The Fear Avoidance Belief Questionnaire (FABQ) has been around for quite some time to investigate the fear-avoidance beliefs of patients with chronic low back pain (LBP).  It is valid and reliable. It is helpful in the clinical setting to quantify the level of fear-avoidance behavior through two subscales, physical activity (FABQPA) and work-related activities (FABQW).  FABQPA has 24 possible points with>15 being a high score.  FABQW has 42 possible points with >34 being a high score.

This can be associated with increased likelihood of current and future work loss and disability.  Clinicians can also use this tool to help them identify patients who will not return to work within 4 weeks (FABQW>34).

I use it for these purposes at times but I really want to use this post to demonstrate other uses of the FABQ.  I like to go to work thinking how I can help patients by getting them to fill out these forms, other than me simply thinking to myself that a high score on FABQ may warrant more “supervision”.  I like to think of glass half full than half empty.

The FABQ is used as a predictor in clinical prediction rules.  Here are a few examples:

1.  Flynn 2002.

-FABQW of less than 19 (low fear) is one predictor that can show success of manipulation for short-term improvement.

2. Hicks 2005.

-The main purpose of this study was to find predictors of success with stabilization, but FABQPA can be used to predict failure with stabilization exercise.  FABQPA of >9 points was actually the best individual screening test to predict failure.  Meaning, a score of less than or equal to 8 points would decrease the odds of improvement by 0.26 (which is the LR-)

3.  Cleland 2007.

-6 variables were found in this study to be predictors of success for treating neck pain with thoracic spinal manipulation.  Specifically, 3+/6 increased probability of success from 54% to 86%.  One of the predictors, yes it is FABQPA score less than 12.  Make sure you make some changes though as the authors did change the word “back” to “neck”.
 
The FABQ can be used as a tool to aid in identifying disability, but I find it to be even more useful (and less degrading to the patient about the ultimate goal with the scale) to use it as a predictor variable for success, or lack of success.  You may want to keep this data handy as the values and subscales differ between these studies.  

Check out more information of FABQ at PhysioPedia here.  What are your thoughts on using FABQ?

Flynn T, Fritz J, Whitman J, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvements with spinal manipulation. Spine. 2002; 27: 2835-2843.

Hicks G et al.  Prelimary Development of a Clinical Prediction Rule for Determining Which Patients with Low Back Pain Will Respond to Stabilization Exercise Program. Arch Phys Med Rehabil. 2005;86:1753-1762. 

Cleland et al. Development of a Clinical Prediction Rule for Guiding Treatment of a Subgroup of Patients with Neck Pain: Use of Thoracic Spine Manipulation, Exercise, and Patient Education.  Physical Therapy. 2007;87:9-23. 
 

Harrison Vaughan, PT, DPT, Cert. SMT is a physical therapist at In Touch Therapy in South Hill, Virginia.  His clinical interests involve orthopedic and manual physical therapy, including clinical diagnostic tests.  He enjoys treating the spine but his dynamic work setting in a rural area provides an opportunity to treat a wide variety ranging from pediatrics to the neurological population.  Harrison received both his Bachelors of Science degree and Doctor of Physical Therapy from Old Dominion University in Norfolk, Virginia. Dr. Vaughan is certified in Spinal Manipulative Therapy through the Spinal Manipulative Institute and American Academy of Manipulative Therapy. He is a member of the American Physical Therapy Association with a special subsection in Sports and Orthopedics and currently assists as Co-Chair of Technology position of the Virginia Physical Therapy Association.  More of Harrison’s blogs can be found at

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