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European Journal of Physical and Rehabilitation Medicine 2020 May 18

DOI: 10.23736/S1973-9087.20.06158-4


language: English

Reliability, responsiveness and minimal clinically important difference of the two Fear Avoidance and Beliefs Questionnaire scales in Italian subjects with chronic low back pain undergoing multidisciplinary rehabilitation

Marco MONTICONE 1, 2 , Luca FRIGAU 3, Howard VERNON 4, Barbara ROCCA 5, Andrea GIORDANO 6, Salvatore S. VULLO 1, 2, Francesco MOLA 3, Franco FRANCHIGNONI 5

1 Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; 2 Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy; 3 Department Economics and Business Science, University of Cagliari, Cagliari, Italy; 4 Canadian Memorial Chiropractic College, Toronto, ON, Canada; 5 ICS Maugeri, IRCCS, Physical Medicine and Rehabilitation Unit, Institute of Lissone, Monza e Brianza, Italy; 6 Bioengineering Unit, ICS Maugeri, IRCCS, Institute of Veruno, Novara, Italy


BACKGROUND: The Fear-Avoidance Beliefs Questionnaire (FABQ) is a widely used outcome measure. There is still a lack of information concerning responsiveness and minimal clinically important difference (MCID), limiting its use for clinical and research purposes.
AIM: To examine reliability, responsiveness and MCID of the two FABQ scales in subjects with chronic Low Back Pain.
DESIGN: Methodological research based on a prospective single-group observational study. SETTING: Outpatient, rehabilitation unit.
POPULATION: Chronic non-specific Low Back Pain.
METHODS: At the beginning and the end of a multidisciplinary programme (8-week), 129 subjects completed the FABQ scales. Reliability was determined as internal consistency (Cronbach’s alpha) and test-retest reliability (96-hour interval; n= 64). Responsiveness was calculated both by distribution-based and anchor-based methods, using as external criterion the global perceived effect scale (GPE: 7 levels), rated by each individual.
RESULTS: Cronbach’s alpha and ICC(2,1) were respectively: 0.75 and 0.90 for FABQ-Physical Activity scale (FABQ-PA), and 0.85 and 0.95 for FABQ-Work scale (FABQ-W). Minimum detectable change (MDC95) values were 3.69 points for FABQ-PA, and 5.95 points for FABQ-W. In receiver-operating characteristics curves, splitting GPE data into null/minimal/moderate improvement vs. large improvement (GPE 0-2 vs. GPE 3): 1) for FABQ-PA, the area under the curve (AUC) was 0.97. The best cutoff score identifying meaningful change in fear-avoidance beliefs about physical activity was a change of 4 points; 2) for FABQ-W, the AUC was 0.97 and the best cutoff score for meaningful change in fear-avoidance beliefs about work activities was a change of 7 points.
CONCLUSIONS: After triangulation of the above results, a change of 4 points for FABQ-PA and 7 points for FABQ-W were selected as MCID. These two values represent cutoffs that seem to accurately identify meaningful change in fear-avoidance beliefs, according to subject’s judgement.
CLINICAL REHABILITATION IMPACT: The present study calculated - in a sample of people with chronic Low Back Pain - the minimal clinically important change of the two FABQ scales (FABQ-Physical Activity scale and FABQ-Work scale). These values increase confidence in interpreting score changes, thus enhancing their meaningful use in both research and clinical contexts.

KEY WORDS: Chronic low back pain; Rehabilitation; Responsiveness; Minimal clinically important difference; Fear-avoidance beliefs questionnaire; Kinesiophobia

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