Original article
Psychometric Properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in Patients With Shoulder Pain

https://doi.org/10.1016/j.apmr.2010.04.009Get rights and content

Abstract

Mintken PE, Cleland JA, Whitman JM, George SZ. Psychometric properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in patients with shoulder pain.

Objective

To investigate the reliability and validity of 2 commonly used measures of pain related fear in patients with shoulder pain.

Design

A preplanned secondary analysis of a prospective single-arm trial involving a repeated-measures design.

Setting

Outpatient physical therapy clinics.

Participants

Patients (N=80) with a primary report of shoulder pain.

Intervention

All patients completed the outcome measures at baseline and at follow-up.

Main Outcome Measures

Patients completed a modified Fear-Avoidance Beliefs Questionnaire (FABQ), the 11-item version of Tampa Scale of Kinesiophobia (TSK-11), and the Shoulder Pain and Disability Index (SPADI) at baseline and at a 48-hour follow-up. Patients were dichotomized as improved or stable at follow-up based on the Global Rating of Change.

Results

Factor analysis indicated 3 stable factors for the FABQ and 1 stable factor for the TSK-11. Shoulder specific scoring for the FABQ and TSK-11 were used in subsequent analyses. Test-retest reliability intraclass correlation coefficient (ICC) was substantial for the FABQ and the TSK-11. The FABQ correlated significantly with SPADI pain and disability scores, while the TSK-11 correlated significantly only with SPADI pain scores. The shoulder-specific FABQ–W (work beliefs subscale) was a better than chance predictor of missing days of work during the 48-hour study period.

Conclusions

The modified FABQ and TSK-11 may be appropriate for use in patients with shoulder pain. Shoulder-specific scoring of these measures resulted in substantial test-retest reliability, and the FABQ correlated with the SPADI for pain and disability. The FABQ also showed potential for prediction of short-term work loss in this sample. Pain-related fear may be an important variable in patients with shoulder pain and merits future consideration in longitudinal studies.

Section snippets

Subjects

Subjects included in this preplanned secondary analysis were consecutive patients with a primary report of mechanical shoulder pain referred to physical therapy at 1 of 7 outpatient physical therapy clinics who agreed to participate in a prospective single-group cohort trial.58 The specific aim of this trial was to investigate the effects of cervicothoracic manipulation on patients with shoulder pain, with a secondary aim of investigating the presence of fear-avoidance beliefs in this

Results

Eighty consecutive patients with shoulder pain were enrolled in the study. PCA for the FABQ identified a 4-factor solution with a cumulative response variance of 73.5% (table 1). Eigenvalues of the individual factors were 5.8 (36.0% variance), 2.5 (15.9%), 2.2 (13.5%), and 1.3 (8.1%), respectively. Items loading less than .50 were not retained on the individual factors, so item loading ranged from .52 to .90 after orthogonal rotation with 2 items cross-loaded (2 and 12). In the exploratory

Discussion

Current evidence demonstrates that a large percentage of patients with shoulder pain will progress to chronicity, and this group will be responsible for a significant proportion of the health care costs for this condition.79, 80, 81 Fear-avoidance behaviors have been identified as contributing to the development of chronic symptoms in patients with musculoskeletal disorders.18, 19, 32, 33, 82, 83, 84 Pain-related fear plays a role in shoulder disability.30, 34, 38, 39, 40, 56 We believe that

Conclusions

The results of the current study support the measurement of pain-related fear in shoulder pain using a modified FABQ over the TSK-11. We presented shoulder-specific factor solutions and scoring of these measures. Our findings provide additional evidence that pain-related fear should be considered when assessing patients with shoulder pain. Although definitive conclusions cannot be made from these data, FABQ demonstrated an association with shoulder pain and disability in comparison with the

Acknowledgments

We thank Kristin Carpenter, PT, DPT, Melanie Bieniek, PT, DPT, Scott Burns, PT, DPT, Mike Keirns, PT, PhD, Amy Garrigues, PT, DPT, Paul Glynn, PT, DPT, John Groves, PT, DPT, Tim Mondale, PT, DPT, and Emilio “Louie” Puentedura, PT, DPT, for their assistance with data collection.

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    Supported by the American Academy of Orthopaedic Manual Physical Therapists and Cardon Rehabilitation (grant no. _____).

    This study is registered at www.clinicaltrials.gov: Identifier: NCT00835302.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

    Reprints are not available from the author.

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