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BMC Primary Care
Published in: BMC Primary Care 1/2020

Open Access 01-12-2020 | Musculoskeletal Pain | Research article

Cross-cultural adaptation and validity of the Spanish fear-avoidance components scale and clinical implications in primary care

Authors: Antonio I. Cuesta-Vargas, Randy Neblett, Robert J. Gatchel, Cristina Roldán-Jiménez

Published in: BMC Primary Care | Issue 1/2020

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Abstract

Background

Pain-related fear-avoidance (FA) is a common problem affecting many patients with painful medical conditions. As there is great interest in the clinical importance of the relationship between FA and disability, several questionnaires have been developed to measure FA. The Fear-Avoidance Components Scale (FACS) is a recently developed patient-reported instrument that addresses critical issues not previously considered in previous FA-related questionnaires. The original English version of the FACS demonstrated good reliability, internal consistency, and construct, criterion, and predictive validity. Two factors were determined: General Fear Avoidance and Types of Activities That are Avoided. The aim of this study was to to translate the FACS into European-style Spanish (FACS-Sp), and validate its psychometric properties.

Methods

This two-stage psychometric study included 330 subjects with various chronic musculoskeletal pain disorders. An initial translation and cross-cultural adaptation of the FACS, from English to Spanish, was performed. Then, critical psychometric properties were analysed, including internal consistency by Cronbach’s α coefficients, structural validity from the Maximum Likelihood Extraction (MLE), and convergent validity by Pearson correlation with the Central Sensitization Inventory (CSI).

Results

This study reports for the first time the psychometric properties of the Spanish version of the FACS. Total scores ranged from 0 to 88 points, with a mean of 30.49 (±17.18). The FACS-Sp showed a high internal consistency for factor 1 (α = 0.902) and factor 2 (α = 0.88). Factor structure was two-dimensional and supported structural validity, accounting for 48.75% of the total variance. Convergent validity analysis found a significant Pearson correlation r = 0.414.

Conclusion

This study reports for the first time the psychometric properties of the Spanish version of the FACS-Sp. Psychometric properties supported the validation of FACS-Sp and ensured the conceptual equivalence with the original English version. In primary care and chronic pain rehabilitation, FA assessment is crucial for clinical decision-making and treatment guidance. The FACS-Sp offers a new measure of FA in Spanish speaking populations. Future research on the FACS-Sp should evaluate test-retest reliability, treatment responsiveness and psychometric comparisons with other translated versions.
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Literature
1.
2.
Lethem J, Slade PD, Troup JD, Bentley G. Outline of a fear-avoidance model of exaggerated pain perception--I. Behav Res Ther. 1983;21(4):401–8.CrossRefPubMed
3.
Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62(3):363–72.CrossRefPubMed
4.
Crombez G, Eccleston C, Van Damme S, Vlaeyen JWS, Karoly P. Fear-avoidance model of chronic pain: the next generation. Clin J Pain. 2012;28(6):475–83.CrossRefPubMed
5.
Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85(3):317–32.CrossRefPubMed
6.
Vlaeyen JWS, Linton SJ. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain. 2012;153(6):1144–7.CrossRefPubMed
7.
Lundberg M, Grimby-Ekman A, Verbunt J, Simmonds MJ. Pain-related fear: a critical review of the related measures. Pain Res Treat. 2011;2011:494196.PubMedPubMedCentral
8.
9.
Cella D, Yount S, Rothrock N, Gershon R, Cook K, Reeve B, et al. The patient-reported outcomes measurement information system (PROMIS): progress of an NIH roadmap cooperative group during its first two years. Med Care. 2007;45(5 Suppl 1):S3–11.CrossRefPubMedPubMedCentral
10.
Fayers PM, Machin D. Quality of Life: The Assessment, Analysis and Interpretation of Patient-reported Outcomes. John Wiley & Sons; 2013. 579 p.
11.
Miller RP, Kori SH, Todd D. The Tampa scale: a measure of kinesiophobia. Clin J Pain. 1991;7(1):51–2.CrossRef
12.
McCracken LM, Zayfert C, Gross RT. The pain anxiety symptoms scale: development and validation of a scale to measure fear of pain. Pain. 1992;50(1):67–73.CrossRefPubMed
13.
Sullivan MJL, Bishop SR, Pivik J. The pain Catastrophizing scale: development and validation. Psychol Assess. 1995;7(4):524–32.CrossRef
14.
Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52(2):157–68.CrossRefPubMed
15.
Neblett R, Hartzell MM, Mayer TG, Bradford EM, Gatchel RJ. Establishing clinically meaningful severity levels for the Tampa scale for Kinesiophobia (TSK-13). Eur J Pain Lond Engl. 2016;20(5):701–10.CrossRef
16.
Neblett R, Mayer TG, Hartzell MM, Williams MJ, Gatchel RJ. The fear-avoidance components scale (FACS): development and psychometric evaluation of a new measure of pain-related fear avoidance. Pain Pract Off J World Inst Pain. 2016;16(4):435–50.CrossRef
17.
18.
Gómez-Pérez L, López-Martínez AE, Ruiz-Párraga GT. Psychometric properties of the Spanish version of the Tampa scale for Kinesiophobia (TSK). J Pain Off J Am Pain Soc. 2011;12(4):425–35.CrossRef
19.
García Campayo J, Rodero B, Alda M, Sobradiel N, Montero J, Moreno S. Validación de la versión española de la escala de la catastrofización ante el dolor (Pain Catastrophizing Scale) en la fibromialgia. Med Clínica:487–93.
20.
Kovacs FM, Muriel A, Medina JM, Abraira V, Sánchez MDC, Jaúregui JO, et al. Psychometric characteristics of the Spanish version of the FAB questionnaire. Spine. 2006;31(1):104–10.CrossRefPubMed
21.
Gil-Martínez A, Navarro-Fernández G, Mangas-Guijarro MÁ, Lara-Lara M, López-López A, Fernández-Carnero J, et al. Comparison between chronic migraine and Temporomandibular disorders in pain-related disability and fear-avoidance behaviors. Pain Med Malden Mass. 2017;18(11):2214–23.CrossRef
22.
Sánchez-Herán Á, Agudo-Carmona D, Ferrer-Peña R, López-de-Uralde-Villanueva I, Gil-Martínez A, Paris-Alemany A, et al. Postural stability in osteoarthritis of the knee and hip: analysis of association with pain Catastrophizing and fear-avoidance beliefs. PM R. 2016;8(7):618–28.CrossRefPubMed
23.
Ariza-Mateos MJ, Cabrera-Martos I, Ortiz-Rubio A, Torres-Sánchez I, Rodríguez-Torres J, Valenza MC. Effects of a patient-centered graded exposure intervention added to manual therapy for women with chronic pelvic pain: a randomized controlled trial. Arch Phys Med Rehabil. 2018;9.
24.
Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63(7):737–45.CrossRefPubMed
25.
Muñiz J, Elosua P, Hambleton RK. International test commission. [international test commission guidelines for test translation and adaptation: second edition]. Psicothema. 2013;25(2):151–7.PubMed
26.
Cuesta-Vargas AI, Roldan-Jimenez C, Neblett R, Gatchel RJ. Cross-cultural adaptation and validity of the Spanish central sensitization inventory. SpringerPlus. 2016;5(1).
27.
Cuesta-Vargas AI, Roldan-Jimenez C, Neblett R, Gatchel RJ. Cross-cultural adaptation and validity of the Spanish central sensitization inventory. SpringerPlus. 2016;5(1):1837.CrossRefPubMedPubMedCentral
28.
Costello AB, Osborne JW. Best practices in exploratory factor analysis: four recommendations for getting the Most from your analysis. Pract Assess Res Eval. 2005;10(7):1–9.
29.
Tabachnick BG, Linda S Fidell. Using Multivariate Statistics. Boston, MA: Allyn and Bacon; 2001.
30.
Noten S, Struyf F, Lluch E, D’Hoore M, Van Looveren E, Meeus M. Central pain processing in patients with shoulder pain: a review of the literature. Pain Pract Off J World Inst Pain. 2017;17(2):267–80.CrossRef
31.
Van Oosterwijck J, Nijs J, Meeus M, Paul L. Evidence for central sensitization in chronic whiplash: a systematic literature review. Eur J Pain Lond Engl. 2013;17(3):299–312.CrossRef
32.
Lluch E, Nijs J, Courtney CA, Rebbeck T, Wylde V, Baert I, et al. Clinical descriptors for the recognition of central sensitization pain in patients with knee osteoarthritis. Disabil Rehabil. 2017;2:1–10.
33.
Terwee CB, Bot SDM, de Boer MR, van der Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34–42.CrossRefPubMed
34.
Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16(3):297–334.CrossRef
35.
Neblett R, Mayer TG, Williams MJ, Asih S, Cuesta-Vargas AI, Hartzell MM, et al. The fear-avoidance components scale (FACS): responsiveness to functional restoration treatment in a chronic musculoskeletal pain disorder (CMPD) population. Clin J Pain. 2017 Mar;21.
36.
Knezevic A, Neblett R, Gatchel RJ, Jeremic-Knezevic M, Bugarski-Ignjatovic V, Tomasevic-Todorovic S, et al. Psychometric validation of the Serbian version of the fear avoidance component scale (FACS). PLoS One. 2018;13(9).
37.
Pfingsten M, Kröner-Herwig B, Leibing E, Kronshage U, Hildebrandt J. Validation of the German version of the fear-avoidance beliefs questionnaire (FABQ). Eur J Pain. 2000;4(3):259–66.CrossRefPubMed
38.
Burwinkle T, Robinson JP, Turk DC. Fear of movement: factor structure of the Tampa scale of kinesiophobia in patients with fibromyalgia syndrome. J Pain Off J Am Pain Soc. 2005;6(6):384–91.CrossRef
39.
Vlaeyen JW, Kole-Snijders AM, Rotteveel AM, Ruesink R, Heuts PH. The role of fear of movement/(re)injury in pain disability. J Occup Rehabil. 1995;5(4):235–52.CrossRefPubMed
40.
Clark ME, Kori SH, Brockel J. Kinesiophobia and chronic pain: psychometrics characteristics and factor analysis of the Tampa Scale. In American Pain Society; 1996. p. 77.
41.
Gatchel RJ, Neblett R, Kishino N, Ray CT. Fear-avoidance beliefs and chronic pain. J Orthop Sports Phys Ther. 2016;46(2):38–43.CrossRefPubMed
42.
Cuesta-Vargas AI, Neblett R, Chiarotto A, Kregel J, Nijs J, van Wilgen CP, et al. Dimensionality and reliability of the central sensitization inventory (CSI) in a pooled multi-country sample. J Pain Off J Am Pain Soc. 2017;30.
43.
Kregel J, Schumacher C, Dolphens M, Malfliet A, Goubert D, Lenoir D, et al. Convergent validity of the Dutch central sensitization inventory: associations with psychophysical pain measures, quality of life, disability, and pain cognitions in patients with chronic spinal pain. Pain Pract Off J World Inst Pain. 2018;18(6):777–87.CrossRef
44.
van Wilgen CP, Vuijk PJ, Kregel J, Voogt L, Meeus M, Descheemaker F, et al. Psychological distress and widespread pain contribute to the variance of the central sensitization inventory: a cross-sectional study in patients with chronic pain. Pain Pract Off J World Inst Pain. 2017;27.
45.
Huysmans E, Ickmans K, Van Dyck D, Nijs J, Gidron Y, Roussel N, et al. Association between symptoms of central sensitization and cognitive behavioral factors in people with chronic nonspecific low Back pain: a cross-sectional study. J Manip Physiol Ther. 2018;41(2):92–101.CrossRef
46.
47.
Linton SJ, Shaw WS. Impact of psychological factors in the experience of pain. Phys Ther. 2011;91(5):700–11.CrossRefPubMed
48.
Hasenbring MI, Chehadi O, Titze C, Kreddig N. Fear and anxiety in the transition from acute to chronic pain: there is evidence for endurance besides avoidance. Pain Manag. 2014;4(5):363–74.CrossRefPubMed
49.
Institute of Medicine (US) Committee on Advancing Pain Research C. Pain as a Public Health Challenge. In: Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, D.C.: National Academies Press (US); 2011. p. 91–5.
50.
Zale EL, Lange KL, Fields SA, Ditre JW. The relation between pain-related fear and disability: a meta-analysis. J Pain Off J Am Pain Soc. 2013;14(10):1019–30.CrossRef
51.
Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. (The National Academies Collection: Reports funded by National Institutes of Health).
52.
Becker WC, Dorflinger L, Edmond SN, Islam L, Heapy AA, Fraenkel L. Barriers and facilitators to use of non-pharmacological treatments in chronic pain. BMC Fam Pract. 2017;18:41.CrossRefPubMedPubMedCentral
53.
Keeley P, Creed F, Tomenson B, Todd C, Borglin G, Dickens C. Psychosocial predictors of health-related quality of life and health service utilisation in people with chronic low back pain. Pain 2008;135(1–2):142–50.
54.
Wertli MM, Rasmussen-Barr E, Weiser S, Bachmann LM, Brunner F. The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J Off J North Am Spine Soc. 2014;14(5):816–836.e4.
55.
Hruschak V, Cochran G. Psychosocial predictors in the transition from acute to chronic pain: a systematic review. Psychol Health Med. 2018;28:1–17.
56.
Saragiotto BT, Maher CG, Moseley AM, Yamato TP, Koes BW, Sun X, et al. A systematic review reveals that the credibility of subgroup claims in low back pain trials was low. J Clin Epidemiol. 2016;79:3–9.CrossRefPubMed
57.
Fritz JM, Childs JD, Flynn TW. Pragmatic application of a clinical prediction rule in primary care to identify patients with low back pain with a good prognosis following a brief spinal manipulation intervention. BMC Fam Pract. 2005;6:29.CrossRefPubMedPubMedCentral
58.
Rose-Dulcina K, Vuillerme N, Tabard-Fougère A, Dayer R, Dominguez DE, Armand S, et al. Identifying subgroups of patients with chronic nonspecific low Back pain based on a multifactorial approach: protocol for a prospective study. JMIR Res Protoc. 2018;7(4):e104.CrossRefPubMedPubMedCentral
59.
Rushton AB, Verra ML, Emms A, Heneghan NR, Falla D, Reddington M, et al. Development and validation of two clinical prediction models to inform clinical decision-making for lumbar spinal fusion surgery for degenerative disorders and rehabilitation following surgery: protocol for a prospective observational study. BMJ Open. 2018;8(5):e021078.CrossRefPubMedPubMedCentral
60.
Metadata
Title
Cross-cultural adaptation and validity of the Spanish fear-avoidance components scale and clinical implications in primary care
Authors
Antonio I. Cuesta-Vargas
Randy Neblett
Robert J. Gatchel
Cristina Roldán-Jiménez
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2020
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-020-01116-x

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