Fear Avoidance Belief Questionnaire

Objective[edit | edit source]

The Fear-Avoidance Beliefs Questionnaire (FABQ) is a patient reported questionnaire which specifically focuses on how a patient's fear avoidance beliefs about physical activity and work may affect and contribute to their low back pain and resulting disability

Description[edit | edit source]

With the emergence of the biopsychosocial mode of low back pain (LBP) led to the development of the the Fear-Avoidance Beliefs Questionnaire (FABQ) by Waddel et al in 1993[1]. The 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[2][3][4]. The FABQ measures patients’ fear of pain and consequent avoidance of physical activity because of their fear[2][3].

Areas of assessment include; ADLs, behaviour, functional mobility, general health, life participation, mental health, motivation, occupational performance, pain, personality, quality of life, self-efficacy, stress and coping.

Methods of Use[edit | edit source]

The questionnaire consists of 16 items in which a patient rates their agreement with each statement on a 7-point Likert scale. Where 0= completely disagree, 6=completely agree. A higher score indicates more strongly held fear avoidance beliefs. [2] There are two subscales within the FABQ; the work subscale (FABQw) with 7 questions (maximum score of 42) and the physical activity subscale (FABQpa) with 4 questions (maximum score of 24). [2][3]. The numbers in parentheses below designate which items from the FABQ are included in each subscale[2].
            

Subscale Questions Included Total Possible Points High Score
FABQw 6,7,9-12, 15 42 >34[3]
FABQpa 2-5 24 >15[5]


The questionnaire takes approximately 10 minutes to complete.

A strong relationship exists between elevated fear avoidance beliefs and chronic disability secondary to LBP[2][3]. “Avoidance may lead to reduced activity levels, an exacerbation of the fear and avoidance behaviors, prolonged disability, and adverse physical and psychological effects” [3][4][6]. 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[3].

Intended Population[edit | edit source]

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[3].

Evidence[edit | edit source]

Reliability

  • Total FABQ test-retest reliability (ICC=0.97)[5]
  • FABQ Physical Activity subscale test-retest reliability (ICC=0.72-0.90)[5]
  • FABQ Work subscale test-retest reliability (ICC=0.80-0.91)[5]

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.[5]
  • 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.[5]

Resources[edit | edit source]

Fear-Avoidance Beliefs Questionnaire 

References[edit | edit source]

  1. Waddell et al (1993) Pain 52: 157–168.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 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
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 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.
  4. 4.0 4.1 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.
  5. 5.0 5.1 5.2 5.3 5.4 5.5 Williamson E. Fear Avoidance Behavior Questionnaire. Austrailian Journal of Physiotherapy. 2006; 52: 149.
  6. 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.