Validation and reliability testing of the "Athlete Fear Avoidance Questionnaire (AFAQ)"

Abstract

Sports injuries may have severe implications for an athlete's career. Psychological factors play an important role on an athlete's journey from the injury to the return to competitive sports. These factors are often insufficiently evaluated, which may lead to prolonged downtime. The Athlete Fear Avoidance Questionnaire (AFAQ) may be used to measure fear avoidance patterns in injured athletes. There is no validated German version of the questionnaire at this time. This study aims to evaluate the test-retest reliability, internal consistency and construct validity of the transculturally translated German version of the AFAQ (AFAQ_D) in injured athletes. The German version of the AFAQ_D was translated using the TRAPD model. Construct validity was evaluated with correlations to the Fear Avoidance Beliefs Questionnaire (FABQ) and the Tampa Scale for Kinesiophobia (TSK). Internal consistency was calculated using Cronbach's Alpha, while the interclass coefficient was used to calculate test-retest reliability. This study included 64 athletes aged 16 to 36 years (Ø 23.15 years, ♀ 17%, ♂ 83%) after a variety of injuries. The AFAQ_D yielded good reliability values with Crohnbach's Alpha being 0.76 (95%CI; 0.67-0.84) in the first measurement and 0.82 (95%CI; 0.76-0.88) in the second measurement, and the interclass coefficient being 0.798 (95%CI; 0.674-0.876). Regarding validity, a moderate correlation was found between the AFAQ_D and the TSK (r=0.57, p<0.01), and a weak and non-significant correlation was found between the AFAQ_D and the FABQ (r=0.13, p=0.31). By and large, the German version of the AFAQ is a valid and reliable questionnaire to evaluate fear avoidance as well as the psychological readiness of athletes after an injury. Correlations with TSK and FABQ are roughly comparable with the original study.