Abstract
Objectives: In regards to pain-related fear, this study aimed to: (1) identify existing measures and review their measurement properties, and (2) identify the optimum measure for specific constructs of fear-avoidance, pain-related fear, fear of movement, and kinesiophobia. Design: Systematic literature search for instruments designed to measure fear of pain in patients with persistent musculoskeletal pain. Psychometric properties were evaluated by adjusted Wind criteria. Results: Five questionnaires (Fear-Avoidance Beliefs Questionnaire (FABQ), Fear-Avoidance of Pain Scale (FAPS), Fear of Pain Questionnaire (FPQ), Pain and Anxiety Symptoms Scale (PASS), and the Tampa Scale for Kinesiophobia (TSK)) were included in the review. The main findings were that for most questionnaires, there was no underlying conceptual model to support the questionnaire's construct. Psychometric properties were evaluated by diverse methods, which complicated comparisons of different versions of the same questionnaires. Construct validity and responsiveness was generally not supported and/or untested. Conclusion: The weak construct validity implies that no measure can currently identify who is fearful. The lack of evidence for responsiveness restricts the current use of the instruments to identify clinically relevant change from treatment. Finally, more theoretically driven research is needed to support the construct and thus the measurement of pain-related fear.
Highlights
Over the last decennia, fear of pain and/or injury has become an integral part of our understanding in the explanation of disability in patients with persistent musculoskeletal pain [1]
All questionnaires had weaknesses in relation to their psychometric properties, poor reliability and validity indicating a lack of construct validity
The fact that no or only limited information is available concerning the description of the conceptual model has direct impact on the manner in which the concepts are consecutively operationalised and measured
Summary
Fear of pain and/or injury has become an integral part of our understanding in the explanation of disability in patients with persistent musculoskeletal pain [1]. One of the reasons for this is the fact that fear in relation to pain has been described with a variety of conceptual definitions among which pain-related fear, fearavoidance beliefs, fear of movement, and kinesiophobia are the most commonly used. These are, constructs rather than a disorder or other pathological state in and of itself. Kori et al presented their thoughts about kinesiophobia [13]
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