review article pain-relatedfear

Hindawi Publishing CorporationPain Research and TreatmentVolume 2011, Article ID 494196, 26 pagesdoi:10.1155/2011/494196

Review Article

Pain-Related Fear: A Critical Review of the Related Measures

M. Lundberg,1 A. Grimby-Ekman,2 J. Verbunt,3 and M. J. Simmonds4, 5

1 Division of Occupational Orthopedics, Department of Orthopedics, Sahlgrenska University Hospital,University of Gothenburg, Goteborg, Sweden

2 Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy at University of Gothenburg,Goteborg, Sweden

3 Department of Rehabilitation Medicine, Maastricht University Medical Center and Research School CAPHRI,M D Maastricht University, 6211 LK Maastricht, The Netherlands

4 A.T. Still Research Institute, A.T. Still University, Kirksville, MO 63501, USA5 Department of Physical Therapy, University of Texas Health Sciences Center, San Antonio, 7703 Floyd Curl Drive San Antonio,TX 78229-3900, USA

Correspondence should be addressed to M. J. Simmonds, [email protected]

Received 13 April 2011; Accepted 29 July 2011

Academic Editor: Giustino Varrassi

Copyright © 2011 M. Lundberg et al. This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objectives: In regards to pain-related fear, this study aimed to: (1) identify existing measures and review their measurementproperties, and (2) identify the optimum measure for specific constructs of fear-avoidance, pain-related fear, fear of movement,and kinesiophobia. Design: Systematic literature search for instruments designed to measure fear of pain in patients with persistentmusculoskeletal pain. Psychometric properties were evaluated by adjusted Wind criteria. Results: Five questionnaires (Fear-Avoidance Beliefs Questionnaire (FABQ), Fear-Avoidance of Pain Scale (FAPS), Fear of Pain Questionnaire (FPQ), Pain and AnxietySymptoms Scale (PASS), and the Tampa Scale for Kinesiophobia (TSK)) were included in the review. The main findings were that formost questionnaires, there was no underlying conceptual model to support the questionnaire’s construct. Psychometric propertieswere evaluated by diverse methods, which complicated comparisons of different versions of the same questionnaires. Constructvalidity and responsiveness was generally not supported and/or untested. Conclusion: The weak construct validity implies that nomeasure can currently identify who is fearful. The lack of evidence for responsiveness restricts the current use of the instrumentsto identify clinically relevant change from treatment. Finally, more theoretically driven research is needed to support the constructand thus the measurement of pain-related fear.

1. Introduction

Over the last decennia, fear of pain and/or injury has becomean integral part of our understanding in the explanation ofdisability in patients with persistent musculoskeletal pain[1]. Pain-related fear has been identified in the generalpopulation [2] as well as in various patients’ groups with per-sistent musculoskeletal pain [3–9]. Subsequently, treatmentstrategies have been developed to reduce fear and disability inpatients with low back pain [10, 11], as well as neuropathicpain [4]. In the clinical setting fear is acknowledged as animportant aspect in patients’ disability which needs to beaddressed to achieve successful outcome. Although the roleof fear in pain-related disability seems thus well established,

consensus concerning proper assessment and interpretationof fear in relation to pain is currently still lacking.

One of the reasons for this is the fact that fear inrelation to pain has been described with a variety ofconceptual definitions among which pain-related fear, fear-avoidance beliefs, fear of movement, and kinesiophobia arethe most commonly used. These are, however, constructsrather than a disorder or other pathological state in andof itself. The relationship between fear and pain was firstdescribed by Lethem et al. 1982 in “the fear-avoidancemodel of exaggerated pain perception” [12], in which fearand pain were both presented as associated with behaviourthrough avoidance learning. Almost a decade later, Koriet al. presented their thoughts about kinesiophobia [13].

2 Pain Research and Treatment

Kinesiophobia was originally defined as a condition in whicha patient has “an excessive, irrational, and debilitating fearof physical movement and activity resulting from a feeling ofvulnerability to painful injury or reinjury”. The model that hasgained most interest among researchers and clinicians alikeis the “cognitive-behavioural fear-avoidance model” [14]. Inthat model fear of movement was identified as an importantfactor to result in disability, disuse, and depression in patientswith persistent musculoskeletal pain. A subsequent constructis pain-related fear [15], defined as fear that incorporatesfear of pain, fear of injury, fear of physical activity, and soforth. Closely related constructs are “fear-avoidance beliefs”[16] and “pain-related fear-avoidance beliefs” [17], but fornone of them a conceptual definition is available. In theliterature, the above-mentioned constructs are often usedinterchangeably, although they are not synonyms. Therefore,it seems that, currently, the conceptual framework of thevarious constructs used in relation to fear and pain are farfrom clear.

Despite the limited evidence available concerning theunderlying constructs, over years several questionnaires havealready been developed for the assessment of fear in relationto pain [16, 18, 19]. The Tampa Scale for Kinesiophobia(TSK) is the oldest existing measure and was designed 1991by Miller et al. [19] to measure the patient’s subjectiveestimation of kinesiophobia. The Fear-Avoidance BeliefsQuestionnaires (FABQ) [16] and the Pain Anxiety SymptomsScale (PASS) [18] were subsequently developed. Thesequestionnaires are currently all used in research as well inclinical practice, in order to identify problem areas and to aidin the design of targeted treatment strategies for the patient.However, no systematic evaluation of the psychometricproperties of the existing measures has ever been performed.

Therefore, the aims of the present study were threefold;first to identify the existing measures, second to reviewthe measurement properties, and thirdly to identify theoptimum measure for specific constructs fear-avoidance,pain-related fear, fear of movement and kinesiophobia.

2. Methods

2.1. Search Strategy. A systematic literature search forinstruments specifically designed to measure fear of pain inpatients with persistent pain was performed. The databasesused for this search included PubMed, Cinahl, Embase,PsycINFO, and articles published between January 1990 toJune 2009 were saved. The search was conducted in twosteps. First the search items “assessment” and “pain” werecombined with the subordinate terms “fear avoidance”,“pain-related fear”, “fear of movement”, and “kinesiophobia”.Once the relevant questionnaires were found, the second stepwas performed to assess the measurement properties of thevarious questionnaires using the search terms “reliability”,“validity”, and “psychometric”.

2.2. Inclusion Criteria. Article abstracts were read to deter-mine which questionnaires were included. An article wasincluded if it contained research on adults (>18 years of age)with persistent pain and if the article was written in the

English language. All articles that met inclusion criteria werereviewed by the two authors (M. Lundberg and A. Grimby-Ekman.). In case of disagreement between the reviewers, anindependent reviewer (J. Verbunt) was consulted in order toobtain a consensus.

2.3. Assessment Criteria. The review criteria included anevaluation of the following psychometric steps: Conceptualand measurement model, reliability, validity, responsiveness,interpretability, practicality, and cross-cultural applicability[20]. To assess the levels of the psychometric steps mentionedabove we used criteria adjusted after Wind et al. [21](Table 1).

2.4. Psychometric Terms Defined for This Study. The follow-ing definitions were used in the current study.

A conceptual model is a rationale for and a descriptionof a concept(s) that the measure is intended to assess anddescribes the relationship between the concepts included[20].

Reliability is the extent to which a measurement isconsistent and free from error [22, 23]. Reliability can beassessed based on various subconstructs. For the purpose ofthis study we have chosen to divide reliability into internalconsistency [24] and reproducibility [20].

Measurement Validity refers to the extent to which aninstrument measures what it is intended to measure [22, 23,25]. Validity can be assessed based on different components[22, 23, 26]. For the purpose of this study validity will bepresented as face-, content-, construct-, and criterion-relatedvalidity [20].

Responsiveness describes the instrument’s ability to detectchange. Less frequently used, but clinically important termsare interpretability and practicality. Interpretability describesthe degree to which one can assign easily understoodmeaning to an instrument’s quantitative scores. Practicalityrefers to aspects as time, effort, and other demands placedon those on which the instrument is being administered(respondent burden) or on those who administer theinstrument (administrative burden).

The cross-cultural adaptation is about assessment ofconceptual and linguistic equivalence and evaluation of theirpsychometric properties. For the purpose of this study,we have chosen to evaluate the cross-cultural adaptationseparately for each instrument.

3. Results

The initial search strategy identified 588 abstracts from thePubMed, Cinahl, Embase, PsycINFO, and Web of Sciencedatabases. After removing duplicates, 37 abstracts wereretrieved for further review. Of the 37 articles, 13 articlesaddressed the FABQ, one article the FAPS, 2 articles the FPQ,10 articles the PASS, and 12 articles the TSK. The resultsare presented as a brief summary of the assessment of themeasurement properties of all questionnaires (Table 2). Inaddition, a more detailed overview of the included articlesis presented in Table 3.

Pain Research and Treatment 3

Table 1: A simplified summary of the criteria for assessing the levels of reliability, validity, and responsiveness adjusted after Wind et al. [21].

Reliability Ways to measure Criteria Level

Stability over time(i) test-retest

Pearson product momentcorrelation coefficient

Lowa

Spearman correlationcoefficient

Lowa

Percentage of agreement %

High % > 0.90 and the raters can choose from more than two scorelevels

Moderate % > 0.90 and the raters can choose from between two scorelevels

Low The raters can choose only between two score levels

Kappa value

High κ > 0.60

Moderate 0.41 < κ < 0.60

Low κ < 0.60

Intraclass correlationcoefficient (ICC)

High ICC > 0.90

Moderate ICC 0.75–0.90

Low ICC < 0.75

Internal consistency

Cronbach’s alpha

High α > 0.80

Moderate 0.71 < α < 0.80

Low α > 0.70

Intraclass correlationcoefficient (ICC)

High ICC > 0.90

Moderate ICC 0.75–0.90

Low ICC < 0.75

VALIDITY Content/Face

HighThe test measures what it is intended to measure and allrelevant components are included

ModerateThe test measures what it is intended to measure but not allrelevant components are included

Low The test does not measure what it is intended to measure

Criterion-related(i) concurrent(ii) predictive

High Substantial similarity between the test and the criterionmeasure (with documented high reliability and validity)

(PA ≥ 90%; κ > 0.60; r ≥ 0.75)

Moderate Some similarity between the test and the criterion measure

(PA ≥ 70%; κ ≥ 0.40; r ≥ 0.50)

Low Little or no similarity between the test and the criterionmeasure (PA < 70%; κ < 0.40; r < 0.50)

Construct(i) convergent(ii) divergent

HighGood ability to differentiate between groups orinterventions, or good convergence/divergence betweensimilar tests (r > 0.95b)

ModerateModerate ability to differentiate between groups orinterventions, or moderate convergence/divergence betweensimilar tests (0.85 < r ≤ 0.95b)

LowPoor ability to differentiate between groups or interventions,or weak convergence/divergence between similar tests (r ≤0.85b)

Responsiveness

Effect size

High r c, SMRd ≥ 0.80

Moderate 0.40 < r c, SMRd < 0.80

Low r c, SMRd < 0.40

Area under ROC-curve(AUC)

High AUC > 0.75

Moderate 0.5 ≤ AUC ≤ 0.75

Low AUC < 0.5aAccording to Grotle et al. [27] bThe correlations are between two random variables, therefore the criteria are higher compared to those chosen by Wind et

al. The original limit of r = 0.50 gives an explained variation of less than 13%; r = 0.85 implies that 53% of the variation of the variable at one time pointis explained by knowing the other time point, and r = 0.95 implies an explained variation of 69%. Formula for calculation; Var(Y | x) = (1 − ρ2)σ2

Y , whereboth X and Y are random variables see also p. 484 in [28]. cEffect size according to Wind et al. [21] Correlation (pearson) between test results preoperativeand postoperative, and also pretreatment and posttreatment. dCohen’s effect size. Criteria limits defined according to Grotle et al. [27].


Ta

ble

2:A

brie

fsu

mm

ary

ofth

eas

sess

men

tof

the

psyc

hom

etri

cpr

oper

ties

ofal

lsel

ecte

dqu

esti

onn

aire

spr

esen

ted

inal

phab

etic

alor

der.

Inst

rum

ent

Rel

iabi

lity

Val

idit

yR

espo

nsi

ven

ess

Inte

rnal

con

sist

ency

Rep

rodu

cibi

lity

Face

con

ten

tC

onst

ruct

(i)

conv

erge

nt

(ii)

dive

rgen

t

Cri

teri

onre

late

d(i

)co

ncu

rren

t(i

i)pr

edic

tive

(i)

Eff

ect

size

(ii)

Are

au

nde

rth

ecu

rve

(AU

C)

Fear

-Avo

idan

ceB

elie

fsQ

ues

tion

nai

re(F

AB

Q)

Chi

nese

Lee

etal

.[29

,30]

FAB

Q=

hig

hFA

BQ

=m

oder

ate

Con

ten

t:U

nev

alu

ated

met

hod

saC

onst

ruct

:Un

eval

uat

edm

eth

odsa

Con

curr

ent

FAB

Qto

tal=

low

-mod

erat

eFA

BQ

pa,F

AB

Qw

ork,

FAB

Qpr

ogn

osis

wor

k=

low

Eff

ect

size

:FA

BQ

wor

k=

low

FAB

Qpa=

low

Dut

chC

rom

bez

etal

.[31

];R

enem

anet

al.

[32]

FAB

Qw

ork=

hig

hFA

BQ

pa=

low

Con

curr

ent

FAB

Qw

ork,

FAB

Qpa=

low

-mod

erat

eP

redi

ctiv

e:U

nev

alu

ated

met

hod

sa

Engl

ish

Wad

dell

etal

.[33

];M

cCra

cken

etal

.[34

]

FAB

Qw

ork=

hig

hFA

BQ

pa=

mod

erat

eFA

BQ

=h

igh

FAB

Qw

ork,F

AB

Qpa=

low

Con

stru

ct:U

nev

alu

ated

met

hod

sa

Con

curr

ent

FAB

Qw

ork,

FAB

Qpa

,FA

BQ

tota

l=

low

mod

erat

eP

redi

ctiv

e:U

nev

alu

ated

met

hod

sa

Fren

chC

haor

yet

al.[

35]

FAB

Qw

ork=

mod

erat

eFA

BQ

pa=

low

Con

stru

ct:U

nev

alu

ated

met

hod

sdi

verg

ent

FAB

Qw

ork,

FAB

Qpa=

low

Eff

ect

size

:FA

BQ

wor

k=

low

FAB

Qw

ork=

low

Ger

man

Pfi

ngs

ten

etal

.[3

6];

Stae

rkle

etal

.[3

7,38

],

FAB

Qw

ork=

hig

hFA

BQ

pa=

hig

h(a

fter

FA)

FAB

Qto

tal;

FAB

Qw

ork1

;FA

BQ

wor

k2=

hig

hFA

BQ

pa=

low

FAB

Qw

ork

tota

l=

low

FAB

Q1,

FAB

Qw

ork2=

low

FAB

Qpa=

low

FAB

Qw

ork=

hig

hFA

BP

pa=

mod

erat

e

Con

stru

ct:U

nev

alu

ated

met

hod

sa

Con

curr

ent

FAB

Qw

ork

(bas

e);

FAB

Qpa

(bas

e)=

low

-mod

erat

eFA

BQ

wor

k(f

ollo

wu

p)=

low

FAB

Qpa

(fol

low

up)

=lo

wP

redi

ctiv

e:U

nev

alu

ated

met

hod

sa

Eff

ect

size

:FA

BQ

wor

k=

low

FAB

Qpa=

mod

erat

e

Gre

ece

Geo

rgou

dis

etal

.[39

]

FAB

Qpa=

mod

erat

eFA

BQ

wor

k1,F

AB

Qw

ork2=

hig

h

FAB

Qpa=

mod

erat

eFA

BQ

wor

k1,

FAB

Qw

ork2=

hig

h

Con

verg

ent:

FAB

Qw

ork,

FAB

Qpa=

low

Div

erge

nt:

FAB

Qw

ork1

,FA

BQ

pa=

low

Heb

rew

sJa

cob

etal

.[40

]FA

BQ

wor

k=

hig

hFA

BQ

pa=

low

FAB

Qw

ork,F

AB

Qp;

FAB

Qw

ork=

mod

erat

eFA

BQ

pa=

hig

h

Nor

weg

ian

Gro

tle

etal

.[2

7]

FAB

Qw

ork=

hig

hFA

BQ

pa=

mod

erat

eFA

BQ

wor

k=

mod

erat

eFA

BQ

pa=

low

Con

stru

ctva

lidit

y:FA

BQ

wor

kch

ron

ic;

FAB

Qpa

chro

nic=

low

Un

eval

uat

edm

eth

odsa

Eff

ect

size

:FA

BQ

wor

k=

mod

erat

eFA

BQ

pa=

low


Ta

ble

2:C

onti

nu

ed.

Inst

rum

ent

Rel

iabi

lity

Val

idit

yR

espo

nsi

ven

ess

Span

ish

Kov

acs

etal

.[41

]FA

BQ

=h

igh

FAB

Q=

hig

hFA

BQ

tota

l,FA

BQ

wor

k,

FAB

Qpa=

low

Floo

rce

ilin

g(i

)U

nev

alu

ated

met

hod

sa

Fear

Avo

idan

ceof

Pain

Qu

esti

onn

aire

(FA

PQ

)

Engl

ish

Cro

wle

yan

dK

enda

ll[4

2]FA

PQ

=H

igh

FAP

Q=

Low

Con

curr

ent

FAP

Q=

low

mod

erat

e

Sen

siti

vity

and

spec

ifici

ty(i

)U

nev

alu

ated

met

hod

sa

Fear

ofPa

inQ

ues

tion

nai

re(F

PQ

)En

glis

hH

urs

eyan

dJa

cks

[43]

;M

cCra

cken

etal

.[34

];M

cNei

lan

dR

ainw

ater

[44,

45]

Tota

lsca

le=

mod

erat

e-h

igh

Min

or=

mod

erat

e-h

igh

Seve

re=

hig

hM

edic

al=

low

-hig

h

Con

curr

ent:

FPQ

tota

l=

low

Un

eval

uat

edm

eth

odsa

Pain

An

xiet

ySy

mpt

oms

Scal

e(P

ASS

)D

utch

Cro

mbe

zet

al.

[30]

PASS

=h

igh

Con

verg

ent

PASS

=Lo

w-m

oder

ate

Com

bine

dD

utch

and

USA

stu

dyR

oelo

fset

al.[

46]

Du

tch

/Th

eN

eth

erla

nds

En

glis

h/U

SAO

rigi

nal

PASS

+PA

SS-2

0

PASS

tota

l,PA

SSco

gnit

ive

anxi

ety,

PASS

fear

ofpa

in,

PASS

phys.s

ofan

xiet

y,

PASS

-20=

hig

hPA

SSes

cape/a

void

ance=

mod

erat

ePA

SSes

cape/a

void

ance

,PA

SSph

ysio

logi

cals

ympt

omso

fan

xiet

y=

mod

erat

e

Con

verg

ent

PASS

tota

l,PA

SSco

gnit

ive

anxi

ety

PASS

fear

ofpa

in,

PASS

esca

pe/a

void

ance

,PA

SSph

ysio

logi

cals

ympt

omso

fan

xiet

y:

PASS

-20 c

ogn

itiv

ean

xiet

y,

PASS

-20 f

earo

fpa

in,

PASS

-20 e

scap

e/av

oida

nce

,=lo

wEn

glis

h53

item

sM

cCra

cken

etal

.[18

,34]

;B

urn

set

al.

[47]

;St

rah

let

al.

[48]

PASS

tota

l,PA

SSso

mat

ic,

PASS

cogn

itiv

e;PA

SSfe

ar,

PASS

esca

pe/a

void

ance=

hig

h

Con

curr

ent

PASS

tota

l,PA

SSso

mat

ic,

PASS

fear

,an

dPA

SSco

gnit

ive=

low

-mod

erat

ePA

SSes

cape/a

void

ance=

low

Engl

ish

orFr

ench

20it

ems

Coo

ns

etal

.[4

9]

PASS

20=

hig

hPA

SS20

esca

pe/a

void

ance=

low

PASS

20ph

ysio

logi

cals

ympt

omso

fan

xiet

y

=m

oder

ate

PASS

20co

gnit

ive

anxi

ety,

PASS

20fe

arof

pain=

hig

h

PASS

20fe

ar=

low

PASS

20es

cape

,PA

SS20

phys

iolo

gica

l,PA

SS20

cogn

itiv

e,an

d=

low

-mod

erat

e

Eff

ect

size

PASS

20;

PASS

20fe

ar;

PASS

20es

cape

,PA

SS20

phys

iolo

gica

l,PA

SS20

cogn

itiv

e=

mod

erat

e


Ta

ble

2:C

onti

nu

ed.

Inst

rum

ent

Rel

iabi

lity

Val

idit

yR

espo

nsi

ven

ess

Pain

An

xiet

ySy

mpt

oms

Scal

e(P

ASS

)

Engl

ish

Lars

enet

al.[

28]

PASS

cata

stro

phic

thou

ghts

,PA

SSph

ysio

logi

cala

nxi

ety,

PASS

esca

pe/a

void

ance

,PA

SSco

gnit

ive

inte

rfer

ence

,an

dPA

SSco

pin

gst

rate

gies=

low

Un

eval

uat

edm

eth

odsa

Tam

paSc

ale

for

Kin

esio

phob

ia(T

SK)

Dut

ch12

item

sV

laey

enet

al.

[50]

TSK

17=

mod

erat

e(1

7it

ems)

TSK

13=

low

mod

erat

e(1

3it

ems)

Item

-tot

al:

Un

eval

uat

edm

eth

odsa

Con

stru

ct:

Un

eval

uat

edm

eth

odsa

Con

curr

ent:

TSK

tota

l,T

SKfe

ar=

low

mod

erat

eT

SKh

arm

,T

SKA

void

ance

ofac

tivi

ty=

low

Dut

ch13

item

sG

oube

rtet

al.

[51]

TSK

tota

l

CL

BP=

mod

erat

e;FM

S=

hig

hT

SKac

tivi

tyav

oida

nce

CL

BP

;FM

S=

mod

erat

e.T

SKpa

thol

ogic

som

atic

focu

sC

LB

P;

FMS=

low

Con

stru

ct:

Un

eval

uat

edm

eth

odsa

Dut

ch11

item

sR

oelo

fset

al.

[52]

UE

DT

SK11=

mod

erat

eC

hro

nic

pain

TSK

11=

mod

erat

e

Con

stru

ct:

Un

eval

uat

edm

eth

odsa

Con

curr

ent

TSK

SF=

low

TSK

AA=

low

TSK

Engl

ish

4it

ems

Bu

rwin

kle

etal

.[53

]

TSK

4=

mod

erat

eC

onst

ruct

:U

nev

alu

ated

met

hod

sa

Engl

ish

11it

ems

Wob

yet

al.

[54]

TSK

tota

l,T

SK11=

mod

erat

eIt

em-t

otal

Un

eval

uat

edm

eth

odsa

TSK

=m

oder

ate

TSK

tota

l:,T

SK11

:=lo

w

Eff

ect

size

:T

SKto

tal,

TSK

11=

low

AU

CT

SKto

tal,

TSK

11=

mod

erat

eSe

nsi

tivi

tyan

dsp

ecifi

city

-U

nev

alu

ated

met

hod

sa

Engl

ish

13it

ems

Cla

rket

al.

[55]

;Fr

ench

etal

.[5

6]

TSK

tota

l=h

igh

TSK

taa=

mod

erat

eT

SKts

f=

low

Item

-tot

alU

nev

alu

ated

met

hod

sa

Con

stru

ct:

Un

eval

uat

edm

eth

odsa

Con

curr

ent

low


Ta

ble

2:C

onti

nu

ed.

Inst

rum

ent

Rel

iabi

lity

Val

idit

yR

espo

nsi

ven

ess

Tam

paSc

ale

for

Kin

esio

phob

ia(T

SK)

Nor

weg

ian

Dam

sgar

det

al.[

57]

Un

eval

uat

edm

eth

odsa

Con

stru

ct:

Un

eval

uat

edm

eth

odsa

Swed

ish

17it

ems

Lun

dber

get

al.[

7];

Bu

nke

torp

etal

.[58

]

TSK

=h

igh

Item

-tot

alU

nev

alu

ated

met

hod

sa

TSK

=lo

w-h

igh

Un

eval

uat

edm

eth

odsa

Face

and

con

ten

t:U

nev

alu

ated

met

hod

saC

onst

ruct

:U

nev

alu

ated

met

hod

sa

Abb

revi

atio

ns

inre

liabi

lity:α

:Cro

nba

ch’s

alph

a,IC

C:I

ntr

acla

ssC

orre

lati

onC

oeffi

cien

t,r p

:Pea

rson

’spr

odu

ctm

omen

tco

rrel

atio

nco

effici

ent,

RC

,RP

;RV

.A

bbre

viat

ion

sin

valid

ity:

CFA

:Con

firm

ator

yFa

ctor

An

alys

is,E

FA:E

xplo

rato

ryFa

ctor

An

alys

is.

Abb

revi

atio

ns

inre

spon

sive

nes

s:A

UC

:Are

aU

nde

rC

urv

e,SR

M:S

tan

dard

ised

Res

pon

seM

ean

.a A

ddit

ion

alm

eth

ods

not

eval

uat

edas

they

are

not

incl

ude

din

the

tabl

eof

mod

ified

Win

dcr

iter

ia.


Ta

ble

3:O

verv

iew

ofps

ych

omet

ric

prop

erti

esof

alls

elec

ted

ques

tion

nai

res.

Inst

rum

ent

Stu

dypo

pula

tion

Rel

iabi

lity

Val

idit

yR

espo

nsi

ven

ess

Pre

sen

ted

inac

cord

ance

wit

hla

ngu

age

vers

ion

,in

alph

abet

ical

orde

r

(a)

sam

ple

size

(b)

gen

der

(%m

ale)

(c)

mea

nag

e(y

ears

)(d

)pa

indu

rati

on(m

onth

s)

(a)

inte

rnal

con

sist

ency

(b)

repr

odu

cibi

lity

(c)

oth

er

(a)

con

ten

t(b

)co

nst

ruct

(1)

conv

erge

nt

(2)

dive

rgen

t(c

)cr

iter

ion

rela

ted

(1)

con

curr

ent

(2)

pred

icti

ve(d

)ot

her

(a)

Eff

ect

size

(b)

Are

au

nde

rR

OC

-cu

rve

(AU

C)

(c)

oth

er

Fear

-Avo

idan

ceB

elie

fsQ

ues

tion

nai

re(F

AB

Q)

Chi

nese

Lee

etal

.[2

9,30

]

(a)

476

NP

(b)

40%

(c)

42.5

(d)

no

info

(a)α

FAB

Q=

0.90

(b)

ICC

FAB

Q=

0.81

(c)

Item

-tot

alFA

BQ

=0.

31–0

.68

(a)

Con

ten

t:Tr

ansl

atio

nan

dba

cktr

ansl

atio

n+

Exp

ert

grou

p(b

)C

onst

ruct

:PC

A:3

fact

ors

(61.

6%)

(c)

Cri

teri

onre

late

d:C

oncu

rren

tr s FA

BQ

tota

l

(NR

S)en

try=

0.34

∗∗∗ ;

disc

har

ge=

0.33

∗∗∗ ;

(NP

Q)

entr

y=

0.56

∗∗∗ ;

disc

har

ge=

0.53

∗∗∗ ;

(SF3

6ph

ysic

al)

entr

y=−0

.45∗

∗∗;d

isch

arge

=−0

.64∗

∗∗;(

SF36

men

tal)

entr

y=−0

.36∗

∗∗;d

isch

arge

=−0

.43∗

∗∗

FAB

Qpa

pain

rela

ted:

pain

rati

ng=−0

.32∗

∗ ;N

orth

wic

kPa

rkN

eck

Pain

Qu

est.=−0

.39∗

∗

phys

ical

:act

ive

ran

geof

mot

ion=−0

.13∗

∗ ;ag

e=−0

.12∗

∗ ;st

ren

gth

inde

x=−0

.15∗

∗ ;SF

36ph

ysic

al=−0

.47∗

∗

emot

iona

l:SF

36:m

enta

l=−0

.12∗

∗

FAB

Qw

ork

pain

rela

ted:

pain

rati

ng=−0

.44∗

∗ ;N

orth

wic

kPa

rkN

eck

Pain

Qu

est.=−0

.47∗

∗

phys

ical

:age

=−0

.07∗

∗ ;ac

tive

ran

geof

mot

ion=−0

.19∗

∗ ;SF

36:p

hysi

cal=−0

.40∗

∗ ;st

ren

gth

inde

x=−0

.17∗

∗

psyc

hoso

cial

:SF3

6:m

enta

l=−0

.36∗

∗

FAB

Qpr

ogn

osis

wor

k

pain

rela

ted:

Nor

thw

ick

Park

Nec

kPa

inQ

ues

t.=−0

.422

∗∗;p

ain

rati

ng=−0

.35∗

∗

phys

ical

:age

=−0

.12∗

∗ ;ac

tive

ran

geof

mot

ion=−0

.20∗

∗ ;st

ren

gth

inde

x=−0

.17∗

∗

psyc

hoso

cial

:SF-

36:m

enta

l=−0

.29∗

∗ ;SF

-36:

phys

ical=−0

.49∗

∗

(a)

SRM

FAB

Qw

ork=

0.38

FAB

Qpa=

0.32

(b)

—


Ta

ble

3:C

onti

nu

ed.

Inst

rum

ent

Stu

dypo

pula

tion

Rel

iabi

lity

Val

idit

yR

espo

nsi

ven

ess

Dut

chC

rom

bez

etal

.[31

];R

enem

anet

al.[

32]

(a)

35C

P+

38C

LB

P;5

8C

LB

P;

(b)

31%

+34

%;6

7%(c

)36

.1+

40.8

;35.

6an

d40

.4(d

)80

.4+

76;n

oin

fo

(a)α

FAB

Qw

ork=

0.84

FAB

Qpa=

0.57

(b)

—

(a)

—(b

)—

(c)

Cri

teri

onre

late

d:C

oncu

rren

tFA

BQ

wor

k(r

p)

pain

rela

ted:

base

line

pain

=0.

56∗∗∗ ;

disa

bilit

y(R

DQ

)=

0.63

∗∗∗ ;

expe

rien

ced

pain

incr

ease

=0.

42∗∗

phys

ical

:FC

E-d

ynam

icfo

rwar

dbe

nd=

0.30

∗ ;FC

E-l

ifti

ng

perf

orm

ance

(men

)=−0

.37∗

pea

kto

rqu

e=

0.45

∗∗

psyc

hoso

cial

:kin

esio

phob

ia(T

SK)=

0.56

∗∗∗

+0.

53∗∗

;n

egat

ive

affec

t(N

EM

)=

0.35

∗+

0.38

∗∗

FAB

Qpa

pain

rela

ted:

base

-lin

epa

in=

0.31

∗ ;di

sabi

lity

(RD

Q)=

0.51

∗∗∗

phys

ical

:FC

E-s

tati

cfo

rwar

dbe

nd=

0.30

∗ ;p

eak

torq

ue=−0

.45∗

∗

psyc

hoso

cial

:kin

esio

phob

ia(T

SK)=

0.57

∗∗∗ ,

0.76

∗∗∗ ;

0.39

2;n

egat

ive

affec

t(N

EM

)=

0.42

∗∗

Reg

ress

ion

Dep

ende

nt:

Dis

abili

ty(R

DQ

)β

FAB

Qw

ork=

0.57

∗∗;β

FAB

Qpa=

0.40

∗

(d)

—

(a)

—(b

)—

Engl

ish

Wad

dell

etal

.[3

3];

McC

rack

enet

al.[

34]

(a)

184

LBP

;45

CP

(b)

55%

;47%

(c)

39.7

;46.

3(d

)13

.7;2

7

(a)α

FAB

Qw

ork=

0.88

FAB

Qpa=

0.77

(b)

r pFA

BQ

wor

k=

0.95

FAB

Qpa=

0.88

(c)

Oth

er:k

app

aFA

BQ

=0.

74∗∗∗

(a)

—(b

)C

onst

ruct

PC

A:2

fact

ors:

FAB

Qw

ork

belie

fs(w

ork)

and

FAB

Qac

tivi

tybe

liefs

(pa)

(c)

Cri

teri

onre

late

d:C

oncu

rren

tR

pFA

BQ

wor

k

avoi

dan

ce(P

BC

)=

0.35

∗∗;d

epre

ssiv

esy

mpt

oms

(ZD

I)=

0.41

∗∗∗ ;

disa

bilit

y(R

DQ

)=

0.55

∗∗∗ ;

hel

pse

ekin

g(P

BC

)=

0.43

∗∗,(

PD

I)=

0.48

∗∗

pain

seve

rity

(VA

S)=

0.23

∗∗;p

sych

.dis

tres

s(M

SPQ

)=

0.36

∗∗∗ ;

wor

klo

sspr

esen

t=

0.39

∗∗∗ ;

wor

klo

sspa

stye

ar=

0.55

∗∗∗

FAB

Qpa

avoi

dan

ce(P

BC

)=

0.46

∗∗;d

epre

ssiv

esy

mpt

oms

(ZD

I)=

0.36

∗∗∗ ;

disa

bilit

y(R

DI)=

0.51

∗∗∗ ;

(PD

I)=

0.37

∗ ;w

ork

loss

past

year=

0.23

∗∗

FAB

Qto

tal

avoi

dan

ce(P

BC

)=

0.46

∗∗;d

isab

ility

(PD

I)=

0.52

∗∗∗ ;

hel

pse

ekin

g(P

BC

)=

0.46

∗∗

Reg

ress

ion

(1)

Dep

ende

nt:

disa

bilit

y(R

DQ

);(P

DI)

ßFA

BQ

wor

k=

0.32

∗∗∗ ;

0.26

∗∗;ß

FAB

Qpa=

0.27

∗∗∗

(2)

Dep

ende

nt:

wor

klo

sspa

stye

ar

ßFA

BQ

wor

k=

0.48

∗∗∗

(3)

Dep

ende

nt:

hel

pse

ekin

gß

FAB

Qw

ork=

0.43

∗

(d)

—

(a)

—(b

)—


Ta

ble

3:C

onti

nu

ed.

Inst

rum

ent

Stu

dypo

pula

tion

Rel

iabi

lity

Val

idit

yR

espo

nsi

ven

ess

Fren

chC

hao

ryet

al.

[35]

(3st

udi

esin

1ar

ticl

e)

(a)

31C

LBP

;147

CLB

P;

70C

LB

P(b

)n

oin

fo;n

oin

fo;n

oin

fo(c

)46

;45.

3;42

.5(d

)42

.5;1

13;4

5.5

(a)

—(b

)IC

CFA

BQ

wor

k=

0.88

FAB

Qpa=

0.72

(a)

—(b

)C

onst

ruct

:Fac

tor

An

alys

is(F

A):

4fa

ctor

s;fe

arof

prof

essi

onal

acti

viti

es,p

hysi

cala

ctiv

ity,

belie

fsab

out

retu

rnto

wor

k,be

liefs

abou

tth

ere

spon

sibi

lity

ofw

ork

wit

hch

ron

icsy

mpt

oms

2fa

ctor

s;be

liefs

abou

tpr

ofes

sion

alac

tivi

ties

,bel

iefs

abou

tph

ysic

alac

tivi

tyC

onst

ruct

:div

erge

nt

FAB

Qw

ork:d

epre

ssio

n(H

AD

S)=

0.29

;dis

abili

ty(Q

ueb

ecsc

ore)

=0.

36FA

BQ

pa:h

andi

cap

(VA

S)=

0.36

;0.3

4

(a)

FAB

Qw

ork=

0.30

FAB

Qw

ork=

0.31

(b)

—

Ger

man

Pfi

ngs

ten

etal

.,[3

6];

Stae

rkle

etal

.,[3

7,38

]

(a)

302

CLB

P;3

88LB

P(b

)52

%;4

4%(c

)44

.6;5

4.2

(d)

71.4

;no

info

(a)α

FAB

Qw

ork=

0.89

FAB

Qpa=

0.94

;0.9

1α

(aft

erFA

)FA

BQ

tota

l=

0.91

;FA

BQ

wor

k1=

0.89

;FA

BQ

wor

k2=

0.94

FAB

Qpa=

0.69

(b)

r pFA

BQ

wor

k=

0.89

FAB

Qw

ork1=

0.83

;FA

BQ

wor

k2=

0.89

;FA

BQ

pa=

0.90

;0.8

4(c

)W

eigh

ted

Kap

pa=

0.76

∗∗

ICC

FAB

Qw

ork=

0.91

FAB

Ppa

=0.

83

(a)

—(b

)C

onst

ruct

:Fac

tor

An

alys

is3

fact

ors:

wor

kas

aca

use

(43.

4%);

prog

nos

isw

ork

(11.

8%)

phys

ical

acti

vity

(8.9

%)

2fa

ctor

s(e

xclu

sion

item

1,8,

13,1

4):f

ear-

avoi

dan

cebe

liefs

rela

tion

wor

k-LB

P;

fear

-avo

idan

cebe

liefs

rela

tion

phys

ical

acti

vity

-LB

P(c

)C

rite

rion

rela

ted

:Con

curr

ent(

r p)

FAB

Qw

ork(b

asel

ine)

pain

rela

ted:

disa

bilit

y(R

DQ

)=

0.57

∗∗∗ ;

pain

seve

rity

(VA

S)=

0.47

∗∗∗

phys

ical

:wor

kab

sen

cela

stm

onth

=0.

47∗∗∗

psyc

hoso

cial

:dep

ress

ive

sym

ptom

s(Z

DI)=

0.42

∗∗∗ ;

psyc

hol

.dis

tres

s(M

SPQ

)=

0.36

∗∗∗

FAB

Qpa

(bas

elin

e)pa

inre

late

d:di

sabi

lity

(RD

Q)=

0.56

∗∗∗ ;

pain

seve

rity

(VA

S)=

0.48

∗∗∗

phys

ical

:wor

kab

sen

cela

stm

onth

=0.

42∗∗∗

psyc

hoso

cial

:dep

ress

ive

sym

ptom

s(Z

DI)=

0.37

∗∗∗ ;

psyc

hol

ogic

aldi

stre

ss(M

SPQ

)=

0.31

∗∗∗2

FAB

Qw

ork(f

ollo

wu

p)P

hysi

cal:

disa

bilit

y(R

DQ

)=

0.47

∗∗∗ ;

wor

kab

sen

cela

stm

onth

=0.

44∗∗∗

Psyc

hoso

cial

:dep

ress

ive

sym

ptom

s(Z

DI)=

0.34

∗∗∗ ;

pain

seve

rity

(VA

S)=

0.37

∗∗∗

psyc

hol

ogic

aldi

stre

ss(M

SPQ

)=

0.29

∗∗∗

FAB

Qpa

(fol

low

up)

pain

rela

ted:

disa

bilit

y(R

DQ

)=

0.39

∗∗∗ ;

pain

seve

rity

(VA

S)=

0.29

∗∗∗

phys

ical

:wor

kab

sen

cela

stm

onth

=0.

29∗∗∗

psyc

hoso

cial

:dep

ress

ive

sym

ptom

s(Z

DI)=

0.25

∗∗∗ ;

psyc

hol

ogic

aldi

stre

ss(M

SPQ

)=

0.24

∗∗∗

Reg

ress

ion

(1)

Dep

ende

nt:

disa

bilit

y(F

FbH

-R)

βFA

BQ

wor

k=

0.35

∗∗

βFA

BQ

pa=

0.22

∗

(2)

Dep

ende

nt:

wor

klo

ssβ

FAB

Qw

ork=

0.65

∗∗∗

βFA

BQ

pa=

0.12

∗

(d)

—

(a)

Eff

ect

size

FAB

Qw

ork=

0.33

FAB

Qpa=

0.41

(b)

—

Pain Research and Treatment 11T

abl

e3:

Con

tin

ued

.

Inst

rum

ent

Stu

dypo

pula

tion

Rel

iabi

lity

Val

idit

yR

espo

nsi

ven

ess

Gre

ece

Geo

rgou

dis

etal

.[39

]

(a)

70C

LB

P(b

)17

%(c

)42

.2(d

)n

oin

fo

(a)α

FAB

Qpa=

0.72

FAB

Qw

ork1=

0.90

FAB

Qw

ork2=

0.86

(b)

ICC

FAB

Qw

ork1=

0.93

FAB

Qw

ork2=

0.94

FAB

Qpa=

0.85

(a)

—(b

)C

onst

ruct

:Con

verg

ent

FAB

Qw

ork=

TSK

=0.

39∗∗∗ ;

FAB

Qpa=

TSK

=0.

55∗∗∗

Div

erge

nt

FAB

Qw

ork1

:HA

DS=

0.26

∗ ;H

AD

S dep

ress

ion=

0.35

∗ ;H

AD

S an

xiet

y=

0.22

∗ ;Pa

inin

ten

sity

(VA

S)=

0.56

FAB

Qpa=

HA

DS d

epre

ssio

n=

0.29

∗ ;Pa

in-i

nte

nsi

ty(V

AS)

=0.

49

(a)

—(b

)—

Heb

rew

sJa

cob

etal

.[4

0]

(a)

151

LBP

(b)

44%

(c)

44.3

(d)>

1

(a)α

FAB

Qw

ork=

0.89

FAB

Qpa=

0.70

(b)

ICC

FAB

Qw

ork=

0.90

FAB

Qpa=

0.77

Kap

pa

FAB

Qw

ork=

0.53

FAB

Qpa=

0.64

(a)

—(b

)—

(c)

—

(a)

—(b

)—

Nor

weg

ian

Gro

tle

etal

.[27

]

(a)

(123

acu

teLB

P)+

50C

LB

P(b

)45

%+

38%

(c)

37.8

+40

.4(d

)0.

3+

18.7

(a)α

(n=

28)

FAB

Qw

ork=

0.90

FAB

Qpa=

0.79

(b)

ICC

FAB

Qw

ork=

0.82

FAB

Qpa=

0.66

(a)

Con

ten

t:Tr

ansl

atio

n-b

ack

tran

slat

ion

+P

ilot

stu

dy(b

)C

onst

ruct

:Con

firm

ator

yFa

ctor

An

alys

is(C

FA):

2fa

ctor

s(i

tem

8ex

clu

ded)

;FA

BQ

wor

k(6

0%),

FAB

Qpa

(54%

)FA

BQ

wor

kch

ron

ic

pain

rela

ted:

disa

bilit

y(O

DI)=

0.34

∗ ;di

sabi

lity

days

=0.

52∗∗

phys

ical

:age

=−0

.36∗

;sm

okin

g=

0.52

∗∗;s

trai

ght

leg

rais

ing

(SL

R)=−0

.31∗

psyc

hoso

cial

:(H

SCL2

5)=

0.43

∗∗;(

MSP

Q)=

0.59

∗∗;n

onor

gan

icsi

gns=

0.32

∗

FAB

Qpa

chro

nic

p

pain

rela

ted:

disa

bilit

y(O

DI)=

0.39

∗∗;d

isab

ility

days

=0.

33∗

phys

ical

:sm

okin

g=

0.45

∗∗;s

trai

ght

leg

rais

ing=−0

.36∗

;wal

kin

gte

st=

0.31

∗

psyc

hoso

cial

:(M

SPQ

)=

0.32

∗ ;(H

SCL2

5)=

0.36

∗

(c)

—

(a)

SRM

(Coh

en’s

effec

tsi

ze)

FAB

Qw

ork=

0.56

FAB

Qpa=

0.32

(b)

—

Span

ish

Kov

acs

etal

.[41

]

(a)

209

LBP

(b)

42%

(c)

45.7

(d)

65

(a)α

FAB

Q=

0.94

(b)

ICC

FAB

Q=

0.97

(c)

Wei

ghte

dka

pp

aFA

BQ

=0.

74

(a)

—(b

)(c

)C

rite

rion

rela

ted

:Con

curr

ent

FAB

Qw

ork

Dis

abili

ty(R

M)=

0.46

7∗∗∗

;low

back

pain

(VA

S)=

0.38

1∗∗∗

;qu

alit

yof

life

(SF-

36,

PC

S)=−0

.386

∗∗∗ ;

qual

ity

oflif

e(S

F-36

,MC

S)=−0

.320

∗∗;r

efer

red

pain

(VA

S)=

0.32

3∗∗∗

FAB

Qpa

disa

bilit

y(R

M)=

0.41

2∗∗∗

;low

back

pain

(VA

S)=

0.32

4∗∗∗

;qu

alit

yof

life

(SF-

36,

PC

S)=−0

-304

∗∗∗ ;

qual

ity

oflif

e(S

F-36

,MC

S)=−0

.201

∗∗;r

efer

red

pain

(VA

S)=

0.25

1∗∗∗

FAB

Qto

tal

Dis

abili

ty(R

M)=

0.52

2∗∗∗

;low

back

pain

(VA

S)=

0.39

8∗∗∗

;qu

alit

yof

life

(SF-

36,

PC

S)=−0

432∗

∗∗;q

ual

ity

oflif

e(S

F-36

,MC

S)=−0

.361

∗ ;re

ferr

edpa

in(V

AS)

=0.

320∗

∗∗

(a)

—(b

)—

(c)

Floo

ran

dce

ilin

geff

ects

FAB

Qw

ork

Floo

reff

ect

2.9%

Cei

ling

effec

t8.

6%FA

BQ

pa

Floo

reff

ect

1.4%

Cei

ling

effec

t23

.9%

FAB

Qto

tal

Floo

reff

ect

1.0%

Cei

ling

effec

t3.

3%


Ta

ble

3:C

onti

nu

ed.

Inst

rum

ent

Stu

dypo

pula

tion

Rel

iabi

lity

Val

idit

yR

espo

nsi

ven

ess

Fear

Avo

idan

ceof

Pain

Scal

e(F

AP

S)

Engl

ish

Cro

wle

yan

dK

enda

ll[4

2]

(a)

21+

63ch

ron

icm

usc

ulo

skel

etal

pain

(b)

33%

(c)

35.7

(d)

48.8

(a)α

0.92

(b)

r p0.

84∗∗

(N=

21)

(a)

—(b

)—

(c)

Cri

teri

onre

late

d:C

oncu

rren

tde

pres

sion

(Zu

ng)

=0.

48∗∗−0

.54∗

∗ ;di

sabi

lity

(FLP

)=

0.42

∗∗−0

.69∗

∗ ;im

pact

ofpa

in(M

PI)=−0

.04∗−0

.73∗

∗ ;pa

in(V

AS)

=0.

37∗∗−0

.48∗

∗ ;pa

in-r

elat

edth

ough

ts(P

RSS

-CA

T)=

0.51

∗∗−0

.63∗

∗

(a)

—(b

)—

(c)

Sen

siti

vity

totr

eatm

ent

Ch

ange

AN

OV

AP

retr

eatm

ent

vers

us

post

-tre

atm

ent

14.8

5∗P

re-t

reat

men

tve

rsu

sfo

llow

up

22.4∗

Fear

ofPa

inQ

ues

tion

nai

re(F

PQ

)

Engl

ish

Hu

rsey

and

Jack

s[4

3];

McC

rack

enet

al.[

34];

McN

eila

nd

Rai

nwat

er[4

4,45

]

(a)

45h

eada

che

and

58co

ntr

ols,

45C

P;4

0C

Pan

d40

hea

lthy

con

trol

s+

275

stu

den

ts(b

)12

%;4

7%;3

2.5%

(c)

462;

474

(d)

272;

no

info

(a)α

Hea

dach

e:FP

QTo

tals

cale=

0.92

FPQ

Min

or=

0.86

FPQ

Seve

re,

FPQ

Med

ical=

0.87

Con

trol

s:FP

QTo

tals

cale=

0.80

FPQ

Min

or=

0.71

FPQ

Seve

re=

0.86

PQ

Med

ical=

0.64

(b)

—

(a)

—(b

)—

(c)

Cri

teri

onre

late

d:C

oncu

rren

tFP

Qto

tal

disa

bilit

y(P

DI)=

0.15

;som

atic=

0.38

∗∗∗

ange

r=

0.13

;an

xiet

y=

0.0.

37∗∗∗ ;

avoi

dan

ce(P

BC

)=

0.25

;com

plai

nts

(PB

C)=

0.22

;dep

ress

ion=

0.46

∗∗∗ ;

hel

pse

ekin

g(P

BC

)=

0.11

;pai

n(M

PQ

)=

0.03

FPQ

Seve

re

Com

plai

nts

(PB

C)=

0.32

∗∗

(d)

Inte

rcor

rela

tion

ssu

bsca

les

r αM

inor

-med

ical=

0.30

∗∗∗ ;

Seve

re-m

edic

al=

0.65

∗∗∗

Gro

upeff

ectf

or:

Seve

repa

in<

0.02

4;G

ende

reff

ect:

Subs

cale

san

dto

tals

caleP<

0.01

,Eth

nic

aleff

ect

inco

ntr

olgr

oup,

Med

ical

pain

P<

0.05

(a)

—(b

)—

Pain

An

xiet

ySy

mpt

oms

Scal

e(

PASS

)

Dut

chC

rom

bez

etal

.[30

]

(a)

31C

LB

P(b

)48

%(c

)41

.61

(d)

121

(a)α

PASS

=0.

91(b

)—

(a)

—(b

)—

(c)

Cri

teri

onre

late

d:C

oncu

rren

tval

idit

yca

tast

roph

izin

g(P

CS)

=0.

61∗∗∗ ;

kin

esio

phob

ia(T

SK)=

0.34

∗ ;n

egat

ive

affec

t(N

EM

)=

0.63

∗∗∗ ;

wei

ght

lifti

ng

(s)=−0

.33∗

(a)

—(b

)—


Ta

ble

3:C

onti

nu

ed.

Inst

rum

ent

Stu

dypo

pula

tion

Rel

iabi

lity

Val

idit

yR

espo

nsi

ven

ess

Com

bine

dD

utch

and

USA

stud

yR

oelo

fset

al.

[46]

Du

tch

/Th

eN

eth

erla

nds

En

glis

h/U

SAO

rigi

nal

PASS

+PA

SS-2

0

(a)

398

FMS

(Du

tch

)+2.

228

CLB

P(D

utc

h)

+3.

284

pain

(USA

)(b

)6%

+39

%+

35%

(c)

47.6

+50

.0+

46.6

(d)

159

+2.

74+

63

(a)α

PASS

tota

l=

0.94

PASS

cogn

itiv

ean

xiet

y=

0.85

PASS

fear

ofpa

in=

0.86

PASS

esca

pe/a

void

ance=

0.75

PASS

phys.s

ofan

xiet

y=

0.86

PASS

-20=

0.91

PASS

cogn

itiv

ean

xiet

y=

0.84

PASS

fear

ofpa

in=

0.84

PASS

esca

pe/a

void

ance=

0.73

PASS

phys

iolo

gica

lsym

ptom

sof

anxi

ety

=0.

74(b

)—

(a)

—(b

)C

onst

ruct

vali

dit

y:C

onve

rgen

tval

idit

yPA

SSto

tal:

cata

stro

phiz

ing

(PC

S)=

0.76

;fea

r(T

SK)=

0.55

,PV

AQ

=0.

59PA

SSco

gnit

ive

anxi

ety:c

atas

trop

hiz

ing=

0.69

;fea

r(T

SK)=

0.45

;PV

AQ

=0.

52PA

SSfe

arof

pain

:cat

astr

oph

izin

g=

0.73

;fea

r(T

SK)=

0.54

;PV

AQ

n=

0.51

PASS

esca

pe/a

void

ance

:cat

astr

oph

izin

g=

0.58

;fea

r(T

SK)=

0.49

;PV

AQ

=0.

55PA

SSph

ysio

logi

cals

ympt

omso

fan

xiet

y:c

atas

trop

hiz

ing

(PC

S)=

0.76

;fea

r(T

SK)=

0.41

;PV

AQ

=0.

42PA

SS-2

0 cog

nit

ive

anxi

ety:c

atas

trop

hiz

ing

(PC

S)=

0.70

;fea

r(T

SK)=

0.44

;P

VA

Q=

0.54

PASS

-20 f

earo

fpa

in:c

atas

trop

hiz

ing

(PC

S)=

0.74

,fea

r(T

SK)=

0.53

;PV

AQ

=0.

53PA

SS-2

0 esc

ape/

avoi

dan

ce;c

atas

trop

hiz

ing

(PC

S)=

0.54

;fea

r(T

SK)=

0.47

;P

VA

Q=

0.50

PASS

phys

iolo

gica

lsym

ptom

sof

anxi

ety:c

atas

trop

hiz

ing

(PC

S)=

0.56

;fea

r(T

SK)=

0.37

;PV

AQ

=0.

40(c

)—

(a)

—(b

)—

Engl

ish

53it

ems

McC

rack

enet

al.,

[18]

;[34

];B

urn

set

al.,

[47]

;St

rah

let

al.

[48]

(a)

104

CP

;45

CP

;98

CP

;15

4R

A(b

)46

%;4

7%;1

00%

;14%

(c)

45;4

6.3;

38.9

;54

(d)

63.;

27;9

.5;1

78

(a)α

PASS

tota

l=

0.94

1PA

SSso

mat

ic=

0.89

1PA

SSco

gnit

ive=

0.87

1PA

SSfe

ar=

0.85

1PA

SSes

cape/a

void

ance=

0.81

1(b

)—

(a)

—(b

)—

(c)

Cri

teri

onre

late

d:C

oncu

rren

tval

idit

yr p

PASS

tota

l

pain

rela

ted:

disa

bilit

y(P

DI)=

0.45

∗∗∗ ;

0.61

∗∗∗ ;

pain

inte

rfer

ence

(IS)

=0.

22∗∗

subj

ecti

vepa

in(M

cGill

) sen

sory=

0.31

∗∗∗ ;

(McG

ill) a

ffec

tive=

0.44

∗∗∗ ;

(MP

I)pa

inse

veri

ty=

0.32

∗∗∗ ;

pain

expe

rien

ce(M

PQ

) pai

n=

0.56

∗∗∗ ;

pain

seve

rity

(PSS

)=

0.31

∗∗∗ ;

subj

ecti

vepa

in(M

PI)

inte

rfer

ence=

0.39

∗∗∗

phys

ical

:car

ryin

gca

paci

ty(C

CE

)=−0

.30∗

∗ ;ge

ner

alac

tivi

ty(G

AS)

=−0

.23∗

∗ ;lif

tin

gca

paci

ty(P

ILE

)=−0

.30∗

∗ ;tr

anqu

ilize

r=

0.29

∗∗

psyc

hoso

cial

:an

xiet

y(S

TAI)

trai

t=

0.60

∗∗∗ ;

0.54

∗∗∗ ;

copi

ng

(CSQ

) cat

stro

phis

ing=

0.73

∗∗∗ ;

depr

essi

on(B

DI)=

0.57

∗∗∗ ;

0.52

∗∗∗ ;

pain

beh

avio

ur

(PB

C) a

void

ancee=

0.45

∗∗;p

ain

beh

avio

ur

(PB

C) h

elps

eeki

ng=

0.32

∗ ;sy

mpt

oms

ofan

xiet

y(C

SAQ

) cog

nit

ive=

0.54

∗∗∗ ;

sym

ptom

sof

anxi

ety

(CSA

Q) s

omat

ic=

0.61

∗∗∗

PASS

som

atic

pain

rela

ted:

disa

bilit

y(P

DI)=

0.39

∗∗∗ ;

0.51

∗∗∗ ;

pain

expe

rien

ce(M

PQ

) pai

n=

0.63

∗∗∗ s

ubj

ecti

vepa

in(M

cGill

) sen

sory=

0.45

∗∗∗ ;

(McG

ill) a

ffec

tive=

0.51

∗∗∗ ;

(MP

I)pa

inse

veri

ty=

0.35

∗∗∗ ;

(MP

I)in

terf

eren

ce=

0.28

∗∗

phys

ical

:tra

nqu

ilize

r=

0.25

∗∗

psyc

hoso

cial

:an

xiet

y(S

TAI)

trai

t=

0.52

∗∗∗ ;

copi

ng

(CSQ

) cat

stro

phis

ing=

0.67

∗∗∗ ;

depr

essi

on(B

DI)=

0.51

∗∗∗ ;

sym

ptom

sof

anxi

ety

(CSA

Q) c

ogn

itiv

e=

0.49

∗∗∗ ;

(CSA

Q) s

omat

ic=

0.74

∗∗∗

(a)

—(b

)—


Ta

ble

3:C

onti

nu

ed.

Inst

rum

ent

Stu

dypo

pula

tion

Rel

iabi

lity

Val

idit

yR

espo

nsi

ven

ess

PASS

cogn

itiv

e

pain

rela

ted:

disa

bilit

y(P

DI)=

0.39

∗∗∗ ;

0.51

∗∗∗ ;

pain

expe

rien

ce(M

PQ

) pai

n=

0.43

∗∗;

subj

ecti

vepa

in(M

cGill

) aff

ecti

ve=

0.33

∗∗∗ ;

(McG

ill) s

enso

ry=

0.26

∗∗;s

ubj

ecti

vepa

in(M

PI)

inte

rfer

ence=

0.25

∗∗;(

MP

I)pa

inse

veri

ty=

0.35

∗∗∗

Phy

sica

l:tr

anqu

ilize

r=

0.27

∗∗

Psyc

hoso

cial

:an

xiet

y(S

TAI)

trai

t=

0.67

∗∗∗ ;

copi

ng

(CSQ

) cat

stro

phis

ing=

0.67

∗∗∗ ;

depr

essi

on(B

DI)=

0.67

∗∗∗ ;

pain

beh

avio

ur

(PB

C) a

void

ance=

0.33

∗ ;sy

mpt

oms

ofan

xiet

y(C

SAQ

) cog

nit

ive=

0.61

∗∗∗ ;

(CSA

Q) s

omat

ic=

0.55

∗∗∗

PASS

fear

pain

rela

ted:

disa

bilit

y(P

DI)=

0.30

∗∗∗ ;

0.38

∗∗;p

ain

expe

rien

ce(M

PQ

) pai

n=

0.44

∗∗;

subj

ecti

vepa

in(M

cGill

) aff

ecti

ve=

0.36

∗∗∗ ;

(MP

I)in

terf

eren

ce=

0.31

∗∗∗ ;

(MP

I)pa

inse

veri

ty=

0.28

∗∗

psyc

hoso

cial

:an

xiet

y(S

TAI)

trai

t=

0.53

∗∗∗ ;

depr

essi

on(B

DI)=

0.50

∗∗∗1

;cop

ing

(CSQ

) cat

stro

phis

ing=

0.66

∗∗∗ ;

pain

beh

avio

ur

(PB

C) a

void

ance=

0.39

∗∗;(

PB

C) c

ompl

ain

ts=

0.39

∗∗;s

ympt

oms

ofan

xiet

y(C

SAQ

) cog

nit

ive=

0.53

∗∗∗ ;

(CSA

Q) s

omat

ic=

0.56

∗∗∗

PASS

esca

pe/a

void

ance

pain

rela

ted:

disa

bilit

y(P

DI)=

0.30

∗∗∗ ;

subj

ecti

vepa

in(M

cGill

) aff

ecti

ve=

0.31

∗∗∗ ;

(MP

I)in

terf

eren

ce=

0.36

∗∗∗

Psyc

hoso

cial

:an

xiet

y(S

TAI)

trai

t=

0.29

∗∗;c

opin

g(C

SQ) c

atst

roph

isin

g=

0.42

∗∗∗ ;

depr

essi

on(B

DI)=

0.30

∗∗∗

(d)

Pre

dic

tion

:Reg

ress

ion

(1)

Dep

ende

nt:

Inte

rfer

ence

1:β

PASS

tota

l(+

STA

I-T

)=

0.28

∗ ;0.

087∗

;(+

MP

Q-s

enso

ry)

=0.

39∗∗∗ ;

(+Pa

inse

veri

ty)=

0.28

∗∗;(

+P

SS)=

0.25

4∗∗∗

;(+

BD

I)=

0.25

4∗∗∗

(2)

Dep

ende

nt:

Dis

abili

ty:β

PASS

tota

l(+

BD

I)=

0.32

∗ ;(+

STA

I-T

)=

0.38

∗∗;

(+M

PQ

-sen

sory

)=

0.44

∗∗∗ ;

(+Pa

inse

veri

ty)=

0.32

∗∗∗

(3)

Dep

ende

nt:

Gen

eral

acti

vity

:βPA

SS(+

STA

I)=

0.08

7∗;(

+B

DI)=

0.05

7∗;(

+P

SS)

=0.

054∗

(4)

Dep

ende

nt:

Pain

seve

rity

(MP

Q);β

(PA

SSph

ysio

logi

cal)=

0.63

∗∗∗

(5)

Dep

ende

nt:

Dis

abili

ty(P

DI)

;βPA

SSes

cape/a

void

ance

)=

0.44

∗∗

(6)

Dep

ende

nt:

Avo

idan

ce(P

BC

);β

PASS

esca

pe/a

void

ance=

0.54

∗∗∗

(7)

Dep

ende

nt:

Com

plai

nts

(PB

C);β

PASS

fear=

0.39

∗∗

(8)

Dep

ende

nt:

Hel

pse

ekin

g(P

BC

);β

PASS

esca

pe/a

void

ance=

0.30


Ta

ble

3:C

onti

nu

ed.

Inst

rum

ent

Stu

dypo

pula

tion

Rel

iabi

lity

Val

idit

yR

espo

nsi

ven

ess

Engl

ish

orFr

ench

20it

ems

Coo

ns

etal

.[4

9]

(a)

201

curr

ent

pain

(b)

45%

(c)

41.5

(d)

23

(a)α

PASS

=0.

83PA

SSfe

arof

pain=

0.83

PASS

esca

pe/a

void

ance=

0.70

PASS

phys

iolo

gica

lsym

ptom

sof

anxi

ety

=0.

76PA

SSco

gnit

ive

anxi

ety=

0.85

(b)

—

(a)

—(b

)C

onst

ruct

valid

ity:

Eff

ect

size

PASS

20fe

ar

pain

rela

ted:

disa

bilit

y(M

PI)=

0.32

∗∗;p

ain

seve

rity

(MP

I)=

0.28

∗∗

phys

ical

:phy

siol

ogic

al(A

SI)=

0.35

∗∗

psyc

hoso

cial

:cog

nit

ive

(ASI

)=

0.37

∗∗;p

ubl

ic(A

SI)=

0.31

∗∗

Aff

ect

(AIM

S2)=

0.43

∗ ;pa

insx

(AIM

S2)=

0.22

∗ ;So

cial

(AIM

S2)=

0.33

∗ ;Sy

mpt

oms

(ASE

)=−0

.38∗

;pai

n(A

SE)=−0

.45∗

;neg

ativ

eaff

ect

(MP

I)=

0.44

∗∗;p

erce

ived

con

trol

(MP

I)=−0

.34∗

∗ ;so

cial

supp

ort

(MP

I)=

0.18

∗∗;P

assi

veco

pin

g=

0.73

∗ ;A

ctiv

eco

pin

g=−0

.44∗

PASS

20es

cape

pain

rela

ted

disa

bilit

y(M

PI)=

0.36

∗∗;p

ain

seve

rity

(MP

I)=

0.16

∗ ;pa

in(A

SE)=−0

.30∗

;sy

mpt

oms

(ASE

)=−0

.29∗

phys

ical

phys

iolo

gica

l(A

SI)=

0.23

∗∗

psyc

hoso

cial

Aff

ect

(AIM

S2)=

0.26

∗ ;R

ole

(AIM

S2)=

0.20

∗ ;So

cial

(AIM

S2)=

0.24

∗ ;co

gnit

ive

(ASI

)=

0.28

∗∗;p

ubl

ic(A

SI)=

0.26

∗∗;n

egat

ive

affec

t(M

PI)=

0.22

∗∗;s

ocia

lsu

ppor

t(M

PI)=

0.19

∗∗;A

ctiv

eco

pin

g=−0

.39∗

;Pas

sive

copi

ng=

0.67

∗

PASS

20ph

ysio

logi

cal

pain

rela

ted

disa

bilit

y(M

PI)=

0.27

∗∗;p

ain

(ASE

)=−0

.35∗

;pai

nse

veri

ty(M

PI)=

0.15

∗ ;p

erce

ived

con

trol

(MP

I)=−0

.23∗

∗ ;sy

mpt

oms

(ASE

)=−0

.29∗

phys

ical

phys

iolo

gica

l(A

SI)=

0.33

∗∗

psyc

hoso

cial

affec

t(A

IMS2

)=

0.51

∗ ;pa

insx

(AIM

S2)=

0.25

∗ ;ro

le(A

IMS2

)=

0.29

∗ ;so

cial

(AIM

S2)=

0.31

∗ ;co

gnit

ive

(ASI

)=

0.34

∗∗;p

ubl

ic(A

SI)=

0.26

∗∗;A

ctiv

eco

pin

g=

−0.2

8∗;P

assi

veco

pin

g=

0.61

∗ ;n

egat

ive

affec

t(M

PI)=

0.44

∗∗

PASS

20co

gnit

ive

pain

rela

ted

Dis

abili

ty(M

PI)=

0.25

∗∗;P

ain

(ASE

)=−0

.42∗

;pai

nse

veri

ty(M

PI)=

0.20

∗∗

Sym

ptom

s(A

SE)=−0

.32∗

Phy

sica

lP

hysi

olog

ical

(ASI

)=

0.32

∗∗

psyc

hoso

cial

affec

t(A

IMS2

)=−0

.42∗

;cog

nit

ive

(ASI

)=

0.31

∗∗;p

ubl

ic(A

SI)=

0.25

∗∗;n

egat

ive

affec

t(M

PI)=

0.39

∗∗;p

erce

ived

con

trol

(MP

I)=−0

.30∗

∗ ;A

ctiv

eco

pin

g=

−0.3

3∗Pa

ssiv

eco

pin

g=

0.69

∗ ;so

cial

(AIM

S2)=

0.30

∗

Reg

ress

ion

(1)

Dep

ende

nt:

Aff

ect;

PASS

and

STA

I=

0.33

2∗∗∗

(2)

Dep

ende

nt:

Rol

efu

nct

ion

;PA

SSan

dST

AI=

0.31

5∗∗

(d)

—

(a)

Eff

ects

ize

r p0.

68∗∗∗

(b)

—


Ta

ble

3:C

onti

nu

ed.

Inst

rum

ent

Stu

dypo

pula

tion

Rel

iabi

lity

Val

idit

yR

espo

nsi

ven

ess

Engl

ish

Lars

enet

al.

[28]

(a)

259

CP

(b)

58%

(c)

38.2

(d)

21

(a)

—(b

)—

(a)

—(b

)C

onst

ruct

vali

dit

y:E

FA(P

CA

)5-

fact

orso

luti

on(4

4%):

cata

stro

phic

thou

ght;

phys

iolo

gica

lan

xiet

y;es

cape

/avo

idan

ce;

cogn

itiv

ein

terf

eren

ce;c

opin

gst

rate

gies

r pPA

SSca

tast

roph

icth

ough

ts

pain

rela

ted:

pain

(MP

Q) a

ffec

tive

scal

e=

0.23

∗∗

psyc

hoso

cial

:an

xiet

y(S

TAI)=

0.49

∗∗;d

epre

ssio

n(B

DI)=

0.40

∗∗

PASS

phys

iolo

gica

lan

xiet

y

pain

rela

ted:

pain

(MP

Q) p

rese

ntp

ain

inde

x=

0.29

∗∗

phys

ical

:an

alge

sic

use

=−0

.18∗

psyc

hoso

cial

:an

xiet

y(S

TAI)=

0.35

∗∗;d

epre

ssio

n(B

DI)=

0.35

∗∗;p

ain

(MP

Q) a

ffec

tive

scal

e=

0.33

∗∗;(

MP

Q) p

ain

inte

nsi

ty=

0.30

∗∗;(

MP

Q) s

enso

rysc

ale=

0.36

∗∗;

pain

-rel

ated

chan

gein

lifes

tyle=

0.17

∗ ;pa

in-r

elat

eddi

stre

ss=

0.22

∗∗PA

SSes

cape/a

void

ance

pain

rela

ted:

Pain

(MP

Q) p

rese

ntp

ain

inde

x=

0.25

∗∗;(

MP

Q) p

ain

inte

nsi

ty=

0.24

∗∗

phys

ical

:an

alge

sic

use

=−0

.25∗

∗

psyc

hoso

cial

:an

xiet

y(S

TAI)=

0.30

∗∗;d

epre

ssio

n(B

DI)=

0.19

∗∗;p

ain

-rel

ated

chan

gein

lifes

tyle=

0.38

∗∗;p

ain

-rel

ated

dist

ress=

0.25

∗∗

PASS

cogn

itiv

ein

terf

eren

ce

pain

rela

ted:

pain

(MP

Q) p

rese

ntp

ain

inde

x=

0.35

∗∗

phys

ical

:an

alge

sic

use

=−0

.33∗

∗

psyc

hoso

cial

:an

xiet

y(S

TAI)=

0.50

∗∗;d

epre

ssio

n(B

DI)=

0.38

∗∗;p

ain

-rel

ated

chan

gein

lifes

tyle=

0.25

∗∗;p

ain

-rel

ated

dist

ress=

0.21

∗∗;p

ain

(MP

Q) a

ffec

tive

scal

e=

0.17

∗∗(M

PQ

) pai

nin

ten

sity=

0.22

∗∗

PASS

copi

ng

stra

tegi

es

phys

ical

:an

alge

sic

use

=−0

.27∗

∗

psyc

hoso

cial

:an

xiet

y(S

TAI)=

0.33

∗∗;d

epre

ssio

n(B

DI)=

0.20

∗∗

(a)

—(b

)—

Tam

paSc

ale

for

Kin

esio

phob

ia(T

SK)

Dut

ch12

item

sV

laey

enet

al.

[50]

(a)

129

+33

CLB

P(b

)39

%+

48%

(c)

40.1

+37

.4(d

)11

9+

91

(a)α

TSK

17=

0.77

(17

item

s)T

SK13=

0.53

–0.7

3(1

3it

ems)

(b)

—(c

)It

emto

tal<

.40

(a)

—(b

)C

onst

ruct

vali

dit

y:P

CA

:4

fact

ors

(36.

2%):

har

m,f

ear

of(r

e)in

jury

,im

port

ance

ofex

erci

se,a

void

ance

ofac

tivi

ty(c

)C

rite

rion

-rel

ated

vali

dit

y:C

oncu

rren

tva

lidit

y:T

SKto

tal:

cata

stro

phis

ing

(PC

S)=

0.54

∗∗∗ ;

fear

ofbl

ood,

inju

ry(F

SS)=

0.32

∗∗pa

inim

pact

(PC

L-e)

=0.

27∗∗

;pai

nin

ten

sity

(MP

Q)=

0.21

∗∗

TSK

har

m:c

atas

trop

his

ing

(PC

S)=

0.47

∗∗∗ ;

fear

ofbl

ood,

inju

ry(F

SS)=

0.32

∗∗;p

ain

impa

ct(P

CL-

e)=

0.23

∗∗;p

ain

inte

nsi

ty(M

PQ

)=

0.24

∗∗

TSK

fear

:cat

astr

oph

isin

g(P

CS)

=0.

52∗∗∗ ,

fear

ofbl

ood,

inju

ry(F

SS)=

0.37

∗∗;p

ain

impa

ct(P

CL-

e)=

0.38

∗∗∗ ;

pain

inte

nsi

ty(M

PQ

)=

0.25

∗∗

TSK

Avo

idan

ceof

acti

vity

:cat

astr

oph

isin

g(P

CS)

=0.

35∗∗∗

Reg

ress

ion

:Pre

dic

tion

Dep

ende

nt:

Dis

abili

ty:β

TSK

tota

l=

0.44

∗

(d)

—

(a)

—(b

)—


Ta

ble

3:C

onti

nu

ed.

Inst

rum

ent

Stu

dypo

pula

tion

Rel

iabi

lity

Val

idit

yR

espo

nsi

ven

ess

Dut

ch13

item

sG

oube

rtet

al.

[51]

(a)

277

CL

BP

+FM

S(b

)33

.6%

(c)

41.3

3(d

)97

.9+

116.

4

(a)α

(1)

TSK

tota

lC

LB

P=

0.80

;FM

S=

0.82

(2)

TSK

acti

vity

avoi

dan

ceC

LB

P=

0.73

;FM

S=

0.76

(3)

TSK

path

olog

icso

mat

icfo

cus

CL

BP=

0.70

;FM

S=

0.70

(b)

—

(a)

—(b

)C

onst

ruct

vali

dit

y:C

FA:

2fa

ctor

s:ac

tivi

tyav

oida

nce

;pat

hol

ogic

also

mat

icfo

cus

(c)

—

(a)

—(b

)—

Dut

ch11

item

sR

oelo

fset

al.

[52]

(a)

1109

UE

D+

2825

CP

(b)

33%

+n

oin

fo(c

)41

.7+

no

info

(d)

no

info

(a)α

UE

DT

SK11=

0.77

Ch

ron

icpa

inT

SK11=

0.75

–0.8

0(b

)—

(a)

—(b

)C

onst

ruct

vali

dit

y:C

FA:2

fact

ors

(11

item

s):S

omat

icfo

cus,

Act

ivit

yav

oida

nce

(c)

Cri

teri

onre

late

d:C

oncu

rren

tT

SKSF

pain

rela

ted:

fun

ctio

nin

g(D

ASH

)=

0.23

∗∗;p

ain

inte

nsi

ty=

0.24

∗∗ph

ysic

al:s

port

s(D

ASH

)=

0.18

∗∗;w

ork

(DA

SH)=

0.31

∗∗

TSK

AA

pain

rela

ted:

fun

ctio

nin

g(D

ASH

)=

0.32

∗∗;p

ain

dura

tion

=0.

14∗∗

;pai

nin

ten

sity

=0.

19∗∗

phys

ical

:spo

rts

(DA

SH)=

0.25

∗∗;w

ork

(DA

SH)=

0.27

∗∗

Reg

ress

ion

:Pre

dic

tive

(1)

Dep

ende

nt:

Dis

abili

ty:β

TSK

AA=

0.13

∗∗∗

(2)

Dep

ende

nt:

Dis

abili

ty,w

ork:β

TSK

SF=

0.16

∗∗∗ :

βT

SKA

A=

0.06

∗

(3)

Dep

ende

nt:

Dis

abili

ty,s

port

s:β

TSK

AA=

0.18

∗∗∗

(d)

—

(a)

—(b

)—

Engl

ish

4it

ems

Bu

rwin

kle

etal

.[5

3]

(a)

233

FMS

(b)

0%(c

)43

.79

(d)

122.

4

(a)α

TSK

4=

0.71

(b)

—

(a)

—(b

)C

onst

ruct

valid

ity:

PC

A:1

fact

or(5

4.2%

)(c

)—

(a)

—(b

)—

Engl

ish

11it

ems

Wob

yet

al.

[54]

(a)

111

+10

4C

LBP

(b)

no

info

(c)

43.4

+44

.4(d

)79

.2+

80.4

(a)α

TSK

tota

l=

0.76

TSK

11=

0.79

(b)

ICC

TSK

=0.

82(c

)SE

M=

3.16

item

-tot

al<

.20

(4,8

,9,1

2,14

,16)

(a)

—(b

)C

onst

ruct

vali

dit

y:C

orre

lati

ons

betw

een

chan

gesc

ores

TSK

tota

l:D

isab

ility

(RD

Q)=

0.50

∗∗∗ ;

Pain

(VA

S)=

0.22

∗

TSK

11:D

isab

ility

(RD

Q)=

0.51

∗∗∗ ;

Pain

(VA

S)=

0.27

∗∗

(c)

Cri

teri

onre

late

d:P

red

icti

veR

egre

ssio

nD

epen

den

t:ch

ange

indi

sabi

lity;β

TSK

tota

l=

0.39

;βT

SK11=

0.38

(d)

—

(a)

SRM

TSK

tota

l=−1

.19;

TSK

11=−1

.11

(b)

AU

CT

SKto

tal=

0.70

;TSK

11

=0.

71(c

)Se

nsi

tivi

tyT

SKto

tal=

71%

;T

SK11=

66%

Spec

ifici

tyT

SKto

tal=

63%

;T

SK11=

67%

TSK

tota

l=

4pt

s;T

SK11=

4pt

s


Ta

ble

3:C

onti

nu

ed.

Inst

rum

ent

Stu

dypo

pula

tion

Rel

iabi

lity

Val

idit

yR

espo

nsi

ven

ess

Engl

ish

13it

ems

Cla

rket

al.

[55]

;Fr

ench

etal

.[56

]

(a)

167

vete

ran

s;20

0C

BP

+N

P(b

)10

0%;4

6%(c

)47

.6;4

0.0

(d)

180;

16.7

(a)α

TSK

tota

l=

0.86

;0.8

4T

SKta

a=

0.78

TSK

tsf=

0.70

(b)

—(c

)It

em-t

otal

=0.

29–0

.69

(a)

—(b

)C

onst

ruct

vali

dit

y(E

FA):

2fa

ctor

s:ac

tivi

tyav

oida

nce

,pat

hol

ogic

also

mat

icfo

cus

3fa

ctor

s(c

)C

rite

rion

-rel

ated

vali

dit

y:co

ncu

rren

tpa

inre

late

d:di

sabi

lity

(Qu

ebec

)=

0.30

∗∗;p

ain

inte

rfer

ence

(MV

AS)

=0.

39∗∗

;pai

nin

ten

sity

(VA

S)=

0.23

∗∗

Psyc

hoso

cial

:an

xiet

y(S

TAI)=

0.28

∗∗;c

atas

trop

his

ing

(PC

S)=

0.53

∗∗;d

epre

ssio

n(B

DI)=

0.34

∗∗;F

AB

Qpa=

0.35

∗∗;F

AB

Qw

ork=

0.34

∗∗

Reg

ress

ion

(1)

Dep

ende

nt:

Pain

inte

rfer

ence

(MV

AS)

;β(T

SK)=

0.29

∗∗∗

(2)

Dep

ende

nt:

Dis

abili

ty(Q

ueb

ec);β

(TSK

)=

0.22

∗∗∗

(d)

—

(a)

—(b

)—

Nor

weg

ian

Dam

sgar

det

al.[

57]

(a)1

20pa

tien

ts:4

8LB

P,72

WP

(b)L

BP

:42%

wom

en,5

8%m

enW

P:5

8%w

omen

,42%

men

(c)m

ean

age

42(S

D10

)(d

)—

(a)

—(b

)R

epro

duci

bilit

y:Pe

arso

nse

para

tion

relia

bilit

y=

0.87

(a)

—(b

)M

ean

item

fit=

0.26

(SD

0.86

);M

ean

per

son

fit=−0

.17

(SD

1.15

)Ta

rget

ing:

Item

dist

ribu

tion−3

.2to

3.2

Pear

son

slo

cati

onm

ean=−0

.21

(SD

1.12

)In

vari

ance

:Ite

m10

vari

edfo

rge

nde

rA

nal

ysis

ofre

sidu

alpa

tter

n:

Un

idim

ensi

onal

un

derl

yin

gco

nst

ruct

acco

rdin

gto

bin

omia

ltes

tC

Ifo

rpr

obab

ility

0.05

to0.

13(c

)—

(a)

—(b

)—


Ta

ble

3:C

onti

nu

ed.

Inst

rum

ent

Stu

dypo

pula

tion

Rel

iabi

lity

Val

idit

yR

espo

nsi

ven

ess

Swed

ish

17it

ems

Lun

dber

get

al.[

7];

Bu

nke

torp

etal

.[58

]

(a)

102

CL

BP

;46

WA

D(b

)49

%(c

)45

.3(d

)66

;1.5

–3

(a)α

TSK

=0.

81(b

)IC

C=

0.91

r p=

0.91

∗∗∗

RP=−0

.01,

CI=

(−0.

12;

0.14

)R

C=−0

.08,

CI=

(−0.

25;0

.09)

RV=

0.21

,CI

=(0

.04;

0.38

)K

appa

=0.

0(c

)It

em-t

otal<

.40

(a)

Con

ten

tval

idit

y:P

ilot

stu

dy,T

ran

slat

ion

,bac

ktr

ansl

atio

n(b

)C

onst

ruct

vali

dit

y:P

CA

:5fa

ctor

s(5

9%)

+kn

own

grou

pte

chn

iqu

e(c

)—

(a)

—(b

)—

Abb

revi

atio

ns

inst

udy

popu

lati

on:C

BP

:Ch

ron

icba

ckpa

in,C

LBP

:Ch

ron

icLo

wB

ack

Pain

,CP

:Ch

ron

icPa

in,F

MS:

Fibr

omya

lgia

Syn

drom

e,LB

P:L

owB

ack

Pain

,NP

:Nec

kpa

in,R

A:R

heu

mat

oid

Art

hri

tis,

UE

D:

Upp

erE

xtre

mit

yD

isor

der,

WA

D:W

hip

lash

Ass

ocia

ted

Dis

orde

r.A

bbre

viat

ion

sin

relia

bilit

y:α

:Cro

nba

ch’s

alph

a,IC

C:I

ntr

acla

ssC

orre

lati

onC

oeffi

cien

t,rp

:Pea

rson

’spr

odu

ctm

omen

tco

rrel

atio

nco

effici

ent.

Abb

revi

atio

ns

inva

lidit

y:A

IMS:

Art

hri

tis

Impa

ctM

easu

rem

ent

Scal

es,

ASE

:A

rth

riti

sSe

lf-E

ffica

cysc

ale,

ASI

:A

nxi

ety

Sen

siti

vity

Inde

x,B

DI:

Bec

kD

epre

ssio

nIn

ven

tory

,C

CE

:C

arry

ing

Cap

acit

yEv

alu

atio

n;

CFA

:Con

firm

ator

yFa

ctor

An

alys

is,C

SAQ

:Cog

nit

ive

Som

atic

An

xiet

yQ

ues

tion

nai

re,C

SQ:C

opin

gSt

rate

gyQ

ues

tion

nai

re,D

ASH

:Dis

abili

ties

ofth

eA

rm,S

hou

lder

and

Han

dqu

esti

onn

aire

,EFA

:Exp

lora

tory

Fact

orA

nal

ysis

,FC

E:F

un

ctio

nal

Cap

acit

yEv

alu

atio

n,F

FbH

-R:p

hysi

calf

un

ctio

nin

gsc

ale

(Fu

nkt

ion

sfra

gebo

gen

Han

nov

er-R

uck

en),

FLP

:Fu

nct

ion

alLi

mit

atio

ns

Pro

file

,FSS

:Fea

rSu

rvey

Sch

edu

le,G

AS:

Gen

eral

Act

ivit

ySc

ale,

HA

DS:

Hos

pita

lA

nxi

ety

Dep

ress

ion

Scal

e,H

SCL

:H

opki

ns

Sym

ptom

Ch

eck

list,

McG

ill:

Mc

Gill

pain

ques

tion

nai

re,

MP

I:M

ult

idim

ensi

onal

Pain

Inve

nto

ry,

MP

Q:

Mc

Gill

pain

ques

tion

nai

re,

MSP

Q:M

odifi

edSo

mat

icPe

rcep

tion

sQ

ues

tion

nai

re,N

EM

:Neg

ativ

eE

mot

ion

alit

yQ

ues

tion

nai

re,N

PQ

:Nec

kPa

inQ

ues

tion

nai

re,N

RS:

Nu

mer

ical

Rat

ing

Scal

e,O

DQ

:Osw

estr

yD

isab

ility

Qu

esti

onn

aire

,PB

C:

Pain

Beh

avio

ur

Ch

eckl

ist,

PC

A:P

rin

cipa

lCom

pon

entA

nal

ysis

,PC

L:Pa

inC

ogn

itio

nLi

st,P

CS:

Pain

Cat

astr

oph

isin

gSc

ale,

PD

I:Pa

inD

isab

ility

Inde

x,P

RSS

-CA

T:P

ain

-Rel

ated

Self

-Sta

tem

ents

Scal

e,Q

ueb

ecsc

ore:

Th

eQ

ueb

ecB

ack

Pain

Dis

abili

tySc

ale,

PSS

:Pai

nSe

veri

tySc

ale,

PV

AQ

:Pai

nV

igila

nce

and

Aw

aren

ess

Qu

esti

onn

aire

,RD

Q;R

M:R

olan

dM

orri

sD

isab

ility

Qu

esti

onn

aire

,SF3

6:Sh

ort

Form

36,S

TAI:

Spie

lber

ger

Stat

ean

dTr

ait

An

xiet

yIn

ven

tory

,VA

S:V

isu

alA

nal

ogu

eSc

ale,

ZD

I:Z

un

gD

epre

ssio

nIn

ven

tory

.A

bbre

viat

ion

sin

resp

onsi

ven

ess:

AU

C:A

rea

Un

der

Cu

rve,

SRM

:Sta

nda

rdis

edR

espo

nse

Mea

n.


3.1. Questionnaires Identified in Relation to the ConceptualDefinitions. Fear of Pain Questionnaire (FPQ) and PainAnxiety Symptoms Scale (PASS) were identified as beingdesigned to measure the construct “pain-related fear”. TheFear Avoidance Beliefs Questionnaire (FABQ) and the Fear-Avoidance of Pain Scale (FAPS) were identified as designed tomeasure the construct “fear-avoidance beliefs”. The TampaScale for Kinesiophobia (TSK) was identified to measure“kinesiophobia”. No questionnaire was found to assessthe construct “fear of movement”. Figure 1 demonstratesthe relationship between the constructs and the identifiedmeasures.

3.2. Descriptions of the Included Questionnaires. The Fear-Avoidance Beliefs Questionnaire (FABQ) was originally devel-oped by Waddell et al. [33] to assess fear-avoidance beliefsin patients with back pain. The original version of the FABQcontains 16 items divided into two subscales: fear-avoidancebeliefs about physical activity (5 items) and fear-avoidancebeliefs about work (11 items). Each of the 16 items are ratedon a seven-point Likert Scale (“do not agree at all” = 0 to“completely agree” = 6). The FABQ is available in ninelanguages, with each language version evaluated in relationto its psychometric properties.

The Fear Avoidance of Pain Scale (FAPS) was constructedby Crowley and Kendall [42] to measure fear avoidance ofactivities. The FAPS comprises 21 items ranging from 0(never) to 6 (all the time). Patients are asked to rate how oftenthe mentioned activity occurs.

The Fear of Pain Questionnaire (FPQ) is presented tomeasure fear of pain and is based on the work of Lethem et al.[12]. The FPQ versions used in the two included articlesconsist both of a total number of 30 items, but the individualitems included differ however in both articles. The FPQ itemsare statements briefly describing painful situations, and thepatient is asked to mark the “amount of fear” on a scale of 1(not at all) to 5 (extreme) for each item. Three subscales arereported: fear of minor, severe, and medical pain. A totalscore is used.

The Pain Anxiety Symptoms Scale (PASS) was originallydesigned to assess fear of pain [18] in relation to thethree response modalities: cognitive, physiological, or motorresponse domains. The patients are asked to rate their scorefor each item on a scale from 0 (never) to 5 (always). Itemson the PASS are measured on a 6-point Likert scale. Differentversions of the PASS exist including the 53-item question-naire and an abbreviated version consisting of 20 items.

The Tampa Scale of Kinesiophobia (TSK) was designedto measure kinesiophobia [19]. The original TSK consists of17 items. Each item is evaluated on a 4-point Likert scalewith scoring alternatives ranging from “strongly disagree” to“strongly agree”. A total sum is calculated after inversion ofthe individual scores of items 4, 8, 12, and 16. The total scorecan vary from 17 to 68. The TSK is available in fourlanguages, but can contain various versions of the TSK. Forinstance, the various English language versions contain 4, 11,13, or 17 items.

3.3. General Summary according to the Psychometric Prop-erties for All Questionnaires. None of the articles reviewedprovided a rationale reasoning regarding the conceptual andmeasurement model related to the questionnaire. Extensivework on the definition of psychometric properties has beenperformed on the FABQ and the TSK. At present, theFABQ appeared to be the best available measure, in termsof psychometric properties, to measure the concept “fear-avoidance beliefs”, the PASS seems to be the best availablemeasure to measure “pain-related fear”, and the TSK isthe best available to measure “kinesiophobia”. As shown inTable 2, for various questionnaires information concerningreliability and validity is often lacking. In addition, for almostall measures evidence to confirm its responsiveness is lacking.Measures of interpretability and practicality were rarely ornever addressed and hence not evaluated. Each identifiedmeasure is analysed in depth below.

3.4. Fear-Avoidance Beliefs Questionnaire (FABQ). In total,16 articles were included in the review of the FABQ. Thesearticles addressed the psychometric properties of the Chinese[29, 30], Dutch [31, 32], English [16, 34], French [35],German [36–38], Greek [39], Hebrews [40], Norwegian [27],and Spanish language versions [41], with each languageversion presented separately (Tables 2 and 3).

As shown in Table 2 the internal consistency of theFABQtotal as well as its subscale FABQwork was assessedas high in all language versions. However, the internalconsistency of the subscale FABQphysical activity appeared tobe only low to moderate in most language versions. TheFABQ reproducibility as reported ranged from low to high,whereas the reported FABQ validity could be classified aslow. The quality of the FABQ validity analysis proceduresas performed could be classified as compromised. Studyobjectives were often not clearly focussed, which complicatedidentifying the validation procedure as performed. As shownin Table 2, only limited information appeared to be availablerelated to the FABQ’s content validity. Most often, theconstruct validity was assessed using factor analyses. Variousfactor solutions were presented ranging from one to four,with two being the most common factor solution. The itemswithin the factor solutions varied, but were mostly robust.As shown in Table 3, a variety of measures were used toeither converge or diverge in relation to the FABQ. Testingconditions were not reported in any of the studies.

The criterion-related validity, both concurrent and pre-dictive, of the FABQ was ranging from low to moderate. Thepresentation of the rationale for the choice of the criterion-related measures was often lacking, which complicated theinterpretation.

3.5. Fear Avoidance of Pain Scale (FAPS). One articleappeared to be available that evaluated the psychometricproperties of the FAPS. Based on this information, theinternal consistency is considered as high whereas its repro-ducibility seems low. Concurrent validity was ranging fromlow to moderate. Moreover, the evidence supporting validityof the FAPS is poor in all versions. It is also unclear whatsubscale of the FAPS would be preferable to use.


Pain-related fearFear-avoidance

beliefsKinesiophobia

Fear of

movementConstructs

Conceptual Incorporates fear

of pain, fear of

injury, fear of

physical activity

A specific fear ofmovement andphysical activitythat is(wrongfully)assumed to cause

An excessive,irrational, anddebilitating fear ofphysicalmovement andactivity resultingfrom a feeling ofvulnerability topainful injury or

There is nooriginaldefinition to befound neither inthe article byLethem et

nor by

IdentifiedFear-avoidance

questionnaire

(FABQ)

Fear-avoidance

of Pain

questionnaire

(FAPQ)

definition

nstrumentsiTampa scale for

Kinesiophobia

(TSK)

Fear of pain

questionnaire

(FPQ)

Pain anxiety

symptoms

cale (PASS)

No one

identifiedbeliefs

s

reinjury [14]

reinjury [13]

al. [12]

Waddell et al. [16]

and so forth [15]

Figure 1: A schematic overview of the relationship between the constructs “fear-avoidance beliefs”, “pain-related fear”, “fear of movement,”and “kinesiophobia” and the identified instruments.

3.6. Fear of Pain Questionnaire (FPQ). Our selection ofarticles identified 16 articles that evaluated psychometricproperties of the FPQ. However, only two of these articles[43] fulfilled our inclusion criteria. The FPQ measures fearof pain and is to be based on the work of Lethem et al.[12]. However, a remarkable finding seems to be the fact thatseveral of the selected articles refer to one specific document,classified as proceedings of a meeting, in which the originof the FPQ [45] is reported to be described. The availabilityof this FPQ key manuscript seemed however rather limitedsince we were not able retrieve it, even after a thorough searchin the international literature. The FPQ as referred to in thetwo articles included in the final selection consisted of 30items. All items describe painful situations, and the patientis asked to mark the “amount of fear” he/she is experiencingrelated to each item on a scale of 1 (not at all) to 5 (extreme).The three subscales mentioned are fear of minor, severe, andmedical pain. A total score is used. As reported the internalconsistency varied between low in the medical scale to highin the total scale. The content validity was considered low.

3.7. Pain Anxiety Symptoms Scale (PASS). In total, 12 articleswere included in the review of the PASS. Articles discussingthe psychometric properties of the English [18, 28, 34,47–49] and Dutch language [46] versions were addressed(Table 1). The reliability was high in all PASS language

versions, except for the English 20-item version of thesubscale PASSphysiological symptoms of anxiety which was reported tobe only moderate. As for the FABQ, the description of thevalidation procedure for the PASS was often lacking inthe articles reviewed. In addition, the diversity of versionsof the PASS complicated comparisons between studies.Content validity ranged between low and moderate in theEnglish and the French versions of the PASS. Constructvalidity was found to be low in the combined Dutch andAmerican study [46]. As shown in Table 3, a variety ofmeasures were used as a criterion variable in the variousvalidation procedures. Again motivation for the selection ofthese criterion measures was often not available. Concurrentvalidity was low to moderate in the Dutch and Englishversion of the PASS [59]. Responsiveness was addressed inonly one study. In addition to the original version, twoversions of the PASS are available in Dutch.

3.8. Tampa Scale for Kinesiophobia (TSK). A total numberof 12 articles addressed the psychometric properties ofthe Dutch [50–52], English [53–56], Norwegian [57], andSwedish version of the TSK [7]. Reliability was not evaluatedat all in the Norwegian version of the TSK. The reliability ofthe English version ranged from low in the 13-item versionsubscale TSKtsf [55] to high in TSKtotal. The fact that thereare three different variations of the English language version


available complicates its final qualification. The reliability ofthe various Dutch versions ranged from low on the 13-itemssubscale TSKpathologic somatic focus to high on the TSKtotal ina group of patients with Fibromyalgia. The support forreliability of the Swedish version was found to be high in agroup of patients with persistent low back pain [7]. Validitywas found to be low in all versions of the TSK.

4. Discussion

Five questionnaires, Fear of Pain Questionnaire (FPQ), PainAnxiety Symptoms Scale (PASS), Fear-Avoidance Beliefs Ques-tionnaire (FABQ), the Fear Avoidance of Pain Scale (FAPS),and the Tampa Scale for Kinesiophobia (TSK), were identifiedto assess fear in relation to pain. All questionnaires hadweaknesses in relation to their psychometric properties, poorreliability and validity indicating a lack of construct validity.At present the FABQ seems to be the best available ques-tionnaire to measure the concept “fear-avoidance beliefs”, thePASS seems to be the best available questionnaire to measure“pain-related fear”, and the TSK is the best used to measure“kinesiophobia”.

4.1. Conceptual and Measurement Models. As shown in thisstudy the description of the underlying conceptual modelappeared to be poor (FABQ, FAPQ, PASS) to nonexistent(TSK). The fact that no or only limited information isavailable concerning the description of the conceptual modelhas direct impact on the manner in which the conceptsare consecutively operationalised and measured. As a con-sequence of that, it is currently unclear how individualscores obtained from either of these questionnaires couldbe interpreted for research and clinical settings. Althoughin clinical practice several of the presented questionnairesare already frequently in use in order to screen individualpatients for fear related to pain, based on the results of thisreview, it could be concluded that the interpretation of thescoring has to be performed with caution. For example, whatwould be the clinical relevance of a high score on the FABQ?Based on the results of the current review, it can only beconcluded that in such a situation, a patient who has elevatedscores on the FABQ cannot be interpreted as having highfear-avoidance beliefs. A reported observation of Linton et al.[60] agrees with this finding. In one of their studies, patientsshowed a clinical relevant decrease in their fear-avoidancebeliefs as observed by the rehabilitation staff, although thischange was not represented in a change in TSKscoring.Patients continued to have high scores even after successfulparticipation in the treatment. This finding may suggest thatthe construct validity of the TSK version used was poor as thequestionnaire did not target fear as it was intended to or thatthe measure was not sensitive enough to pick up the actualclinical change. It can be concluded that there is an ambiguityin relation to the conceptual framework, and there are severaldifferent constructs to define what fear is in relation to pain.

It should be emphasized that none of the measuresseem to be explicitly based on the frequently referred toand well-established “cognitive-behavioural fear-avoidancemodel” [14]. All of the identified questionnaires (FABQ,

FAPS, FPQ, PASS and TSK) were already designed beforethe introduction of Vlaeyen’s fear avoidance model in 1995.This fear avoidance model has been further elaborated onby several other researchers [61–63]. In addition, two recentmodels have tried to incorporate alternative activity-relatedbehavioural strategies, among these are the Ergomaniamodel [64] and the Avoidance-Endurance model [65]. Insummary, there seems to be a discrepancy between themoment the measures and the conceptual models availableon fear related to pain were introduced. This leads to thequestion, what the questionnaires in their current versionsreally measure.

4.2. The Link between Models and Measures. At this stage,the reader might wonder whether the questionnaires can beused at all. Closely linked to the conceptual framework isthe validity of each questionnaire. In the current study, theevaluation of the evidence concerning validity was complex.It must however be noted that establishing validity of aninstrument is extremely difficult [26] what seems to implythat no questionnaire can be labelled as 100% valid [66].In the current study, firstly, the validation procedure wasoften poorly described, complicating quality judgment ofthis procedure. Some of the authors, however, succeeded toguide the reader through the procedure [27, 54]. Secondly,a variety of measures were used as external criterion in theconcurrent/criterion validity process. As shown in Table 3 allof the selected questionnaires were validated against otherquestionnaires as part of the validation process. However,the validity of the instrument used as the “gold standard”appeared to be in many occasions less established as it wasassumed. Based on the results of the current review, it wasshown that the FABQ, PASS, and TSK were all used toevaluate the validity of a reference instrument which hasbeen included during the original validity evaluation of thequestionnaire itself. Based on this circular reasoning, it canhowever only be concluded that both instruments measurethe same construct, but whether this construct is indeed thedesired construct is still unknown. For instance, studyingthe association between the TSK and the FABQ will resultin information regarding the construct validity [67] of thequestionnaires, but will not evaluate the concurrent/criterionvalidity for which a gold standard scale is required. Inthe articles reviewed, most authors referred indeed to thevalidation as an evaluation of construct/convergent ratherthan concurrent/criterion validity. However, it should benoted that even if the term for the validation is used properly,the weakness of construct/convergent validity is still present.Moreover, whether a test is valid or not is ultimately a matterof opinion based on the evidence available describing itsvalidity [26].

Some researchers have argued that an evaluation ofconstruct validity is the only proper way to evaluate thevalidity of an instrument [22, 26]. During construct validityevaluations, three essential steps have to be taken. Firstly,the domain of observables related to the construct hasto be specified; secondly, the extent to which observablestend to measure the same construct has to be determined;thirdly studies and/or experiments have to be performed


to determine the extent in which supposed measures ofthe constructs are consistent with “best guesses” aboutthe construct. According to Nunnally and Bernstein [22],researchers often tend to develop a measure of a constructand then leap to the third aspect, for example, correlatinga particular measure of anxiety with a particular measureof shyness instead of tightly defining the initial domain ofobservables for the construct. The challenge that lies aheadis to pool all the observations together by all these measuresand place them into a new elaborated framework.

4.3. Responsiveness. Based on the results of our review, itcan be concluded that the information currently availableon psychometric properties of the instruments is too limitedto establish their quality as diagnostic tests. For example, atthe moment evidence-based cut-off scores for the variousinstruments are still not available. In addition, the limitedinformation regarding responsiveness of the questionnairescomplicates the use in clinical practice, since informationon a clinically relevant change of an instrument is notavailable. Information on responsiveness was only availablefor the FABQ (German, French, Norwegian, Spanish, andChinese versions and the TSK 11-item English version).Whether these instruments are applicable for screeningpatients for pain-related fear seems an important topicfor future research. To support the appropriateness as anoutcome measure, more information must be gathered onthe responsiveness of the various measures.

4.4. Interpretability and Practicality. Both interpretabilityand practicality are seldom discussed in published articles,even though the evaluation of both constructs seem highlyrelevant in the questionnaire selection process. In the presentreview, these issues were only addressed in relation to theSpanish version of the FABQ [41]. In clinical practice, bothcriteria seem relevant and need to be highlighted for futureresearch.

4.5. Cross-Cultural Applicability. During cross-validation,both language and cultural differences should be taken intoaccount. For example, can a questionnaire which has beenreported as reliable and valid in Chinese based on cross-cultural validation between languages be used throughoutentire China, representing various intercultural differenceswithin this enormous country? As for the TSK, in Swedenand Norway, two countries with a comparable culturalbackground, two separate versions of the TSK are used,whereas in Belgium and Holland, the same language versionsare used, without considering possible cultural differences.Furthermore, the focus on language excludes immigrants,and there is a limitation in the generalization of the results.

4.6. Methodological Considerations. This review was basedon an evaluation of psychometric properties. It is evidentthat there is no such thing as a “gold standard” criteria forpsychometric testing. Even within the domain of researchon psychometric evaluation, there is no consensus as towhat should be included in an analysis of reliability andvalidity [66]. We therefore chose to base our analyses of the

psychometric properties on a modified version of the Wind-criteria [21]. For this purpose, the original Wind criteriawas adjusted based on the modification used in criteria ofGrotle et al. [68] and Larsen and Marx [69]. We would alsolike to clarify that the rationale for using criteria instead ofsimply presenting the data as shown in Table 3 was to providea guidance for the reader who is trying to decide whichmeasure to use.

There are, however, other methods available to evaluatereliability and validity. Psychometric theory assumes thatthe data is normally distributed and treated as data on atleast an interval level, while others argue that data fromquestionnaires are ordinal data [70, 71]. Svensson [72]has developed a family of non-parametric rank-invariantmethods that are valid for all types of ordered data withoutassumptions about their distribution. Bunketorp et al. [58]applied Svensson’s method to evaluate the reliability of aslightly different version of the TSK-SV and found it reliable.

Another model available for evaluation of measurementquality is the Rasch Model. [73], Rasch models [50, 52] arelogistic models in item response theory in which a person’slevel on a latent trait and the various items on the samelatent variable can be estimated independently. The Raschmodel was applied to the Norwegian version of the TSK byDamsgard et al. [57].

4.7. Limitations of the Study. Other instruments often pre-sented in association with the evaluated constructs are thePhotographs Series of Daily Activities (PHODA) [74] the PainBeliefs Screening Instrument (PBS) [75], Orebro Musculoskele-tal Pain Questionnaire [76], and the Pain and ImpairmentRelationship Scale (PAIRS) [77]. These instruments were notincluded in this review for various reasons. The PHODAwas not identified as part of the search, since it wasoriginally presented in Dutch. Furthermore, it is designedto determine the level of perceived harmfulness of variousphysical activities and movements. Both the PBS and theOrebro Musculoskeletal Pain Questionnaire are designed toscreen patients at risk of developing persistent pain whereasthe PAIRS was designed to assess beliefs about chronic painand functional impairment and were not included for furtherevaluation in the current review.

Another issue to be raised is the statement that thereis an (over)reliance on self-reports [78] for both constructs(fear and pain). Verbal reports as well as the other methods(observation by others and instrument/apparatus) have boththeir limitations [78]. The best methods of assessment aremultimodal and multimethod. However, such an analysis isnot always possible in a clinical setting. Once again, we needto be cautious when interpreting the results.

In conclusion, evidence supporting the psychometricproperties of questionnaires which are currently available tomeasure fear of pain in patients with musculoskeletal pain isstill incomplete. Future research on the validity of fear of painmeasures seems warranted. In order to facilitate the clinicalapplication of these instruments, it is recommended that thefocus of research be on an agreement of the conceptual andoperational definitions of the various constructs. One wayof starting that process is to combine the more established


psychometric procedures with a qualitative approach, inorder to be able to incorporate the patient’s perspective.

Acknowledgment

The authors would like to express thier sincere gratitudetowards Rita Zakarian for helping out with the languagerevision and the format of the paper.

References

[1] S. J. Linton, N. Buer, J. Vlaeyen, and A. L. Hellsing, “Are fear-avoidance beliefs related to the inception of an episode of backpain? A prospective study,” Psychology and Health, vol. 14, no.6, pp. 1051–1059, 2000.

[2] N. Buer and S. J. Linton, “Fear-avoidance beliefs and catas-trophizing: occurrence and risk factor in back pain and ADLin the general population,” Pain, vol. 99, no. 3, pp. 485–491,2002.

[3] J. Buitenhuis, J. P. C. Jaspers, and V. Fidler, “Can kinesiophobiapredict the duration of neck symptoms in acute whiplash?”Clinical Journal of Pain, vol. 22, no. 3, pp. 272–277, 2006.

[4] J. R. de Jong, J. W. Vlaeyen, P. Onghena, C. Cuypers, M. denHollander, and J. Ruijgrok, “Reduction of pain-related fearin complex regional pain syndrome type I: the application ofgraded exposure in vivo,” Pain, vol. 116, no. 3, pp. 264–275,2005.

[5] H. Heneweer, G. Aufdemkampe, M. W. van Tulder, H. Kiers,K. H. Stappaerts, and L. Vanhees, “Psychosocial variables inpatients with (sub)acute low back pain—an inception cohortin primary care physical therapy in the Netherlands,” Spine,vol. 32, no. 5, pp. 586–592, 2007.

[6] J. Kvist, A. Ek, K. Sporrstedt, and L. Good, “Fear of re-injury:a hindrance for returning to sports after anterior cruciateligament reconstruction,” Knee Surgery, Sports Traumatology,Arthroscopy, vol. 13, no. 5, pp. 393–397, 2005.

[7] M. Lundberg, S. Carlsson, and J. Styf, “A psychometricevaluation of the Tampa Scale for Kinesiophobia-from a phys-iotherapeutic perspective,” Physiotherapy Theory and Practice,vol. 20, no. 2, pp. 1–13, 2004.

[8] S. Lundgren, Pain and Physical Activity in Rheumatoid Arthri-tis: A Cognitive Approach in Physical Therapy, Karolinska Insti-tutet, Stockholm, Sweden, 2005.

[9] H. S. J. Picavet, J. W. Vlaeyen, and J. S. Schouten, “Pain cata-strophizing and kinesiophobia: predictors of chronic low backpain,” American Journal of Epidemiology, vol. 156, no. 11, pp.1028–1034, 2002.

[10] J. W. Vlaeyen, J. de Jong, M. Geilen, P. H. T. G. Heuts, andG. van Breukelen, “Graded exposure in vivo in the treatmentof pain-related fear: a replicated single-case experimentaldesign in four patients with chronic low back pain,” BehaviourResearch and Therapy, vol. 39, no. 2, pp. 151–166, 2001.

[11] J. W. Vlaeyen, J. de Jong, M. Geilen, P. H. T. G. Heuts, and G.van Breukelen, “The treatment of fear of movement/(re)injuryin chronic low back pain: further evidence on the effectivenessof exposure in vivo,” Clinical Journal of Pain, vol. 18, no. 4, pp.251–261, 2002.

[12] J. Lethem, P. D. Slade, J. D. Troup, and G. Bentley, “Outlineof a fear-avoidance model of exaggerated pain perception-I,”Behaviour Research and Therapy, vol. 21, no. 4, pp. 401–408,1983.

[13] S. H. Kori, R. P. Miller, and D. D. Todd, “Kinisiophobia: a newview of chronic pain behavior,” Pain Management, vol. 3, pp.35–43, 1990.

[14] J. W. Vlaeyen, A. M. Kole-Snijders, R. G. Boeren, and H. vanEek, “Fear of movement/(re)injury in chronic low back painand its relation to behavioral performance,” Pain, vol. 62, no.3, pp. 363–372, 1995.

[15] G. J. Asmundson and S. Taylor, “Role of anxiety sensitivityin pain-related fear and avoidance,” Journal of BehavioralMedicine, vol. 19, no. 6, pp. 577–586, 1996.

[16] G. Waddell, M. Newton, I. Henderson, D. Somerville, andC. J. Main, “A Fear-Avoidance Beliefs Questionnaire (FABQ)and the role of fear-avoidance beliefs in chronic low back painand disability,” Pain, vol. 52, no. 2, pp. 157–168, 1993.

[17] B. H. K. Balderson, H. B. N. Lin, and M. von Korff, TheManagement of Pain-Related Fear in Primary Care, OxfordUniversity Press, New York, NY, USA, 2004.

[18] L. M. McCracken, C. Zayfert, and R. T. Gross, “The PainAnxiety Symptoms Scale: development and validation of ascale to measure fear of pain,” Pain, vol. 50, no. 1, pp. 67–73,1992.

[19] R. P. Miller, S. H. Kori, and D. D. Todd, The Tampa Scale,Tampa, Fla, USA, 1991.

[20] K. N. Lohr, N. K. Aaronson, J. Alonso et al., “Evaluatingquality-of-life and health status instruments: development ofscientific review criteria,” Clinical Therapeutics, vol. 18, no. 5,pp. 979–992, 1996.

[21] H. Wind, V. Gouttebarge, P. P. Kuijer, and M. H. W. Frings-Dresen, “Assessment of functional capacity of the muscu-loskeletal system in the context of work, daily living, and sport:a systematic review,” Journal of Occupational Rehabilitation,vol. 15, no. 2, pp. 253–272, 2005.

[22] J. C. Nunnally and I. H. Bernstein, Psychometric Theory,McGraw-Hill, New York, NY, USA, 3rd edition, 1994.

[23] L. G. Portney and M. P. Watkins, Foundations of ClinicalResearch: Applications to Practice, Prentice Hall, Upper SaddleRiver, NJ, USA, 2nd edition, 2000.

[24] L. J. Cronbach, “Coefficient alpha and the internal structure oftests,” Psychometrika, vol. 16, no. 3, pp. 297–334, 1951.

[25] D. F. Polit and B. P. Hungler, Nursing Research: Principles andMethods, Lippincott, Philadelphia, Pa, USA, 6th edition, 1999.

[26] P. Kline, The New Psychometrics: Science, Psychology andMeasurement, Routledge, London, UK, 1998.

[27] M. Grotle, J. I. Brox, and N. K. Vøllestad, “Reliability, validityand responsiveness of the fear-avoidance beliefs questionaire:methodological aspects of the Norwegian version,” Journal ofRehabilitation Medicine, vol. 38, no. 6, pp. 346–353, 2006.

[28] D. K. Larsen, S. Taylor, and G. J. G. Asmundson, “Exploratoryfactor analysis of the Pain Anxiety Symptoms Scale in patientswith chronic pain complaints,” Pain, vol. 69, no. 1-2, pp. 27–34, 1997.

[29] K. C. Lee, T. T. W. Chiu, and T. H. Lam, “Psychometricproperties of the Fear-Avoidance Beliefs Questionnaire inpatients with neck pain,” Clinical Rehabilitation, vol. 20, no.10, pp. 909–920, 2006.

[30] K. C. Lee, T. T. W. Chiu, and T. H. Lam, “The role of fear-avoidance beliefs in patients with neck pain: relationshipswith current and future disability and work capacity,” ClinicalRehabilitation, vol. 21, no. 9, pp. 812–821, 2007.

[31] G. Crombez, J. W. Vlaeyen, P. H. Heuts, and R. Lysens, “Pain-related fear is more disabling than pain itself: evidence on therole of pain-related fear in chronic back pain disability,” Pain,vol. 80, no. 1-2, pp. 329–339, 1999.


[32] M. F. Reneman, W. Jorritsma, S. J. Dijkstra, and P. U. Dijkstra,“Relationship between kinesiophobia and performance ina functional capacity evaluation,” Journal of OccupationalRehabilitation, vol. 13, no. 4, pp. 277–285, 2003.

[33] G. Waddell, M. Newton, I. Henderson, D. Somerville, and C.J. Main, “A Fear-Avoidance Beliefs Questionnaire (FABQ) andthe role of fear-avoidance beliefs in chronic low back pain anddisability,” Pain, vol. 52, no. 2, pp. 157–168, 1993.

[34] L. M. McCracken, R. T. Gross, J. Aikens, and C. L. M. Carnrike,“The assessment of anxiety and fear in persons with chronicpain: a comparison of instruments,” Behaviour Research andTherapy, vol. 34, no. 11-12, pp. 927–933, 1996.

[35] K. Chaory, F. Fayad, F. Rannou et al., “Validation of the Frenchversion of the fear avoidance belief questionnaire,” Spine, vol.29, no. 8, pp. 908–913, 2004.

[36] M. Pfingsten, B. Kroner-Herwig, E. Leibing, and U. Kro-nshage, “Validation of the German version of the Fear-Avoidance Beliefs Questionnaire (FABQ),” European Journal ofPain, vol. 4, no. 3, pp. 259–266, 2000.

[37] R. Staerkle, A. F. Mannion, A. Elfering et al., “Longitudi-nal validation of the Fear-Avoidance Beliefs Questionnaire(FABQ) in a Swiss-German sample of low back pain patients,”European Spine Journal, vol. 13, no. 4, pp. 332–340, 2004.

[38] R. Staerkle, A. F. Mannion, A. Elfering et al., “Longitudi-nal validation of the Fear-Avoidance Beliefs Questionnaire(FABQ) in a Swiss-German sample of low back pain patients,”European Spine Journal, vol. 16, no. 10, pp. 1750–1751, 2007.

[39] G. Georgoudis, G. Papathanasiou, P. Spiropoulos, and K.Katsoulakis, “Cognitive assessment of musculoskeletal painwith a newly validated Greek version of the Fear-AvoidanceBeliefs Questionnaire (FABQ),” European Journal of Pain, vol.11, no. 3, pp. 341–351, 2007.

[40] T. Jacob, M. Baras, and L. Epstein, “Low back pain: reliabilityof a set of pain measurement tools,” Archives of Physical Medi-cine and Rehabilitation, vol. 82, no. 6, pp. 735–742, 2001.

[41] F. M. Kovacs, A. Muriel, J. M. Medina et al., “Psychometriccharacteristics of the Spanish version of the FAB question-naire,” Spine, vol. 31, no. 1, pp. 104–110, 2006.

[42] D. Crowley and A. S. Kendall, “Development and initialvalidation of a questionnaire for measuring fear-avoidanceassociated with pain: the fear-avoidance of pain scale,” Journalof Musculoskeletal Pain, vol. 7, no. 3, pp. 3–19, 1999.

[43] K. G. Hursey and S. D. Jacks, “Fear of pain in recurrentheadache sufferers,” Headache, vol. 32, no. 6, pp. 283–286,1992.

[44] D. W. McNeil and A. J. Rainwater Jr., “Development of the fearof pain questionnaire—III,” Journal of Behavioral Medicine,vol. 21, no. 4, pp. 389–410, 1998.

[45] D. W. McNeil, A. J. Rainwater, and L. Al-Jazireh, “Develop-ment of a methodology to measure fear of pain,” in Proceedingsof the Annual meeting of the Association for Advancement ofBehavior Therapy, 1986.

[46] J. Roelofs, L. McCracken, M. L. Peters, G. Crombez, G. vanBreukelen, and J. W. S. Vlaeyen, “Psychometric evaluationof the Pain Anxiety Symptoms Scale (PASS) in chronic painpatients,” Journal of Behavioral Medicine, vol. 27, no. 2, pp.167–183, 2004.

[47] J. W. Burns, J. T. Mullen, L. Higdon, J. M. Wei, and D.Lansky, “Validity of the Pain Anxiety Symptoms Scale (PASS):prediction of physical capacity variables,” Pain, vol. 84, no. 2-3,pp. 247–252, 2000.

[48] C. Strahl, R. A. Kleinknecht, and D. L. Dinnel, “The roleof pain anxiety, coping, and pain self-efficacy in rheumatoid

arthritis patient functioning,” Behaviour Research and Ther-apy, vol. 38, no. 9, pp. 863–873, 2000.

[49] M. J. Coons, H. D. Hadjistavropoulos, and G. J. G. Asmund-son, “Factor structure and psychometric properties of the PainAnxiety Symptoms Scale-20 in a community physiotherapyclinic sample,” European Journal of Pain, vol. 8, no. 6, pp. 511–516, 2004.

[50] J. Vlaeyen, M. Kole-Snijders, A. Rotteveel, R. Ruesink, and P.H. T. G. Heuts, “The role of fear of movement/(re)injury inpain disability,” Journal of Occupational Rehabilitation, vol. 5,no. 4, pp. 235–252, 1995.

[51] L. Goubert, G. Crombez, S. van Damme, J. W. S. Vlaeyen,P. Bijttebier, and J. Roelofs, “Confirmatory factor analysis ofthe tampa scale for kinesiophobia: invariant two-factor modelacross low back pain patients and fibromyalgia patients,”Clinical Journal of Pain, vol. 20, no. 2, pp. 103–110, 2004.

[52] J. Roelofs, L. Goubert, M. L. Peters, J. W. S. Vlaeyen, andG. Crombez, “The Tampa Scale for Kinesiophobia: furtherexamination of psychometric properties in patients withchronic low back pain and fibromyalgia,” European Journal ofPain, vol. 8, no. 5, pp. 495–502, 2004.

[53] T. Burwinkle, J. P. Robinson, and D. C. Turk, “Fear of move-ment: factor structure of the Tampa Scale of Kinesiophobia inpatients with fibromyalgia syndrome,” Journal of Pain, vol. 6,no. 6, pp. 384–391, 2005.

[54] S. R. Woby, N. K. Roach, M. Urmston, and P. J. Watson,“Psychometric properties of the TSK-11: a shortened versionof the Tampa Scale for Kinesiophobia,” Pain, vol. 117, no. 1-2,pp. 137–144, 2005.

[55] M. E. Clark, S. H. Kori, and J. Brockel, “Kinesiophobia andchronic pain: psychometrics characteristics and factor analysisof the Tampa Scale,” in Proceedings of the American Pain SocietyAnnual Meeting, vol. 15, p. 77, American Pain Society, 1996.

[56] D. J. French, C. R. France, F. Vigneau, J. A. French, and R.T. Evans, “Fear of movement/(re)injury in chronic pain: apsychometric assessment of the original English version of theTampa scale for kinesiophobia (TSK),” Pain, vol. 127, no. 1-2,pp. 42–51, 2007.

[57] E. Damsgard, T. Fors, A. Anke, and C. Røe, “The tampascale of Kinesiophobia: a rasch analysis of its properties insubjects with low back and more widespread pain,” Journal ofRehabilitation Medicine, vol. 39, no. 9, pp. 672–678, 2007.

[58] L. Bunketorp, J. Carlsson, J. Kowalski, and E. Stener-Victorin, “Evaluating the reliability of multi-item scales: anon-parametric apprach to the ordered categorical structureof data collected with the Swedish version of the TampaScale for Kinesiophobia and the Self-Efficacy Scale,” Journal ofRehabilitation Medicine, vol. 37, no. 5, pp. 330–334, 2005.

[59] L. M. McCracken, C. Zayfert, and R. T. Gross, “The PainAnxiety Symptoms Scale: development and validation of ascale to measure fear of pain,” Pain, vol. 50, no. 1, pp. 67–73,1992.

[60] S. J. Linton, T. Overmeer, M. Janson, J. W. S. Vlaeyen, and J. R.de Jong, “Graded in vivo exposure treatment for fear-avoidantpain patients with functional disability: a case study,” CognitiveBehaviour Therapy, vol. 31, no. 2, pp. 49–58, 2002.

[61] G. J. Asmundson, P. J. Norton, and G. R. Norton, “Beyondpain: the role of fear and avoidance in chronicity,” ClinicalPsychology Review, vol. 19, no. 1, pp. 97–119, 1999.

[62] G. Crombez, L. Vervaet, F. Baeyens, R. Lysens, and P. Eelen,“Do pain expectancies cause pain in chronic low back patients?A clinical investigation,” Behaviour Research and Therapy, vol.34, no. 11-12, pp. 919–925, 1996.


[63] U. Kronshage, B. Kroener-Herwig, and M. Pfingsten, “Kine-siophobia in chronic low back pain patients—does the startleparadigm support the hypothesis?” International Journal ofBehavioral Medicine, vol. 8, no. 4, pp. 304–318, 2001.

[64] B. van Houdenhove and E. Neerinckx, “Is ’ergomania’ a pre-disposing factor to chronic pain and fatigue?” Psychosomatics,vol. 40, no. 6, pp. 529–530, 1999.

[65] M. Hasenbring, “Attentional control of pain and the processof chronification,” in Progress in Pain Research, J. B. B.Sandkuhler and G. F. Gebhart, Eds., vol. 129, pp. 525–534,Elsevier, New York, NY, USA, 2000.

[66] P. Kline, Handbook of Psychological Testing, Routledge, Lon-don, UK, 2nd edition, 2000.

[67] E. J. Swinkels-Meewisse, R. A. Swinkels, A. L. Verbeek, J. W. S.Vlaeyen, and R. A. B. Oostendorp, “Psychometric propertiesof the Tampa Scale for kinesiophobia and the fear-avoidancebeliefs questionnaire in acute low back pain,” Manual Therapy,vol. 8, no. 1, pp. 29–36, 2003.

[68] M. Grotle, J. I. Brox, and N. K. Vøllestad, “Concurrentcomparison of responsiveness in pain and functional statusmeasurements used for patients with low back pain,” Spine,vol. 29, no. 21, pp. E492–E501, 2004.

[69] R. J. Larsen and M. L. Marx, An Introduction to Mathemat-ical Statistics and Its Applications, Prentice-Hall, EngelwoodsCliffs, NJ, USA, 1986.

[70] A. Agresti, Categorical Data Analysis, John Wiley & Sons, NewYork, NY, USA, 1990.

[71] E. Svensson, “Ordinal invariant measures for individual andgroup changes in ordered categorical data,” Statistics inMedicine, vol. 17, no. 24, pp. 2923–2936, 1998.

[72] E. Svensson, “Guidelines to statistical evaluation of data fromrating scales and questionnaires,” Journal of RehabilitationMedicine, vol. 33, no. 1, pp. 47–48, 2001.

[73] G. Rasch, Probabilistic Models for Some Intelligence andAttainment Tests, Copenhagen, Denmark, 1960.

[74] K. Kugler, J. Wijn, and M. Geilen, The Photograph Seriesof Daily Activities (PHODA), Heerlen, The Netherlands,Amsterdam, 1999.

[75] M. Sandborgh, P. Lindberg, and E. Denison, “Pain beliefscreening instrument: development and preliminary valida-tion of a screening instrument for disabling persistent pain,”Journal of Rehabilitation Medicine, vol. 39, no. 6, pp. 461–466,2007.

[76] S. J. Linton and K. Hallden, “Can we screen for problematicback pain? A screening questionnaire for predicting outcomein acute and subacute back pain,” Clinical Journal of Pain, vol.14, no. 3, pp. 209–215, 1998.

[77] J. F. Riley, D. K. Ahern, and M. J. Follick, “Chronic painand functional impairment: assessing beliefs about theirrelationship,” Archives of Physical Medicine and Rehabilitation,vol. 69, no. 8, pp. 579–582, 1988.

[78] D. W. McNeil and K. E. Wovles, “Assessment of fear andanxiety associated with pain: conceptualization, methods, andmeasures,” in Understanding and Treating Fear of Pain, G. J. G.Asmundson, J. W. S. Vlaeyen, and G. Crombez, Eds., pp. 189–212, Oxford University Press, New York, NY, USA, 2004.

Submit your manuscripts athttp://www.hindawi.com

Stem CellsInternational

Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014


MEDIATORSINFLAMMATION

of


Behavioural Neurology

EndocrinologyInternational Journal of



Disease Markers


BioMed Research International

OncologyJournal of



Oxidative Medicine and Cellular Longevity


PPAR Research

The Scientific World JournalHindawi Publishing Corporation http://www.hindawi.com Volume 2014

Immunology ResearchHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014

Journal of

ObesityJournal of



Computational and Mathematical Methods in Medicine

OphthalmologyJournal of


Diabetes ResearchJournal of



Research and TreatmentAIDS


Gastroenterology Research and Practice


Parkinson’s Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com

review article pain-relatedfear

Documents