Translation and validation of the Arab version of the fear avoidance beliefs questionnaire

Objective: Determine the reliability and validity of the fear avoidance beliefs questionnaire (FABQ) translated into Arabic. Methods: The FABQ work and physical activity subscales (FABQ-W and FABQ-PA) were translated and culturally adapted into Arabic using the back-translation procedure. Forty-eight subjects with acute low back pain (LBP) and 63 subjects with chronic LBP, whose native language was Arabic, completed a demographic questionnaire, the FABQ, a pain intensity numerical scale, the Modified Oswestry Disability Index (MOSW), and the SF-36 questionnaire. Thirty patients completed the FABQ a second time 3-7 days later. Results: FABQ-W and FABQ-PA showed good internal consistencies (α=0.90 and 0.81 respectively). Test-retest reliability was moderate to high (ICC (1,1) of 0.63 and 0.83 for the FABQ-W and FABQ-PA, respectively). Pain intensity correlated with FABQ-W only for subjects with acute pain (rho 0.41), and with the FABQ-PA only for subjects with chronic pain (rho 0.47). Significant differences between patients with acute and chronic pain were found. Correlations between the FABQ and the MOSW were moderate (rho between 0.40-0.42). Correlations between the FABQ subscales and the SF-36 questionnaire were stronger for subjects with chronic pain. A high ceiling effect was demonstrated for the FABQ-PA, in particular for patients with chronic LBP. Conclusions: The Arabic version of the FABQ has acceptable psychometric properties. However, the results of the physical activity subscale should be interpreted with caution due to a strong ceiling effect.