Avoidance behavior after proximal humerus fracture: implications for rehabilitation and a clinically relevant cutoff for the Avoidance of Daily Activities Photo Scale (ADAP Shoulder Scale)

PURPOSE: Avoidance behavior contributes to disability after proximal humerus fracture (PHF), yet its psychosocial determinants and clinical identification remain unclear. This study examined biopsychosocial correlates of avoidance and developed a clinically relevant cutoff for the Avoidance of Daily Activities Photo Scale (ADAP Shoulder Scale). MATERIALS AND METHODS: In this cross-sectional study, 105 adults with PHF completed measures of avoidance (ADAP Shoulder Scale), shoulder disability (SPADI), kinesiophobia (TSK-17), pain-related self-efficacy (PSEQ-10), resilience (Connor-Davidson Resilience Scale, CD-RISC-25), depressive symptoms (Patient Health Questionnaire, PHQ-9), and catastrophizing (PCS). Multiple regression and receiver operating characteristic (ROC) analyses were performed. RESULTS: = 0.049). The ADAP showed good discrimination of disability (AUC = 0.86). A cutoff score ≥61 may indicate relevant avoidance. CONCLUSIONS: Avoidance behavior, a significant contributor to disability after PHF, is strongly associated with lower pain-related self-efficacy. The ADAP cutoff may help clinicians identify patients with relevant avoidance, enabling early, targeted interventions to enhance confidence and engagement in rehabilitation.