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Fear‐Avoidance Belief Questionnaire

From Physiopedia

Original Editors - Gina Gibson and Katie Werrick

Top Contributors -

Katie Werrick, Gina Gibson, Rachael Lowe and Eric Robertson  

Contents

Summary

          The Fear-Avoidance Beliefs Questionnaire (FABQ) is a questionnaire based on the Fear-Avoidance Model of Exaggerated Pain Perception, a model created in attempts to explain why some patients with acute painful conditions can recover while other patients develop chronic pain from such conditions[1][2][3]. The FABQ measures patients’ fear of pain and consequent avoidance of physical activity because of their fear[1][2]. This questionnaire consists of 16 items, with each item scored from 0-6. Higher scores on the FABQ are indicative of greater fear and avoidance beliefs[1].
          Within the FABQ, two subscales exist, the Work Subscale and the Physical Activity Subscale, which facilitate the identification of the patient’s beliefs about how work and physical activity affect their current Low Back Pain (LBP)[1][2]. The numbers in parentheses below designate which items from the FABQ are included in each subscale[1].
            

Subscale Questions Included Total Possible Points High Score
FABQw 6,7,9-12, 15 42 >34[2]
FABQpa 2-5 24 >15[4]



           A strong relationship exists between elevated fear avoidance beliefs and chronic disability secondary to LBP[1][2]. “Avoidance may lead to reduced activity levels, an exacerbation of the fear and avoidance behaviors, prolonged disability, and adverse physical and psychological effects” [2][3][5]. Thus, the FABQ is an outcome measure that serves as a clinically useful screening tool in identifying patients with high fear avoidance beliefs who are at risk for prolonged disability. Management of patients with elevated FABQ scores requires clinicians to tailor interventions to meet those needs. Research suggests multi-disciplinary approach including cognitive behavioral therapy and graded exposure to physical activity[2].

Intended Population

The FABQ has been proven to be a reliable and valid assessment tool based on patients with chronic low back pain.  In recent research, the FABQ is being used in populations with acute low back pain to identify the risk of long-term disability[2].

Resources

Fear-Avoidance Beliefs Questionnaire 

Evidence

Reliability

  • Total FABQ test-retest reliability (ICC=0.97)[4]
  • FABQ Physical Activity subscale test-retest reliability (ICC=0.72-0.90)[4]
  • FABQ Work subscale test-retest reliability (ICC=0.80-0.91)[4]

Validity

  • Evidence shows that the FABQ is correlated with Roland and Morris Disability Questionnaire. The correlation coefficients for the FABQ, the FABQ Work subscale and the FABQ Physical Activity subscale are 0.52, 0.63, and 0.51, respectively.[4]
  • The FABQ was also shown to be correlated with the Tampa Scale of Kinesiophobia, another measure of fear avoidance. The correlation coefficients for the FABQ Work subscale and the FABQ Physical Activity subscale are 0.53 and 0.76, respectively.[4]


References

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  1. 1.0 1.1 1.2 1.3 1.4 1.5 Waddell C, Newton M, Henderson I, et al. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993; 52:157-168
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Fritz JM, George S. Identifying Psychosocial Variables in Patients With Acute Work-Related Low Back Pain: The Importance of Fear-Avoidance Beliefs. Phys Ther. 2002; 82(10): 973-983.
  3. 3.0 3.1 Lethem J, Slade PD, Troup JDG, Bendey G. Outline of a fear avoidance model of exaggerated pain perceptions, Behav Res Ther. 1983;21:401-408.
  4. 4.0 4.1 4.2 4.3 4.4 4.5 Williamson E. Fear Avoidance Behavior Questionnaire. Austrailian Journal of Physiotherapy. 2006; 52: 149.
  5. Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eck H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62: 36, 272.

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