Validation of the German version of the Fear-Avoidance Beliefs Questionnaire (FABQ-D) for shoulder disorders

Abstract

With aprevalence of up to 30%, shoulder disorders form the third largest group of musculoskeletal complaints worldwide. Their formation and development are influenced by psychosocial factors such as movement-related fear. One of the internationally most common measurements for quantifying fear of movement is the Fear-Avoidance Beliefs Questionnaire (FABQ). To investigate the reliability (internal consistency) and validity (structural validity, construct validity, predictive validity) of the FABQ‑D in ashoulder pain population. Subjects with shoulder pain were included in amulticenter cross-sectional study. In addition to fear-avoidance beliefs, pain intensity, subjective impairment in daily life and kinesiophobia were recorded. To this end, the FABQ‑D, numeric rating scale (NRS), Shoulder and Pain Disability Index (SPADI) and the Tampa Scale for Kinesiophobia (TSK-GV) were used. Atotal of 49subjects (24women and 25men) with amean age of 41.8years (SD = 12.8) were included. The descriptive evaluation at item level showed good internal consistency of the FABQ‑D (Cronbach's α = 0.88). The homogeneity factor differs significantly between the subscales (Loevinger's H = 0.66-0.9). The correlation analyses did not show any clear convergence of the FABQ‑D with the TSK-GV (r = 0.3501; p = 0.0137). Adivergence to the constructs of the NRS (r = 0.1818; p = 0.2112) and SPADI (r = 0.4415; p = 0.0015) were confirmed. The hypothesis testing resulted in 42.87% of the assumed hypotheses and therefore alow construct validity. The FABQ‑D and the TSK-GV showed asignificant influence on the duration of the complaints (R2 = 0.3652; p ≤ 0.0001). It was also shown that the greatest factors for ahigh FABQ‑D value were functional impairment (SPADI) and duration of symptoms (R2 = 0.3066; p = 0.0002). The subgroup analysis showed asignificantly higher FABQ‑D value in older subjects (40-65years; t = 3.8084/df = 47, p = 0.0002). The FABQ‑D is areliable measurement tool. The construct validity should be further investigated in future studies. This study reproduced results from previous studies in other populations. The FABQ‑D appears to be an adequate measurement tool for quantifying fear of movement in patients with shoulder disorders.