The Fear Avoidance Beliefs Questionnaire (FABQ) Does it Really Measure Fear Beliefs?, Aasdahl et al., 2020

Abstract

Study design: A cohort study with 12 months of follow-up.

Objective: To assess (1) the unidimensionality of the Fear-Avoidance Beliefs Questionnaire (FABQ) and (2) whether single questions in the FABQ predict future sickness absence as well as the whole scale.

Summary of background data: The fear-avoidance model is a leading model in describing the link between musculoskeletal pain and chronic disability. However, reported measurement properties have been inconsistent regarding the FABQ.

Methods: Individuals (n = 722) sick listed due to musculoskeletal, unspecified or common mental health disorders undergoing rehabilitation was included. A Rasch analysis was applied to evaluate the measurement properties of FABQ and its two subscales (physical activity and work). Linear regression was used to assess how well single items predicted future sickness absence.

Results: The Rasch analysis did not support the FABQ or its two subscales representing a unidimensional construct. The 7-point scoring of the items was far too fine meshed and in the present population the data only supported a yes or no or a 3-point response option. The items were invariant to age, whereas two of the items revealed sex differences. The item "I do not think that I will be back to my normal work within 3 months" was the best predictor of future sickness absence. Adding the item "I should not do my regular work with my present pain" improved the prediction model slightly.

Conclusion: The FABQ is not a good measure of fear-avoidance beliefs about work or physical activity, and the predictive property of the FABQ questionnaire is most likely related to expectations rather than fear. Based on these results we do not recommend using the FABQ to measure fear-avoidance beliefs.

Source: https://pubmed.ncbi.nlm.nih.gov/31415468/

 

"The FABQ, although originally developed for low back pain, has later been evaluated for other populations and is now widely used. Several studies have showed that the FABQ, particularly the work-subscale, is a good predictor of future work outcomes, and is thus much used in the clinic and in research."

The scale looks like this:

https://www.tac.vic.gov.au/files-to-move/media/upload/fear_avoidance.pdf

This study found that the single item 'I do not think that I will be back to my normal work within 3 months' was a better predictor of work sickness absence than the subscales of the FABQ. Therefore the predictive power of the FABQ is more related to expectations of the patient rather than fear.

 

I have not read the article, but I wonder if it is ever attempted to distinguish between avoidance because you are afraid and avoidance based on a rational evaluation of risk. If there is risk, the fear aspect is almost irrelevant, just considering whether there is any emotion attached to considering a course of action based on accurate prediction of the outcome.

If I walk to the pub I know I will get PEM and be ill the next day, whether I am afraid of attempting this or not has not relevance to the outcome. Not walking to the pub is a rational course of action, whether I am afraid of doing it or not is irrelevant to the outcome, though fear is an adaptive response drawing on previous experience.

 

Obviously no questionnaire could ever do such a thing. The entire premise is ridiculous, and there is no way to validate this one way or another.

The premise of the model is also ridiculous, but as they say it's the dominant model. Only in medicine...

 

wasn't gordon waddell a hatchet man for the DHSS now the dept of work and pensions. patient blaming the easy way to withdraw benefits and health care .