Validation of the Korean version of the avoidance endurance behavior questionnaire in patients with chronic pain

Jeongwi An,Young Hoon Kim,Sungkun Cho

doi:10.1186/s12955-018-1014-8

Abstract

BackgroundThe avoidance-endurance model suggests both fear-avoidance responses and endurance-related responses could affect the chronicity of pain. Proper pain intervention requires measuring fear-avoidance responses and endurance-related responses but no Korean language questionnaire has yet been made to measure them. The purpose of this study was to evaluate the validity and reliability of the Korean version of the Avoidance-Endurance Behavior Questionnaire (K-AEQ-Behavior) by adapting the behavioral responses of Avoidance-Endurance Questionnaire into Korean language.MethodsThe K-AEQ-Behavior was forward and backward translated based on the standards for instrument translation. A total of 136 outpatients with chronic pain of a duration exceeding 3 months were recruited from a pain center at a university hospital in Seoul, Korea. Two weeks later, the K-AEQ-Behavior was re-administered to 36 patients for test-retest reliability. Exploratory factor analysis was performed using principle axis factoring. The internal consistency, test-retest reliability, and concurrent validity of the K-AEQ-Behavior were measured by Cronbach’s ⍺, intraclass correlation coefficient, and Pearson correlation coefficient, respectively.ResultsAlthough the four-factor structure (23 items) was derived in the original study, the two-factor structure of avoidance behavior and endurance behavior (21 items) was derived in the exploratory factor analysis of the Korean version in this study. Other results indicated that K-AEQ-Behavior has good internal consistency, test-retest reliability and concurrent validity.ConclusionThis study suggests that the K-AEQ-Behavior is a reliable and valid instrument for assessing avoidance behavior and endurance behavior in patients with chronic pain.

Highlights

The avoidance-endurance model suggests both fear-avoidance responses and endurance-related responses could affect the chronicity of pain
Both fear-avoidance response (FAR) and endurancerelated responses (ER) have several subscales: for example, in behavior response, FAR consists of avoidance of social activities scale (ASAS) and avoidance of physical activities scale (APAS) and ER consists of humor/distraction scale (HDS) and pain persistence scale (PPS)
Factor structure In exploratory factor analysis (EFA), the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy (.89) and Bartlett’s test of Sphericity (χ2 = 1691.29; p < .001) showed that the items were appropriate for EFA

Summary

Introduction

The avoidance-endurance model suggests both fear-avoidance responses and endurance-related responses could affect the chronicity of pain. The fear-avoidance model suggests that fear-avoidance response (FAR) plays an important role in the development of chronic pain [1]. Studies on AEQ confirmed that all responses were divided into FAR and ER and have good internal consistencies [6, 7]. Both FAR and ER have several subscales: for example, in behavior response, FAR consists of avoidance of social activities scale (ASAS) and avoidance of physical activities scale (APAS) and ER consists of humor/distraction scale (HDS) and pain persistence scale (PPS).

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