title: Translation and validation of the Finnish version of the Fear-Avoidance Beliefs Questionnaire (FABQ).
abstract: Low back pain (LBP) is a debilitating problem worldwide causing disability and reducing quality of life. The Fear Avoidance Beliefs Questionnaire (FABQ) was developed on the basis of the assumption that fear-avoidance beliefs play a major role in LBP-related disability. It comprises 16 items scored by the patient and includes sub-scores for fear-avoidance beliefs regarding work and physical activity. This study aimed to translate and validate the Finnish version of the FABQ and to measure its properties among Finnish patients with LBP.
  
  
  
  A forward-backward translation procedure was used based on modified recommended guidelines. The FABQ was applied to 66 Finnish patients with LBP. Patients answered the FABQ at baseline and again approximately two weeks later. The test-re-test reliability between the baseline and follow-up FABQ was evaluated by calculating intraclass correlation coefficients (ICC). Internal consistency between the items within total and sub-scores was evaluated by calculating Cronbach's alpha. The items of the baseline FABQ were grouped using factor analysis and the correlations between the FABQ, pain intensity in visual analogue scale (VAS) and Oswestry Disability Index (ODI) were assessed using linear regression analysis.
  
  
  
  The Finnish version of the FABQ was successfully adapted. The mean age of patients was 46. Almost all patients (97%) reported LBP, most patients (76%) had chronic pain lasting more than 3 months and the mean intensity of LBP was 58mm on VAS. The follow-up time between the first and second questionnaire ranged from 2 days to 59 days with the median of 16 days. The ICC value for reliability between the baseline and follow-up questionnaires was excellent for the total score (0.91) and work sub-score (0.89), and good for the physical activity sub-score (0.73). The items regarding work showed high or excellent reliability throughout, with ICC values ranging from 0.63 to 0.89. The ICC values for the items related to physical activity ranged from 0.43 to 0.66, displaying moderate to good reliability. Cronbach's alpha for internal consistency was excellent for the total score (0.92) and work (0.89), and good for physical activity (0.71). The best factor analysis solution yielded three factors characterized by the fear that pain aggravates due to (1) work or (2) physical activity, and (3) fear-avoidance beliefs concerning work. Higher total FABQ score was associated significantly with higher VAS (p-value 0.021) and ODI (<0.001).
  
  
  
  The expert committee successfully created an applicable Finnish version of the FABQ. The Finnish FABQ is a valid and reliable instrument for assessing LBP patients' fear avoidance behaviour and has similar properties to those found in other validation studies of the FABQ. Thus it can be used for assessing the risk of disability due to fear avoidance behaviour in Finnish-speaking patients with LBP for both clinical and scientific purposes.
authors.affiliation: Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
authors.forename: Henri
authors.initials: H
authors.lastname: Terho
authors.affiliation: Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.|Department of Psychiatry, Oulu University Hospital, Oulu, Finland.
authors.forename: Marianne
authors.initials: M
authors.lastname: Haapea
authors.affiliation: Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
authors.forename: Markus
authors.initials: M
authors.lastname: Paananen
authors.affiliation: Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
authors.forename: Katariina
authors.initials: K
authors.lastname: Korniloff
authors.affiliation: Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.|Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, Jyväskylä, Finland.
authors.forename: Arja
authors.initials: A
authors.lastname: Häkkinen
authors.affiliation: Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.|Health and Work Ability, and Disability Prevention Centre, Finnish Institute of Occupational Health, Oulu, Finland.
authors.forename: Jaro
authors.initials: J
authors.lastname: Karppinen
mesh_terms: D005239:Fear; D005387:Finland; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology*; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: Fear Avoidance Beliefs Questionnaire; Low back pain; Translation; Validation