Translation, cross-cultural adaptation and psychometric evaluation of the Thai version of the fear-avoidance beliefs questionnaire in patients with non-specific neck pain
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Taweewat Wiangkham
,
Nattawan Phungwattanakul
Abstract
Objectives
Fear-avoidance beliefs questionnaire (FABQ) is a self-report, valid and reliable questionnaire to quantify fear and avoidance beliefs related to physical activity and work. Furthermore, it can be used to predict prolong disability in patients with non-specific neck pain. Although it was originally developed to manage patients with low back pain, it has also been studied in individuals with neck pain. This questionnaire was translated into several languages following reports of potential benefits in patients with neck pain. Recently, Thai neck clinical trials, international multi-centre trials and data sharing are growing throughout the world but no validated Thai version of the FABQ is available for clinical and research uses. Our objectives were to translate and cross-culturally adapt the FABQ into Thai version and evaluate its psychometric properties in Thai patients with non-specific neck pain.
Methods
Cross-cultural translation and adaptation of the FABQ were conducted according to standard guidelines. A total of 129 participants with non-specific neck pain were invited to complete the Thai versions of the FABQ (FABQ-TH), neck disability index and visual analogue scale for pain intensity. Psychometric evaluation included exploratory factor analysis, internal consistency, test-retest reliability, agreement, and convergent validity. Thirty participants completed the FABQ-TH twice with a 48-h interval between tests to assess the test-retest reliability.
Results
Factor analysis identified four components for the FABQ-TH (66.69% of the total variance). The intraclass correlation coefficient of test-retest reliability was excellent for the total score (0.986), work attitudes (0.995), physical activity attitudes (0.958), physical activity experiences (0.927), and expected recovery (0.984). Cronbach’s alpha for internal consistency was excellent (range 0.87–0.88) for all items. The minimal detectable change of the FABQ-TH was 5.85. The FABQ-TH correlated to its subscales (range 0.470–0.936), indicating the strongest association with work attitude. The weakest correlation was observed between the FABQ-TH and disability (rs=0.206, p=0.01). Missing data and significant floor or ceiling effects were not found.
Conclusions
The Thai version of the FABQ for non-specific neck pain was successfully adapted. It is a valid and reliable instrument to quantify fear and avoidance beliefs among patients with non-specific neck pain who speak and read Thai.
Introduction
Among the wide variety of musculoskeletal disorders, neck pain is the second biggest contributor to disability-adjusted life years worldwide [1]. Approximately 50% of adults experience neck pain annually, leading to a reduced quality of life [1]. Pain and disability related to neck pain represent a substantial socioeconomic burden (e.g., health care utilisation, work absenteeism and lost productivity) [2], [3]. In the US, approximately $86.7 billion is spent by the health system for the management of neck and back pain, following diabetes and ischaemic heart disease [4]. In 2016, approximately 31 million days of sickness absence in the UK were due to musculoskeletal conditions (mostly neck and back pain) [5]. In Thailand, musculoskeletal disorders represent the fourth most common health problem, having affected 22 million people in 2015 [6], and up to 50% of these musculoskeletal problems are caused by neck pain [6], [7]. The socioeconomic burden of neck problems in Thailand is approximately US$355 million [8].
Individuals with non-specific neck pain can experience physical (e.g., pain and disability) [1], [2] and psychological (e.g., anxiety, depression and fear avoidance) [9], [10], [11] problems. Assessment tools are commonly used in research and clinical settings to monitor both physical and psychological issues in individuals with neck pain. The neck disability index (NDI) [12] is a popular questionnaire to evaluate physical problems (pain and disability) among individuals with neck pain, which has been translated into many different languages, including Thai [13], [14]. For psychological assessment, the fear-avoidance beliefs questionnaire (FABQ) is an interesting tool to quantify fear and avoidance beliefs related to physical activity and work [15]. It represents an important indicator to predict a poor treatment outcome or delayed recovery and chronicity [16]. Although it was originally developed to manage patients with low back pain [15], it has also been studied in individuals with neck pain [17], [18], [19]. This questionnaire was translated into several languages following reports of potential benefits in patients with neck pain [20], [21], [22], [23].
The FABQ is a self-report questionnaire with 16 items (each scored from 0 to 6) [15]. It is a valid and reliable instrument to predict prolonged disability in patients with neck pain [24], [25], [26]. A higher score indicates higher levels of fear-avoidance beliefs. Recently, Thai neck clinical trials, international multicentre trials and data sharing in clinical research and practice have increased throughout the world, but there is still no Thai version of the FABQ to use for research and clinical purposes. Therefore, this study was conducted to translate and cross-culturally adapt the FABQ into Thai (FABQ-TH), and evaluate its psychometric properties in Thai-speaking patients with non-specific neck pain.
Methods
This study was divided into two stages: (1) linguistic translation and adaptation of the FABQ for native Thai patients with non-specific neck pain, and (2) assessment of its psychometric properties. All processes were performed in accordance with the Declaration of Helsinki.
Stage I: linguistic translation and cross-cultural adaptation
The translation procedure was conducted based on the standard guidelines published by Beaton et al. in 2000 [27]. Forward translation of the original English version of the FABQ into Thai was independently performed by two bilingual translators (Thai and English, with Thai as their first language). The first translator was a musculoskeletal physiotherapist (PhD physiotherapy qualification with 10 years of experience) who was familiar with the FABQ (provided the T1 version). The second translator was an English lecturer (PhD linguistic qualification) and professional translator (provided the T2 version). Then, both translators and two researchers synthesised the T12 version with a written report prior to back translation. Two back translators (PhD linguistic qualification) who were bilingual in Thai and English with no medical background independently translated the T12 version to English without knowledge of the original English version. In the next step, an expert committee (consisting of the four translators, two researchers, one musculoskeletal physiotherapist specialising in neck pain and one expert linguistic chair) discussed the original questionnaire, all translated versions and written reports until agreement regarding the semantic, idiomatic, experiential and conceptual equivalences between the original and targeted versions was reached, used to establish the pre-final version. The committee slightly concerned with item 8 (claiming compensation for pain), as this practice is not common in the Thai context. However, it was still included in the pre-final version suggested by the committee. The pre-final version was tested on 30 patients with neck pain, and the documents completed by these patients were not included in the data analysis. No modifications to the questionnaire were required at this point.
Stage II: psychometric evaluation of the final version
Participants
Potential participants aged 20–59 years old with neck pain were recruited from September to December 2018. At least 100 participants are suggested for sample size of a factor analysis [28]. Consequently, at least 100 participants were expected to recruit although a sample size of ≥50 participants can be conducted to evaluate psychometric properties [29]. Individuals with a history of spinal surgery, vertebral fracture, traumatic neck pain, cervical radiculopathy, cervical myelopathy, cervical tumours, systemic diseases with a possible effect on the musculoskeletal system, clinical cognitive impairment, or who were unable to complete the questionnaire independently were excluded. Participants provided written informed consent prior to participation.
Instruments
Fear-avoidance beliefs questionnaire (FABQ)
The FABQ is a self-report questionnaire with 16 items (each scored 0–6) covering both work (items 1–5) and physical activity (items 6–16) [15]. It is a valid (Cronbach’s α range 0.90–0.97) [20], [30] and reliable (intraclass correlation coefficient [ICC2,1] range 0.81–0.93) [20], [30] tool to predict prolonged disability in patients with neck pain [24], [25]. The FABQ has been translated into several languages (e.g., Chinese, Persian and Greek) for managing patients with neck pain [20], [22], [23].
Neck disability index (NDI)
The NDI is a patient-reported instrument with 10 items to evaluate pain intensity and functional activities (e.g., personal care, lifting, reading, headache, concentration, work, driving, sleeping and recreation) [12]. Each item is scored from 0 to 5 (the highest score representing the greatest disability). The overall score was used to classify the level of disability for each patient [12]. The NDI is a valid, reliable and responsive tool for assessing pain and disability associated with both acute and chronic neck problems [12], [31], [32], [33]. It has been translated into Thai and reported to be a reliable tool (Cronbach α=0.85, ICC=0.85) for assessing Thai patients with neck pain [13]. Thus, the NDI-Thai version was used in this study.
Visual analogue scale (VAS) for pain intensity
The VAS is a simple and commonly used method to assess pain intensity which is valid and reliable (ICC=0.97) [34], [35]. It is a 100-mm horizontal line with “no pain” written at the left end point and “worst imaginable pain” at the right end point. Participants were asked to draw a vertical line on this scale to mark a point corresponding to the magnitude of their current pain.
Content validity
Content validity was evaluated by the expert committee panel during the translation stage. Floor and ceiling effects (>15% of respondents were considered) [29], missing data and skewness (considered acceptable between −1 and 1) [36] were analysed to evaluate the acceptability.
Factor analysis
Exploratory factor analysis was conducted to explore the dimensionality of the questionnaire using principle component analysis with the varimax rotation method. Satisfactory factors were assessed by considering an eigenvalue ≥1 and items of loading ≥0.4. Satisfied factors were named based on included items and their factor loading.
Internal consistency
Internal consistency of the FABQ-TH was tested using Cronbach’s α coefficient. A Cronbach’s α value higher than 0.7 was considered acceptable [29]. A difference in Cronbach’s α values of more than 0.1 for each item can be defined as no correlation.
Test-retest reliability and agreement
The test-retest reliability of the FABQ-TH was assessed using the ICC2,1 in 30 participants. The participants were invited to complete the questionnaire twice with a 48-h interval between tests to minimise any memory of previous answers and variations in clinical conditions. The ICC can range from 0 to 1, with values >0.9 indicating excellent reliability [37]. The standard error of measurement (SEM; standard deviation of all test scores ×
Convergent validity
The correlations between FABQ-TH, NDI-TH and VAS-TH (pain intensity) were evaluated using Spearman’s rank correlation coefficient (r). Correlations were defined as high >0.60, moderate 0.30–0.60, or weak <0.30 [40]. According to the previous versions of the FABQ [20], [41], [42], [43], [44], the scores of FABQ-TH were not expected to be significantly correlated with the scores of VAS-TH but be expected to be at least weakly correlated with the scores of NDI-TH. Additionally, moderate to strong correlations between the scores of FABQ-TH and its subscales were expected [15], [45].
Statistical analysis
Descriptive statistics (percentage, means and standard deviation [SD]) were used to illustrate participants’ demographic characteristics. SPSS statistical package (version 23) was used to analyse reliability and validity as described above.
Results
A total of 129 patients with non-specific neck pain (25 males and 104 females) with mean age 26.3 ± 10.0 years participated in this study. The demographic and clinical characteristics of the participants are fully presented in Table 1.
Demographic and clinical characteristics of the participants (n=129).
| Variables | % (n) | Mean ± SD | Minimum | Maximum |
|---|---|---|---|---|
| Age (year) | 26.38 ± 10.00 | 20.00 | 58.00 | |
| Education | ||||
| No primary school | – | |||
| Primary school | 1.60 (2) | |||
| High school | 3.10 (4) | |||
| Bachelor’s degree | 75.20 (97) | |||
| Master’s degree | 12.40 (16) | |||
| Doctoral degree | 7.80 (10) | |||
| VAS-TH (0–100) | 30.59 ± 18.90 | 3.00 | 100.00 | |
| NDI-TH (0–50) | 7.52 ± 5.08 | 1.00 | 24.00 | |
| FABQ-TH (0–66) | 32.66 ± 11.85 | 1 | 57.00 | |
| FABQTH-PA (0–24) | 13.31 ± 4.69 | 0 | 24.00 | |
| FABQTH-W (0–42) | 19.35 ± 8.48 | 0 | 34.00 | |
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SD, standard deviation; VAS-TH, visual analogue scale-Thai version; NDI-TH, neck disability index-Thai version; FABQ-TH, fear avoidance beliefs questionnaire-Thai version; FABQTH-PA, fear avoidance beliefs questionnaire Thai version about physical activity; FABQTH-W, fear avoidance beliefs questionnaire Thai version about work.
Content validity
All participants completed the questionnaires with no missing data. The mean response score to items of the FABQ-TH ranged from 0.52 to 4.29 (possible range 0–6). No significant floor or ceiling effects were found for the FABQ-TH about physical activity (PA; FABQ-TH-PA) (floor:ceiling ratio of 1.6%:0.8%), FABQ-TH about work (W; FABQ-TH-W) (1.6%:0%) or the total score (0%:0%). The subscale and total scores of the FABQ-TH were normally distributed according to the values of skewness (FABQ-TH-PA, −0.75 ± 0.21; FABQ-TH-W, −0.42 ± 0.21; and FABQ-TH, −0.55 ± 0.21) and kurtosis (FABQ-TH-PA, 0.66 ± 0.42; FABQ-TH-W, −0.61 ± 0.42; and FABQ-TH -0.17 ± 0.42).
Factor analysis
The results of the factor analyses are presented in Table 2. Four factors with an eigenvalue ≥1 (66.69% of the total variance) were extracted. These four factors were work attitude, physical activity attitude, physical activity experience and expected recovery, with eigenvalues of 5.840, 2.433, 1.235 and 1.163, respectively.
Varimax-rotated factor-loading matrix and internal consistency of the FABQ-TH.
| Items | Components | Cronbach’s α | |||
|---|---|---|---|---|---|
| Factor 1 Work attitudes |
Factor 2 Physical activity attitudes |
Factor 3 Physical activity experiences |
Factor 4 Expected recovery |
||
| 1 | 0.769 | 0.88 | |||
| 2 | 0.872 | 0.88 | |||
| 3 | 0.761 | 0.87 | |||
| 4 | 0.737 | 0.88 | |||
| 5 | 0.739 | 0.87 | |||
| 6 | 0.626 | 0.87 | |||
| 7 | 0.543* | 0.410 | 0.442 | 0.87 | |
| 8 | 0.521 | 0.88 | |||
| 9 | 0.804 | 0.87 | |||
| 10 | 0.761 | 0.87 | |||
| 11 | 0.707 | 0.87 | |||
| 12 | 0.619* | 0.403 | 0.88 | ||
| 13 | 0.640 | 0.87 | |||
| 14 | 0.539 | 0.606* | 0.87 | ||
| 15 | 0.845 | 0.88 | |||
| 16 | 0.865 | 0.88 | |||
| Total variance explained | 36.502 | 15.207 | 7.719 | 7.264 | |
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Factors loading ≥ 0.4 were presented, *Factor upon which item loaded most heavily.
Internal consistency
The Cronbach’s α value for the FABQ-TH was 0.881, ranging from 0.867 to 0.881 for each item (Table 2), indicating satisfactory internal consistency. Cronbach’s α values for each item were no difference higher than 0.1, meaning that all items were relevant to this population.
Test-retest reliability
The mean, SD and ICC for the two tests are presented in Table 3. The ICC of the FABQ-TH and subscales ranged from 0.927 to 0.995 (p<0.001), indicating excellent reliability.
Test-retest reliability of the FABQ-TH (n = 30).
| Mean ± SD | ICC (95% CI) | ||
|---|---|---|---|
| Test | Retest | ||
| FABQ-TH | 31.67 ± 11.43 | 32.20 ± 12.41 | 0.986 (0.970–0.993) |
| FABQ-TH subscales | |||
| Factor 1: work attitudes (WA) | 16.60 ± 7.60 | 16.73 ± 7.90 | 0.995 (0.989–0.997) |
| Factor 2: physical activity attitudes (PAA) | 6.57 ± 2.76 | 6.77 ± 3.11 | 0.958 (0.911–0.980) |
| Factor 3: physical activity experiences (PAE) | 7.90 ± 2.22 | 8.10 ± 2.54 | 0.927 (0.734–0.933) |
| Factor 4: expected recovery (ER) | 0.60 ± 1.00 | 0.60 ± 1.07 | 0.984 (0.966–0.992) |
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SD, standard deviation; ICC, intraclass correlation coefficient; CI, confidence interval; FABQ-TH, Fear-Avoidance Beliefs Questionnaire-Thai version.
Agreement
The SEMs of the FABQ-TH, FABQ-TH work attitude (WA; FABQ-TH-WA), FABQ-TH physical activity attitude (PAA; FABQ-TH-PAA), FABQ-TH physical activity experience (PAE; FABQ-TH-PAE) and FABQ-TH expected recovery (ER; FABQ-TH-ER) were 2.11, 0.57, 0.46, 0.12 and 1.44, respectively. The resultant MDCs were 5.85, 1.58, 1.27, 0.33 and 3.99, respectively. The Bland-Altman analysis showed mean differences of −0.53 ± 2.78 for the FABQ-TH, −0.13 ± 1.14 for the FABQ-TH-WA, −0.20 ± 1.19 for the FABQ-TH-PAA, −0.20 ± 1.24 for the FABQ-TH-PAE, and 0.00 ± 0.26 for the FABQ-TH-ER as shown in Figures 1–5.
Bland–Altman plot presenting the agreement of the FABQ-TH.
Bland–Altman plot presenting the agreement of the FABQTH-WA.
Bland–Altman plot presenting the agreement of the FABQTH-PAA.
Bland–Altman plot presenting the agreement of the FABQTH-PAE.
Bland–Altman plot presenting the agreement of the FABQTH-ER.
Convergent validity
The correlations between FABQ-TH (including its subscales), VAS-TH and NDI-TH are presented in Table 4. The FABQ-TH and its subscales were found to be significantly correlated to each other. Strong correlations were revealed for FABQ-TH vs. FABQ-TH-PAA (rs=0.601, p<0.001), FABQ-TH vs. FABQ-TH-PAE (rs=0.622, p<0.001) and FABQ-TH vs. FABQ-TH-WA (rs=0.936, p<0.001), which showed the strongest correlation. Moderate correlations were observed for FABQ-TH vs. FABQ-TH-ER (rs=0.470, p<0.001), FABQ-TH-WA vs. FABQ-TH-PAA (rs=0.421, p<0.001), FABQ-TH-WA vs. FABQ-TH-PAE (rs=0.476, p<0.001), FABQTH-WA vs. FABQ-TH-ER (rs=0.332, p<0.001), FABQ-TH-PAA vs. FABQ-TH-ER (rs=0.330, p<0.001) and VAS-TH vs. NDI-TH (rs=0.562, p<0.001). Weak correlations were observed for FABQ-TH vs. NDI-TH (rs=0.206, p=0.019), FABQ-TH-WA vs. VAS-TH (rs=0.192, p=0.029), FABQ-TH-PAA vs. FABQ-TH-PAE (rs=0.234, p=0.008), FABQ-TH-PAE vs. FABQ-TH-ER (rs=0.177, p=0.045) and FABQ-TH-PAE vs. VAS-TH (rs=0.211, p=0.016).
Convergent validity among FABQ-TH, VAS-TH and NDI-TH.
| Spearman rank correlation (rs) | p-Value | |
|---|---|---|
| FABQ-TH vs | ||
| FABQTH-WA | 0.936 | <0.001* |
| FABQTH-PAA | 0.601 | <0.001* |
| FABQTH- PAE | 0.622 | <0.001* |
| FABQTH- ER | 0.470 | <0.001* |
| VAS-TH | 0.157 | 0.076 |
| NDI-TH | 0.206 | 0.019* |
| FABQTH-WA vs | ||
| FABQTH-PAA | 0.421 | <0.001* |
| FABQTH- PAE | 0.476 | <0.001* |
| FABQTH- ER | 0.332 | <0.001* |
| VAS-TH | 0.192 | 0.029* |
| NDI-TH | 0.166 | 0.059 |
| FABQTH- PAA vs | ||
| FABQTH- PAE | 0.234 | 0.008* |
| FABQTH- ER | 0.330 | <0.001* |
| VAS-TH | −0.029 | 0.748 |
| NDI-TH | 0.049 | 0.579 |
| FABQTH- PAE vs | ||
| FABQTH- ER | 0.177 | 0.045* |
| VAS-TH | 0.211 | 0.016* |
| NDI-TH | 0.151 | 0.087 |
| FABQTH- ER vs | ||
| VAS-TH | −0.067 | 0.450 |
| NDI-TH | 0.115 | 0.193 |
| VAS-TH vs NDI-TH | 0.562 | <0.001* |
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*Statistical significance; FABQ-TH, fear avoidance beliefs questionnaire-Thai version; FABQTH-WA, fear avoidance beliefs questionnaire Thai version about work attitudes; FABQTH-PAA, fear avoidance beliefs questionnaire Thai version about physical activity attitudes; FABQTH-PAE, fear avoidance beliefs questionnaire Thai version about physical activity experiences; FABQTH-ER, fear avoidance beliefs questionnaire Thai version about expected recovery; VAS-TH, visual analogue scale-Thai version; NDI-TH, neck disability index-Thai version.
Discussion
The aims of this study were to translate and cross-culturally adapt the original English version of the FABQ into Thai and assess its psychometric properties. Our findings suggest that the FABQ-TH had satisfactory reliability and validity in Thai patients with non-specific neck pain.
The FABQ-TH appears to be easy to understand and use in the Thai population, evidenced by the absence of missing data. Furthermore, the skewness and ceiling and floor effects are considered acceptable [29], [36]. Although the committee was slightly concerned with item 8 (claiming compensation for pain) in the translation stage, there was no difficulty when the study was implemented. In Thailand, individuals are unable to claim compensation, similar to Saudi Arabia [43], India [41] and Iran [46].
Factor analysis identified four factors (work attitude, physical activity attitude, physical activity experience and expected recovery) which appear to differ from previous studies. Two factors (physical activity and work) were similar to the original version [15], and were also identified in the Italian [42], Norwegian [45], Persian [46] and Swiss-German [47] versions. Three similar factors (adding work prognosis) were demonstrated in the Chinese [20], Finnish [48], German [49], Greek [23], Hausa [44] and Hindi [41] versions. An interesting unique factor in our findings was expected recovery, which can substantially influence clinical outcome measures. For example, patients who were unsure of their expectation for complete pain relief had lower odds of success than patients who expected complete relief (odds ratio 0.33, 95% confidence interval [0.11, 0.99]) [50].
The FABQ-TH demonstrated high internal consistency in the overall score and for each item, reflecting homogenous concept of the questionnaire [29], which is similar to most other studies [15], [20], [23], [41], [42], [45], [46], [47], [48], [49]. Additionally, the differences of Cronbach’s α values for each item were ˂0.1. Furthermore, the ICCs of the FABQ-TH and its subscales indicated excellent test-retest reliability, similar to the Hindi [41], Hausa (overall and physical activity) [44], Gujarati (overall) [51] and Finish (overall) [48] versions. Interestingly, the FABQ-TH demonstrated higher ICCs than other versions [15], [20], [42], [43], [45], [46], [49]. Differences in the test-retest interval in individual studies may explain the variety of ICCs observed in different studies, with intervals ranging from 24 h to 29 days, but the most common intervals were 48 h [15], [43], [45], [51] or 7 days [20], [42], [44]. The interval should be long enough to avoid any memory of previous answers but short enough to avoid clinical/cognitive changes in the measured variables or clinical status [13], [15], [20].
For the agreement, the Bland–Altman plots were performed to show the mean differences between scores on first and second measurements. The mean difference close to 0 indicates low bias. In this study, the Bland–Altman analysis showed mean differences of −0.53 ± 2.78 for the FABQ-TH, −0.13 ± 1.14 for the FABQ-TH-WA, −0.20 ± 1.19 for the FABQ-TH-PAA, −0.20 ± 1.24 for the FABQ-TH-PAE, and 0.00 ± 0.26 for the FABQ-TH-ER (Figures 1–5), representing low bias for the FABQ-TH and its subscales. Unfortunately, there is no study investigating the Bland–Altman plot for the FABQ in patients with non-specific neck pain. An error of measurement of the FABQ-TH and its subscales are small resulting from the SEMs (range from 0.12 to 2.11) and MDCs (range from 0.33 to 5.85). The small of the SEM (2.11) led to the small of MDC (5.85) and which means changed score equal or higher than 5.85 demonstrating a real change. Remarkably, the MDCs of the FABQ-TH and its subscales are lower than the Italian (MDC=12) [42], French (10/42 for work and 7/24 for physical activity) [52] and Norwegian (12 for work and 9 for physical activity) [45] versions. However, the MDC of the questionnaire is similar to Hausa version (MDC=5.40) [44]. Therefore, the FABQ-TH may be a sensitive tool to quantify fear and avoidance beliefs related to physical activity and work in Thai patients with non-specific neck pain. Unfortunately, there are few studies of the MDC of the FABQ, leading to limited discussion.
The FABQ-TH demonstrated no significant correlation with pain intensity (VAS-TH, rs=0.157, p=0.07), which may indicate that the FABQ-TH may be independent from pain, similar to the Hindi [41] and Italian [42] versions. Moreover, a weak correlation was found with disability (NDI-TH, rs=0.206). This finding suggests a relationship between fear-avoidance beliefs and self-reported disability, similar to the Arabic [43], Chinese [20], Hausa [44], Hindi [41] and Italian [42] versions, as a greater fear of movement can be associated with more severe disability, similar to that observed in patients with non-specific low back pain [53]. The correlations between the FABQ-TH and its subscales (WA, rs=0.936; PAA, rs=0.601; PAE, rs=0.622; and ER, rs=0.470) were moderate to strong, and the work subscale showed the strongest correlation, similar to previous studies [15], [44], [45], [47], [49]. The VAS-TH and NDI-TH were found to be moderately correlated to each other (rs=0.562), reflecting the relationship between pain and disability. Thus, the construct validity of this study is supported owing to confirmed ≥75% of the a priori hypotheses [29].
Some limitations of this study should be considered when interpreting the findings. Firstly, the correlation between the FABQ-TH and the Tampa Scale of Kinesiophobia should be determined to assess convergent validity. Although the Portuguese version of both questionnaires demonstrated a strong correlation (rs=0.86) [54], the Italian (rs = range 0.387–0.469) [42] and Greek (rs = range 0.25–0.55) [23] versions showed poor to moderate correlations. This may indicate that the two questionnaires do not completely assess the same theoretical constructs. Moreover, an outcome measure regarding quality of life assessment was not included in this version of the FABQ; however, this can be assessed using the short form health survey-36 or EuroQol-5 dimension, which have both been translated into Thai. Furthermore, the responsiveness of the FABQ-TH is not implemented. Finally, most studies that use this scale have been conducted in patients with low back pain, and only three studies [20], [21], [22] investigated a neck pain population, meaning that comparisons are limited.
Conclusion
The translation and adaptation of the Thai version of the FABQ were successful, with satisfactory internal consistency, reliability and construct validity of the four-factor FABQ-TH. Therefore, the FABQ-TH can be applied in both research and clinical settings to assess fear-avoidance beliefs in Thai-speaking patients with non-specific neck pain.
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Research funding: The authors received no financial support for this study.
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Author contributions: All authors have read and approved the final manuscript.
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Competing interests: No conflict of interest.
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Informed consent: Participants provided written informed consent prior to participation.
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Ethical approval: The study protocol is approved by the Institutional Review Board of Naresuan University (NUIRB_0239/61) and registered in the Thai Clinical Trial Registry (TCTR20180828013).
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Availability of data and material: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
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© 2020 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Editorial
- Salami-slicing and duplicate publication: gatekeepers challenges
- Editorial Comment
- Risk for persistent post-delivery pain – increased by pre-pregnancy pain and depression. Similar to persistent post-surgical pain in general?
- Systematic Review
- Acute experimentally-induced pain replicates the distribution but not the quality or behaviour of clinical appendicular musculoskeletal pain. A systematic review
- Topical Review
- Unwillingly traumatizing: is there a psycho-traumatologic pathway from general surgery to postoperative maladaptation?
- Clinical Pain Research
- Translation, cross-cultural adaptation and psychometric evaluation of the Thai version of the fear-avoidance beliefs questionnaire in patients with non-specific neck pain
- Pain management in patients undergoing radiation therapy for head and neck cancer – a descriptive study
- Do intensity of pain alone or combined with pain duration best reflect clinical signs in the neck, shoulder and upper limb?
- Different pain variables could independently predict anxiety and depression in subjects with chronic musculoskeletal pain
- Symptoms of central sensitization in patients with inflammatory bowel diseases: a case-control study examining the role of musculoskeletal pain and psychological factors
- Acceptability of psychologically-based pain management and online delivery for people living with HIV and chronic neuropathic pain: a qualitative study
- Determinants of pain occurrence in dance teachers
- Observational Studies
- A retrospective observational study comparing somatosensory amplification in fibromyalgia, chronic pain, psychiatric disorders and healthy subjects
- Utilisation of pain counselling in osteopathic practice: secondary analysis of a nationally representative sample of Australian osteopaths
- Effectiveness of ESPITO analgesia in enhancing recovery in patients undergoing open radical cystectomy when compared to a contemporaneous cohort receiving standard analgesia: an observational study
- Shoulder patients in primary and specialist health care. A cross-sectional study
- The tolerance to stretch is linked with endogenous modulation of pain
- Pain sensitivity increases more in younger runners during an ultra-marathon
- Original Experimental
- DNA methylation changes in genes involved in inflammation and depression in fibromyalgia: a pilot study
- Participants with mild, moderate, or severe pain following total hip arthroplasty. A sub-study of the PANSAID trial on paracetamol and ibuprofen for postoperative pain treatment
- Exploring peoples’ lived experience of complex regional pain syndrome in Australia: a qualitative study
- Although tapentadol and oxycodone both increase colonic volume, tapentadol treatment resulted in softer stools and less constipation: a mechanistic study in healthy volunteers
- Educational Case Report
- Updated management of occipital nerve stimulator lead migration: case report of a technical challenge
Artikel in diesem Heft
- Frontmatter
- Editorial
- Salami-slicing and duplicate publication: gatekeepers challenges
- Editorial Comment
- Risk for persistent post-delivery pain – increased by pre-pregnancy pain and depression. Similar to persistent post-surgical pain in general?
- Systematic Review
- Acute experimentally-induced pain replicates the distribution but not the quality or behaviour of clinical appendicular musculoskeletal pain. A systematic review
- Topical Review
- Unwillingly traumatizing: is there a psycho-traumatologic pathway from general surgery to postoperative maladaptation?
- Clinical Pain Research
- Translation, cross-cultural adaptation and psychometric evaluation of the Thai version of the fear-avoidance beliefs questionnaire in patients with non-specific neck pain
- Pain management in patients undergoing radiation therapy for head and neck cancer – a descriptive study
- Do intensity of pain alone or combined with pain duration best reflect clinical signs in the neck, shoulder and upper limb?
- Different pain variables could independently predict anxiety and depression in subjects with chronic musculoskeletal pain
- Symptoms of central sensitization in patients with inflammatory bowel diseases: a case-control study examining the role of musculoskeletal pain and psychological factors
- Acceptability of psychologically-based pain management and online delivery for people living with HIV and chronic neuropathic pain: a qualitative study
- Determinants of pain occurrence in dance teachers
- Observational Studies
- A retrospective observational study comparing somatosensory amplification in fibromyalgia, chronic pain, psychiatric disorders and healthy subjects
- Utilisation of pain counselling in osteopathic practice: secondary analysis of a nationally representative sample of Australian osteopaths
- Effectiveness of ESPITO analgesia in enhancing recovery in patients undergoing open radical cystectomy when compared to a contemporaneous cohort receiving standard analgesia: an observational study
- Shoulder patients in primary and specialist health care. A cross-sectional study
- The tolerance to stretch is linked with endogenous modulation of pain
- Pain sensitivity increases more in younger runners during an ultra-marathon
- Original Experimental
- DNA methylation changes in genes involved in inflammation and depression in fibromyalgia: a pilot study
- Participants with mild, moderate, or severe pain following total hip arthroplasty. A sub-study of the PANSAID trial on paracetamol and ibuprofen for postoperative pain treatment
- Exploring peoples’ lived experience of complex regional pain syndrome in Australia: a qualitative study
- Although tapentadol and oxycodone both increase colonic volume, tapentadol treatment resulted in softer stools and less constipation: a mechanistic study in healthy volunteers
- Educational Case Report
- Updated management of occipital nerve stimulator lead migration: case report of a technical challenge
