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Translation and Validation of the Arabic Version of the Fear-Avoidance Beliefs Questionnaire in Patients With Low Back Pain

Alanazi, Fahad PT, PhD; Gleeson, Peggy PT, PhD; Olson, Sharon PT, PhD; Roddey, Toni PT, PhD

doi: 10.1097/BRS.0000000000001802

Study Design. Prospective cohort study of a cross-cultural low back pain (LBP) questionnaire

Objective. The objectives of the present study were to translate and cross-culturally adapt the Fear-Avoidance Beliefs Questionnaire (FABQ) to create a version in Arabic and to test its psychometric properties.

Summary of Background Data. The FABQ measures the effects that fear and avoidance beliefs have on work and on physical activity.

Methods. An FABQ cross-culturally adapted for Arabic readers and speakers was created by forward translation, translation synthesis, and backward translation. Forty patients in Riyadh, Saudi Arabia, with LBP evaluated use of the questionnaire, and 70 patients from the same hospital participated in reliability, validity, and sensitivity studies. To determine test-retest reliability of the Arabic FABQ, patients completed it twice within 48 hours without receiving any active treatment between these two sessions. Patients completed the Arabic FABQ (and three other scales) at baseline and 14 days later to determine its validity and sensitivity.

Results. Test-retest reliability was good (FABQ–work: intraclass coefficient [ICC] = 0.74; FABQ—physical activity: ICC = 0.90; FABQ overall: ICC = 0.76). Correlations between the FABQ and three other instruments for measuring pain and disability were weak. The strongest correlation was found at the follow-up session with the Arabic Oswestry Questionnaire (r = 0.283; P ≤ 0.05). Sensitivity to change was low.

Conclusion. The translation and adaptation of the Arabic version of the FABQ was successful. Overall, the Arabic FABQ had good test-retest reliability, acceptable construct validity, and low sensitivity to change. The Arabic version of the FABQ shows promise in the assessment of fear-avoidance beliefs among patients with LBP who speak and read Arabic.

Level of Evidence: 3

Department of Physical Therapy, College of Applied Medical Sciences, Aljouf University, Aljouf Region, Saudi Arabia

Department of Physical Therapy, Institute of Health Sciences—Houston Center, Texas Woman's University, Houston, TX.

Address correspondence and reprint requests to Fahad Alanazi, PT, PhD, Assistant Professor, Aljouf University, King Khalid St, Aljouf Region, P.O. Box 2014, Al-Jouf-Skaka, Saudi Arabia; E-mail:

Received 6 April, 2016

Revised 11 June, 2016

Accepted 8 July, 2016

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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