Fear avoidance behavior in youth with poor recovery from concussion: measurement properties and correlates of a new scale

Objectives: In regards to pain-related fear, this study aimed to: (1) identify existing measures and review their measurement properties, and (2) identify the optimum measure for specific constructs of fear-avoidance, pain-related fear, fear of movement, and kinesiophobia. Design: Systematic literature search for instruments designed to measure fear of pain in patients with persistent musculoskeletal pain. Psychometric properties were evaluated by adjusted Wind criteria. Results: Five questionnaires (Fear-Avoidance Beliefs Questionnaire (FABQ), Fear-Avoidance of Pain Scale (FAPS), Fear of Pain Questionnaire (FPQ), Pain and Anxiety Symptoms Scale (PASS), and the Tampa Scale for Kinesiophobia (TSK)) were included in the review. The main findings were that for most questionnaires, there was no underlying conceptual model to support the questionnaire's construct. Psychometric properties were evaluated by diverse methods, which complicated comparisons of different versions of the same questionnaires. Construct validity and responsiveness was generally not supported and/or untested. Conclusion: The weak construct validity implies that no measure can currently identify who is fearful. The lack of evidence for responsiveness restricts the current use of the instruments to identify clinically relevant change from treatment. Finally, more theoretically driven research is needed to support the construct and thus the measurement of pain-related fear.

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The Perceived Opportunity to Avoid Pain Paradoxically Increases Pain-Related Fear Through Increased Threat Appraisals

Annals of Behavioral Medicine ◽

10.1093/abm/kaaa045 ◽

2020 ◽

Author(s):

Christine M van Vliet ◽

Ann Meulders ◽

Linda M G Vancleef ◽

Johan W S Vlaeyen

Keyword(s):

Avoidance Response ◽

Avoidance Behavior ◽

Control Group ◽

Fear Avoidance ◽

Subsequent Test ◽

Heat Stimulus ◽

Threat Appraisals ◽

Bidirectional Relationship ◽

The Relationship ◽

Source Of Information

Abstract Background Although pain-related avoidance is mainly intended to reduce the accompanying anticipatory fear, avoidance behavior may paradoxically increase fear when a previous avoidance response is no longer available, suggesting that there is a bidirectional relationship between pain-related fear and avoidance. Purpose We hypothesized that avoidance can serve as a source of information that fuels irrational pain-related threat appraisals, which, in turn, increases pain-related fear. Methods Participants (N = 66) were exposed to a painful heat stimulus and randomly assigned to the avoidance or control group. They were instructed to avoid the full heat intensity by pressing a stop button in the presence of a stop cue. Only avoidance group participants received a stop cue and were allowed to press the stop button, while control group participants received the same instructions but never had the opportunity to avoid the full heat intensity. In reality and unknown to participants, the intensity and duration of the heat stimulus was independent of the avoidance response. In the subsequent test phase, the avoidance response was unavailable for both groups. We measured pain-related fear, threat appraisals/harmfulness, and pain intensity. Results In line with our expectations, pain-related fear levels were higher when the avoidance response was no longer available compared to those when the avoidance response was available. Increased threat appraisals mediated the relationship between avoidance behavior and increased pain-related fear. Conclusions The perceived opportunity to avoid increased pain-related fear through threat appraisals, suggesting a more complicated relationship between pain-related fear, threat appraisals, and avoidance behavior than the unidirectional relationships proposed in the fear-avoidance model. Clinical implications are discussed.

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Fear Avoidance Behavior, Not Walking Endurance, Predicts the Community Reintegration of Community-Dwelling Stroke Survivors

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2015.05.005 ◽

2015 ◽

Vol 96 (9) ◽

pp. 1684-1690 ◽

Cited By ~ 10

Author(s):

Tai-Wa Liu ◽

Shamay S. Ng ◽

Patrick W. Kwong ◽

Gabriel Y. Ng

Keyword(s):

Avoidance Behavior ◽

Community Dwelling ◽

Stroke Survivors ◽

Community Reintegration ◽

Fear Avoidance ◽

Walking Endurance

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Fear-Avoidance Behavior and Sickness Absence in Patients with Work-Related Musculoskeletal Disorders

Medicina ◽

10.3390/medicina56120646 ◽

2020 ◽

Vol 56 (12) ◽

pp. 646

Author(s):

Israel Macías-Toronjo ◽

José L. Sánchez-Ramos ◽

María J. Rojas-Ocaña ◽

Esperanza Begoña García-Navarro

Keyword(s):

Physical Activity ◽

Sickness Absence ◽

Avoidance Behavior ◽

Neck Disability Index ◽

Pain Scale ◽

Global Dimension ◽

Fear Avoidance ◽

Work Related ◽

Absence Status ◽

Neck Disability

(1) Background and objectives: The purpose of this work is to determine the association of fear-avoidance attitudes with sickness absence status, its duration and disability in a work accident context. (2) Materials and Methods: This is a descriptive observational design, conducting the study in two occupational insurance provider clinics with patients with nonspecific low back and neck pain during the study period. Clinical variables were the Fear Avoidance Questionnaire, Roland Morris Disability Questionnaire, Neck Disability Index, Numerical Pain Scale; sociodemographic variables were sex, age, occupational, educational level, sickness absence status, and duration in days of absence from work. Multiple logistic and linear regressions were used to explore the association between variables. (3) Results: Fear-avoidance behavior is related to sickness absence status (OR = 1.048, p = 0.007), and the physical activity dimension (OR = 1.098, p = 0.013) is more relevant than the work dimension (OR = 1.056, p = 0.028). The duration of sickness absence is related to higher values on the fear-avoidance behavior scale in its global dimension (b = 0.84, p = 0.003, r = 0.327), and the results of the physical activity dimension (B = 1.37, p = 0.035, r = 0.236) were more relevant than the work dimension (B = 1.21, p = 0.003, r = 0.324). Fear-avoidance behavior is related to disability in both dimensions (B = 0.912, p ˂ 0.001, r = 0.505). (4) Conclusions: Fear-avoidance behaviors may influence the typification of sickness absence status, its duration both in its physical activity and work dimension, and its disability reported with higher values than in other healthcare contexts.

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Measurement properties of the Brazilian versions of Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in individuals with shoulder pain

PLoS ONE ◽

10.1371/journal.pone.0260452 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0260452

Author(s):

Danilo Harudy Kamonseki ◽

Melina Nevoeiro Haik ◽

Larissa Pechincha Ribeiro ◽

Rafaela Firmino de Almeida ◽

Lucas Araújo de Almeida ◽

...

Keyword(s):

Factor Analysis ◽

Shoulder Pain ◽

Exploratory Factor Analysis ◽

Internal Consistency ◽

Effect Sizes ◽

Measurement Properties ◽

Fear Avoidance ◽

Good Reliability ◽

Fear Avoidance Beliefs ◽

Fear Avoidance Beliefs Questionnaire

Purpose To verify the measurement properties of the Brazilian versions of Fear-avoidance Beliefs Questionnaire (FABQ) and Tampa Scale of Kinesiophobia (TSK) in individuals with shoulder pain. Methods Individuals with shoulder pain (>18 years) were included in this study. Structural validity was verified by exploratory factor analysis, which was used to identify dimensionality of the FABQ and TSK. Test-retest reliability was assessed with intraclass correlation coefficient(3,1) and internal consistency with Cronbach’s alpha. Floor or ceiling effects were also investigated. Responsiveness was verified by effect sizes and area under the receiver operating characteristic curve (AUC). Results Exploratory factor analysis identified two and one factor in the FABQ and TSK, respectively. FABQ and TSK presented moderate to good reliability and adequate internal consistency (Cronbach’s alpha > 0.70). The floor effect was present in one factor of the FABQ. The FABQ and TSK showed small to moderate effect sizes and did not show adequate AUC. Conclusion FABQ and TSK are multidimensional and unidimensional instruments, respectively. Those instruments presented moderate to good reliability and the responsiveness was considered to be suboptimal in individuals with shoulder pain.

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