Cross-cultural adaptation, reliability, validity, and sensitivity of the Arabic version of the fear-avoidance beliefs questionnaire in a Saudi population with low back pain




Alanazi, Fahad

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Almost 70% of the American population experiences the symptoms of low back pain (LBP) in their lives, and 25% of these adults experience pain for more than a month. Because low back pain is common elsewhere as well, physical therapists around the world face the challenge of finding culturally and linguistically adapted psychometrically sound LBP assessments. The goal of this research was to determine if the new Arabic version of the Fear-Avoidance Beliefs Questionnaire (FABQ) had significant reliability, validity, and sensitivity in a Saudi population with LBP. In the pilot, the Arabic version of the FABQ was tested for clarity and meaning by engaging with Arabic-speaking patients. Testing indicated the FABQ compensation claim question had no relevance in the Arabic culture; otherwise, there was no issue with the questionnaire and no need to adapt it further. The primary study was of the cross-cultural reliability, validity, and sensitivity of the Arabic version of the FABQ in a Saudi population with LBP. Test-retest reliability was good (FABQ–work: intraclass coefficient [ICC1,1] = 0.74; FABQ–physical activity: ICC = 0.90; FABQ overall: ICC = 0.76). Correlations between the FABQ and 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. Overall, the Arabic FABQ had good test-retest reliability, acceptable construct validity, and low sensitivity to change. Despite the disappointing low sensitivity to change, which may be attributable to the short period between baseline and follow-up measures, these findings are characteristic of a successful translation, one that physical therapists can employ to assess fear-avoidance beliefs in patients with LBP speaking Arabic. Researchers may want to expand this investigation in the future beyond self-reports and devise clinical tests to examine self-reported fear-avoidance beliefs, their effect on relevant activities, and the correlation to findings on the FABQ and other tests.



Health and environmental sciences, Beliefs, Fear-avoidance, Low back pain