Development and Validation of the Athlete Fear Avoidance Questionnaire

CONTEXT: The fear-avoidance model was developed in an attempt to explain the process by which "pain experience" and "pain behavior" become dissociated from the actual pain sensation in individuals who manifest the phenomenon of exaggerated pain perception. High levels of fear avoidance can lead to chronic pain and disability and have successfully predicted rehabilitation time in the work-related-injury population. Existing fear-avoidance questionnaires have all been developed for the general population, but these questionnaires may not be specific enough to fully assess fear avoidance in an athletic population that copes with pain differently than the general population. OBJECTIVE: To develop and validate the Athlete Fear Avoidance Questionnaire (AFAQ). DESIGN: Qualitative research to develop the AFAQ and a cross-sectional study to validate the scale. PATIENTS OR OTHER PARTICIPANTS: For questionnaire development, a total of 8 experts in the fields of athletic therapy, sport psychology, and fear avoidance were called upon to generate and rate items for the AFAQ. For determining concurrent validity, 99 varsity athletes from various sports participated. DATA COLLECTION AND ANALYSIS: A total of 99 varsity athletes completed the AFAQ, the Fear-Avoidance Beliefs Questionnaire, and the Pain Catastrophizing Scale. We used Pearson correlations to establish concurrent validity. RESULTS: Concurrent validity was established with significant correlations between the AFAQ and the Fear Avoidance Beliefs Questionnaire-Physical Activity (r = 0.352, P > .001) as well as with the Pain Catastrophizing Scale (r = 0.587, P > .001). High internal consistency of our questionnaire was established with a Cronbach α coefficient of 0.805. The final version of the questionnaire includes 10 items with good internal validity (P < .05). CONCLUSIONS: We developed a questionnaire with good internal and external validity. The AFAQ is a scale that measures sport-injury-related fear avoidance in athletes and could be used to identify potential psychological barriers to rehabilitation.