrossRefGoogle Scholar
  15. 15.
    Vowles KE, Gross RT. Work-related beliefs about injury and physical capability for work in individuals with chronic pain. Pain. 2003;101(3):291–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Pfingsten M, Kroner-Herwig B, Leibing E, Kronshage U, Hildebrandt J. Validation of the German version of the fear-avoidance beliefs questionnaire (FABQ). Eur J Pain. 2000;4(3):259–66.PubMedCrossRefGoogle Scholar
  17. 17.
    Coudeyre E, Tubach F, Rannou F, Baron G, Coriat F, Brin S, et al. Fear-avoidance beliefs about back pain in patients with acute LBP. Clin J Pain. 2007;23(8):720–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Georgoudis G, Papathanasiou G, Spiropoulos P, Katsoulakis K. Cognitive assessment of musculoskeletal pain with a newly validated Greek version of the fear-avoidance beliefs questionnaire (FABQ). Eur J Pain. 2007;11(3):341–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Grotle M, Brox JI, Vollestad NK. Reliability, validity and responsiveness of the fear-avoidance beliefs questionnaire: methodological aspects of the Norwegian version. J Rehabil Med. 2006;38(6):346–53.PubMedCrossRefGoogle Scholar
  20. 20.
    Lee KC, Chiu TT, Lam TH. Psychometric properties of the fear-avoidance beliefs questionnaire in patients with neck pain. Clin Rehabil. 2006;20(10):909–20.PubMedGoogle Scholar
  21. 21.
    Staerkle R, Mannion AF, Elfering A, Junge A, Semmer NK, Jacobshagen N, et al. Longitudinal validation of the fear-avoidance beliefs questionnaire (FABQ) in a Swiss-German sample of low back pain patients. Eur Spine J. 2004;13(4):332–40.PubMedCrossRefGoogle Scholar
  22. 22.
    Kovacs FM, Muriel A, Medina JM, Abraira V, Sanchez MD, Jauregui JO, et al. Psychometric characteristics of the Spanish version of the FAB questionnaire. Spine. 2006;31(1):104–10.PubMedCrossRefGoogle Scholar
  23. 23.
    Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34–42.PubMedCrossRefGoogle Scholar
  24. 24.
    McHorney CA, Tarlov AR. Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res. 1995;4(4):293–307.PubMedCrossRefGoogle Scholar
  25. 25.
    Nunnally JC. Assessment of reliability. Psychometric theory. 2nd ed. New York: McGraw-Hill Book Co.; 1978. p. 225–55.Google Scholar
  26. 26.
    Williamson E. Fear avoidance beliefs questionnaire (FABQ). Aust J Physiother. 2006;52(2):149.PubMedCrossRefGoogle Scholar
  27. 27.
    Burton AK, Waddell G, Tillotson KM, Summerton N. Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care. Spine. 1999;24(23):2484–91.PubMedCrossRefGoogle Scholar
  28. 28.
    George SZ, Bialosky JE, Fritz JM. Physical therapist management of a patient with acute low back pain and elevated fear-avoidance beliefs. Phys Ther. 2004;84(6):538–49.PubMedGoogle Scholar
  29. 29.
    Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthr Care Res. 1991;4(4):143–9.CrossRefGoogle Scholar
  30. 30.
    Heald SL, Riddle DL, Lamb RL. The shoulder pain and disability index: the construct validity and responsiveness of a region-specific disability measure. Phys Ther. 1997;77(10):1079–89.PubMedGoogle Scholar
  31. 31.
    Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain. 1992;50(2):133–49.CrossRefGoogle Scholar
  32. 32.
    Beaton DE, Wright JG, Katz JN, Upper E. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am Vol. 2005;87(5):1038–46.CrossRefGoogle Scholar
  33. 33.
    Ware JEJ. SF-36 health survey update. [Review] [73 refs]. Spine. 2000;25(24):3130–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN. The self-administered comorbidity questionnaire: a new method to assess comorbidity for clinical and health services research. Arthr Rheum. 2003;49(2):156–63.CrossRefGoogle Scholar
  35. 35.
    Gilworth G, Chamberlain MA, Harvey A, Woodhouse A, Smith J, Smyth MG, et al. Development of a work instability scale for rheumatoid arthritis. Arthr Rheum. 2003;49(3):349–54.CrossRefGoogle Scholar
  36. 36.
    Human Resources and Social Development Department Canada. National occupational classification matrix 2006. http://www5.hrsdc.gc.ca/noc/english/noc/2006/welcome.aspx (2006). Accessed 20 April 2011.
  37. 37.
    Shrout PE, Fleiss J. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86(2):420–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Boersma K, Linton SJ. Screening to identify patients at risk: profiles of psychological risk factors for early intervention. Clin J Pain. 2005;21(1):38–43.PubMedCrossRefGoogle Scholar
  39. 39.
    George SZ, Cere A, Zeppieri G, Cere M, Borut M, Hodges M, et al. Behavioral interventions for sub-acute low back pain… 2008 combined sections meeting…Nashville, Tennessee, February 6–9, 2008. J Orthop Sports Phys Ther. 2008;1(Suppl):2.Google Scholar
  40. 40.
    Cleland JA, Fritz JM, Childs JD. Psychometric properties of the fear-avoidance beliefs questionnaire and Tampa scale of Kinesiophobia in patients with neck pain. Am J Phys Med Rehabil. 2008;87(2):109–17.PubMedCrossRefGoogle Scholar
  41. 41.
    van Vuuren BJ, van Heerden HJ, Becker PJ, Zinzen E, Meeusen R. Fear-avoidance beliefs and pain coping strategies in relation to lower back problems in a South African steel industry. Eur J Pain. 2006;10(3):233–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Swinkels-Meewisse IE, Roelofs J, Verbeek AL, Oostendorp RA, Vlaeyen JW. Fear-avoidance beliefs, disability, and participation in workers and non-workers with acute low back pain. Clin J Pain. 2006;22(1):45–54.PubMedCrossRefGoogle Scholar
  43. 43.
    Storheim K, Brox JI, Holm I, Bo K. Predictors of return to work in patients sick listed for sub-acute low back pain: a 12-month follow-up study. J Rehabil Med. 2005;37(6):365–71.PubMedCrossRefGoogle Scholar
  44. 44.
    Kovacs FM, Muriel A, Abriaira V, Medina JM, Castillo S, Olabe J, et al. The influence of fear avoidance beliefs on disability and quality of life is sparse in Spanish low back pain patients. Spine. 2005;30(22):E676–82.PubMedCrossRefGoogle Scholar
  45. 45.
    Staal JB, Hlobil H, Koke AJA, Twisk JWR, Smid T, van MW. Graded activity for workers with low back pain: who benefits most and how does it work? Arthr Rheum (Arthr Care Res) 2008;(5):642–9.Google Scholar
  46. 46.
    van Vuuren B, Zinzen E, van Heerden HJ, Becker P, Meeusen R. Psychosocial factors related to lower back problems in a South African manganese industry. J Occup Rehabil. 2005;15(2):215–25.PubMedCrossRefGoogle Scholar
  47. 47.
    Godges JJ, Anger MA, Zimmerman G, Delitto A. Effects of education on return-to-work status for people with fear-avoidance beliefs and acute low back pain. Phys Ther. 2008;88(2):231–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Voerman GE, Sandsjo L, Vollenbroek-Hutten MM, Larsman P, Kadefors R, Hermens HJ. Changes in cognitive-behavioral factors and muscle activation patterns after interventions for work-related neck-shoulder complaints: relations with discomfort and disability. J Occup Rehabil. 2007;17(4):593–609.PubMedCrossRefGoogle Scholar
  49. 49.
    Lee KC, Chiu TT, Lam TH. The role of fear-avoidance beliefs in patients with neck pain: relationships with current and future disability and work capacity. Clin Rehabil. 2007;31(9):812–21.CrossRefGoogle Scholar
  50. 50.
    Kovacs FM, Muriel A, Castillo S, Medina JM, Royuela A. Spanish back pain research network. Fear avoidance beliefs influence duration of sick leave in Spanish low back pain patients. Spine. 2007;32(16):1761–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Taucha Inrig
    • 1
    • 2
  • Bev Amey
    • 5
  • Cheryl Borthwick
    • 5
  • Dorcas Beaton
    • 1
    • 2
    • 3
    • 4
  1. 1.Mobility Program Clinical Research UnitSt. Michael’s HospitalTorontoCanada
  2. 2.Keenan Research Centre of the Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  3. 3.Institute for Work and HealthTorontoCanada
  4. 4.Health Policy Management and EvaluationUniversity of TorontoTorontoCanada
  5. 5.Holland Orthopaedic and Arthritic CentreSunnybrook Health Sciences CentreTorontoCanada

Personalised recommendations