Validation of the Persian version of the fear avoidance belief questionnaire in patients with low back pain.

OBJECTIVES

Fear of pain or re-injury and avoidance attitudes have a great impact on maintenance of chronic low back pain (CLBP) and disability. Fear-Avoidance Beliefs Questionnaire (FABQ) is developed to assess these psychosocial factors. The aim of this study was to provide a translated and validated version of the FABQ for Persian speaking population.

METHODS

Forward and backward translation techniques were carried out for translation and cultural adaptation of the questionnaire into Persian. Internal consistency and test-retest reliability were used to assess the reliability of the Persian questionnaire. Construct validity of the scale was assessed by divergent validity (using Spearman correlation coefficient) and exploratory factor analysis. Principle component analysis with varimax rotation method was applied for assessment of factor analysis.

RESULTS

The test-retest reliability was excellent with the Intra-class Correlation (ICC) value of 0.802 and 0.808 for the physical activity and work subscales of the questionnaire, respectively. The Chronbach's alpha coefficient value of 0.89, demonstrated adequate internal consistency of the questionnaire. Factor analysis revealed two factors which could explain 57.9% of the total variance. Items 7, 10 and 11 of the questionnaire were used in both major factors of the final Persian version. Regarding the divergent validity of the questionnaire, data demonstrated no correlation (r< 0.3) between factor 2 (which is about physical activity) and measured clinical variables (pain intensity and level of dysfunction), while factor 1 (which is about work) was fairly correlated with both pain intensity and disability level of the subjects.

CONCLUSION

The provided Persian version of FABQ is a reliable and valid measurement and further research into its use as a diagnostic and prognostic tool is warranted. Development of this questionnaire will be useful for comparability between Persian and English language studies and facilitates an international collaboration in this field.