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CROSS CULTURAL ADAPTATION AND VALIDATION OF A QUESTIONNAIRE ON FEAR AND AVOIDANCE BEHAVIORS DUE TO BACK PAIN

Title.

Cross cultural adaptation and validation of the FAB questionnaire.

Background.

The "Fear Avoidance Beliefs Questionnaire" is a questionnaire designed to evaluate the fear and avoidance attitudes that result from a patient's beliefs regarding the origin and risks of his or her back pain (specifically low back pain).

According to the studies carried out, the questionnaire has been shown to be reliable (have a good test/retest) and its result correlates better than pain intensity with the degree of disability and work absenteeism due to low back pain. In fact, according to available studies, pain (its intensity and anatomic and temporal pattern), influences disability 14% and absenteeism 5%, while the result of the questionnaire explains 32% disability and 26% absenteeism.

The questionnaire contains 16 sentences and is divided into two parts. The first part, made up of the first five sentences, explores the patient's feelings and attitude towards physical activity. The second, made up of 11 sentences, treats the patient's attitude towards work. The patient must indicate the degree of his/her agreement with each one of the sentences, with a possible scoring between 0 (complete disagreement) and 6 (complete agreement). Thus, the possible values range from 0 to 96. The higher the score, the greater the degree of fear and avoidance due to low back pain.

Objectives.

1. To adapt the FAB questionnaire cross culturally to the Spanish population.

2. To determine the reliability (repeatability) of the Spanish version.

3. To evaluate the degree of relation between low back pain intensity (measured by means of the visual analog scale, VAS), the degree of disability due to low back pain (measured by the Spanish version of the Roland Morris questionnaire) and the result of the FAB.

4. To evaluate the degree of relation between the results of these questionnaires and:

   • General quality of life (measured by the Spanish versions of the SF-12 questionnaire).

   • Work absenteeism due to low back pain (measured by the numbers of days of sick leave due to low back pain during the period under study).

Methodology.

Study for a cross cultural adaptation and validation organized in several phases:

1. Translation/re-translation back to original language.

   • Translation and re-translation. Spanish and English native speakers (Spaniards in the case of translation into Spanish, and English in the case of back-translation into English) made two translations and two back-translations, both blind (that is to say, no translator had access to the work of his or her colleagues or in the case of the back-translation into English, the original version of the questionnaire).

   • Preparation of the first version of the questionnaire by means of comparing the differences between the two translated versions and the back translated versions, and the revision of the draft with the study coordinators in each center.

2. Pilot Study: analysis of the comprehensibility of the Spanish version, with a sample of 50 patients of low socio-educational level. Each one was asked about his or her interpretation of the wording of each one of the questions.

3. Validation study: determination of measuring characteristics of the FAB questionnaire (validity, consistence, etc.) and analysis of its degree of correlation with intensity of low back pain and radiated pain (measured separately by means of independent visual analog scales), the degree of physical disability (measured by the Roland-Morris scale) and the general quality of life (determined by the SF-12 questionnaire).

A total of 209 patients were recruited: 53 for the pilot study and 156 for the validation study and the correlation study. They were patients who consulted their doctor for low back pain, with or without radiated pain, and they could read and write. Criteria for exclusion were: clinically obvious neurosphincteral or neuromotor deficit (which required urgent surgery), disorder of the Central Nervous System, with or without treatment, existence of warning signs (constant or progressive pain or pain that did not vary according to posture, movement or exertion, persistent inability to bend the spine 5 degrees, scattered neurological signs, history of osteoporosis, recent traumatism, cancer, systematic administration of corticoids, parenteral use of drugs or AIDS, or general signs - unexplained loss of weight, fever, shivering--).

Participants, along with the Foundation's Science Department.

Unit of Clinical Biostatistics at the Hospital Ramón y Cajal, Madrid; Provincial Delegation of Social Services, Granada; Departments of Neurosurgery and Traumatology at the Hospital Universitario de Son Dureta, Palma de Mallorca; Department of Preventative Medicine, Hospital Virgen de las Nieves, Granada; 14 Primary Care Health Centers in 6 Autonomous Communities (Regions of Spain); Spinal Surgery Unit at the Valld'Hebrón, Barcelona; Department of Rheumatology at the Hospital Clinic, Barcelona; Mutua Asepeyo, Madrid; Physiotherapy Unit, Pain Clinic and Spine Unit at the Hospital de Sabadell (Corporación Sanitaria Parc Taulí), Barcelona; Department of Psychology at the Universidad Autónoma, Bellaterra, Barcelona; Department of Traumatology at the Fundación Jimenez Díaz, Madrid; Advanced Research Techniques in Health Services (TAISS), Madrid; who are members of the Spanish Network of Researchers in Back Disorders.

The study has been co-funded by the Kovacs Foundation and the Department of Housing, Economics and Innovation of the Regional Government of the Balearic Islands.

Status.

In progress.