Abstract
Purpose: The aim of this study was to the Athlete Fear Avoidance Questionnaire (AFAQ) into the Turkish language for Turkish-speaking athletes.
Methods: AFAQ-TR performed on 146 high school athletes (88 males and 58 females; (mean age: 17.39±1.6 years, body mass index 21.92±3.82 kg/m2). Complies with worldwide standards, the questionnaire was cross-culturally adapted. The psychometric evaluation included an assessment of reliability with internal consistency, intraclass correlation coefficient (ICC (2,1)), standard error of measurement (SEM) and minimum detectable change (MDC), construct validity with exploratory factor analysis, convergent validity, and feasibility analysis. We used the Numerical Pain Rating Scale (NPRS), the Pain Catastrophizing Scale (PCS) and the Fear Avoidance Beliefs Questionnaire (FABQ) subscales (FABQ-Physical Activity (FABQ-PA) and FABQ-Work (FABQ-W)).
Results: The ICC (2,1) of the AFAQ-TR was 0.912 (95% CI: 0.878–0.937). The SEM and MDC95 for the AFAQ-TR were 2.61 and 7.23, respectively. The findings of the factor analysis indicated that AFAQ-TR had a two-factor solution, and 10-item. As hypothesized a priori, the AFAQ-TR demonstrated a moderate correlation with the NPRS (r=0.207; p=0.013), PCS (r=0.723; p<0.001), FABQ-PA (r=0.539; p<0.001), and FABQ-W (r=0.530; p<0.001). None of the athletes met the maximum or minimum achievable scores, both overall and per item. Thus, there were no floor or ceiling effects.
Conclusion: The AFAQ-TR is a reliable, valid, and feasible questionnaire for Turkish-speaking athletes. It is recommended that clinicians utilize the AFAQ-TR in order to evaluate the fear-avoidance variables in athletes.
Keywords
Fear-avoidance Fear-avoidance behavior model Athletic injuries Psychometrics Rehabilitation Cross-cultural adaptation
References
- Ivarsson A, Johnson U, Andersen MB, et al. Psychosocial factors and sport injuries: meta-analyses for prediction and prevention. Sports Med. 2017;47:353-365.
- Garrick JG, Requa RK. Sports and fitness activities: the negative consequences. J Am Acad Orthop Sur. 2003;11:439-443.
- Crossman J. Psychological rehabilitation from sports injuries. Sports Med. 1997;23:333-339.
- Bianco T, Malo S, Orlick T. Sport injury and illness: Elite skiers describe their experiences. Res Q Exercıse Sport. 1999;70:157-169.
- Gould D, Bridges D, Udry E, et al. Stress sources encountered when rehabilitating from season-ending ski injuries. Sport Psychol. 1997;11(4):361-378.
- Kvist J, Ek A, Sporrstedt K, Good L. Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg Sport Tr A. 2005;13:393-397.
- Taylor J, Taylor S. Psychological approaches to sports injury rehabilitation. Lippincott:Williams & Wilkins; 1997.
- Cozzi AL, Dunn KL, Harding JL, et al. Kinesiophobia after anterior cruciate ligament reconstruction in physically active individuals. J Sport Rehabil. 2015;24:434-439.
- Nippert AH, Smith AM. Psychologic stress related to injury and impact on sport performance. Phys Med Reh Clin N. 2008;19:399-418.
- Porter DA, May BD, Berney T. Functional outcome after operative treatment for ankle fractures in young athletes: a retrospective case series. Foot Ankle Int. 2008;29:887-894.
- Vibe Fersum K, O'Sullivan P, Skouen J, et al. Efficacy of classification‐based cognitive functional therapy in patients with non‐specific chronic low back pain: A randomized controlled trial. Eur J Pain. 2013;17:916-928.
- Vlaeyen JW, Kole-Snijders AM, Boeren RG, et al. H. Fear of movement/(re) injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62:363-372.
- Walker N, Thatcher J, Lavallee D. Psychological responses to injury in competitive sport: a critical review. J R Soc Promot Health. 2007;127:174-180.
- Gignac MA, Cao X, Ramanathan S, et al. Perceived personal importance of exercise and fears of re-injury: a longitudinal study of psychological factors related to activity after anterior cruciate ligament reconstruction. BMC Sports Sci Med Rehabil. 2015;7:1-9.
- Hartigan EH, Lynch AD, Logerstedt DS, et al. Kinesiophobia after anterior cruciate ligament rupture and reconstruction: noncopers versus potential copers. J Orthop Sports Phys Ther. 2013;43:821-832.
- Langford JL, Webster KE, Feller JA. A prospective longitudinal study to assess psychological changes following anterior cruciate ligament reconstruction surgery. Brit J Sport Med. 2009;43:377-378.
- Wiese‐Bjornstal DM. Psychology and socioculture affect injury risk, response, and recovery in high‐intensity athletes: a consensus statement. Scand J Med Sci Spor. 2010;20:103-111.
- Meyers MC, Bourgeois AE, Stewart S, et al. Predicting pain response in athletes: Development and assessment of the Sports Inventory for Pain. Int J Sport Exerc Ps. 1992;14:249-261.
- Glazer DD. Development and preliminary validation of the Injury-Psychological Readiness to Return to Sport (I-PRRS) scale. J Athl Training. 2009;44:185-189.
- Dover G, Amar V. Development and validation of the athlete fear avoidance questionnaire. J Athl Training. 2015;50:634-642.
- Waddell G, Newton M, Henderson I, et al. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52:157-168.
- Franchignoni F, Giordano A, Ferriero G, et al. Measurement precision of the Pain Catastrophizing Scale and its short forms in chronic low back pain. Sci Rep-Uk. 2022;12:12042.
- Monticone M, Dover G, Massidda M, et al. Cross-cultural adaptation and validation of the Athlete Fear Avoidance Questionnaire in Italian university athletes with musculoskeletal injuries. Int J Rehabil Res. 2022;45:223-229.
- Farrar JT, Young Jr JP, LaMoreaux L,et al. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149-158.
- Monticone M, Baiardi P, Bonetti F, et al. The Italian version of the Fear-Avoidance Beliefs Questionnaire (FABQ-I): cross-cultural adaptation, factor analysis, reliability, validity, and sensitivity to change. Spine. 2012;37:E374-E380.
- Sullivan MJ. The pain catastrophizing scale: user manual. Montreal: McGill University. 2009;1:36.
- Stratford PW. Estimating the standard error of measurement from reliability studies. Physiother Can. 2004;56:27-30.
- Boateng GO, Neilands TB, Frongillo EA, et al. Best practices for developing and validating scales for health, social, and behavioral research: a primer. Front Public Health. 2018;6:149.
- Williams B, Onsman A, Brown T. Exploratory factor analysis: A five-step guide for novices. Australas J Paramed. 2010;8:1-13.
- Bonett DG. Sample size requirements for estimating intraclass correlations with desired precision. Stat Med. 2002;21:1331-1335.
- Reis-Junior JR, Bassi-Dibai D, Morais DN, et al. Translation, cross-cultural adaptation, and validation of the Athlete Fear Avoidance Questionnaire (AFAQ) into Brazilian Portuguese. BMC Musculoskel Dis. 2022;23(1):974.
- Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15:155-163.
- Darnall BD, Sturgeon JA, Cook KF, et al. Development and validation of a daily pain catastrophizing scale. J Pain Res. 2017;18:1139-1149.
- O’Connor S, Moran K, Sheridan A, et al. Fear avoidance after injury and readiness to return to sport in collegiate male and female Gaelic games players. Sports Health. 2021;13:532-539.
- DiSanti J, Lisee C, Erickson K, et al. Perceptions of rehabilitation and return to sport among high school athletes with anterior cruciate ligament reconstruction: a qualitative research study. J Orthop Sports Phys Ther. 2018;48:951-959.
- Monticone M, Ambrosini E, Rocca B, et al. Multimodal exercises integrated with cognitive-behavioural therapy improve disability of patients with failed back surgery syndrome: a randomized controlled trial with one-year follow-up. Disabil Rehabil. 2022;44:3422-3429.
- O’Keeffe S, Chéilleachair NN, O’Connor S. Fear avoidance following musculoskeletal injury in male adolescent gaelic footballers. J Sport Rehabil. 2019;29:413-419.
Abstract
Amaç: Bu çalışmanın amacı Sporcu Korku Kaçınma Anketi'ni (AFAQ) Türkçe konuşan sporcular için Türkçe’ye uyarlamaktır.
Yöntem: AFAQ-TR 146 lise sporcusu üzerinde uygulanmıştır (88 erkek ve 58 kadın; (ortalama yaş: 17,39±1,6 yıl, vücut kütle indeksi 21,92±3,82 kg/m2). Psikometrik değerlendirme, iç tutarlılık, sınıf içi korelasyon katsayısı (ICC), ölçümün standart hatası ve minimum tespit edilebilir değişim ile güvenilirlik; açıklayıcı faktör analizi, yakınsak geçerlilik ve fizibilite analizi ile yapı geçerliliği değerlendirmesini içeriyordu. Sayısal Ağrı Derecelendirme Ölçeği (NPRS), Ağrı Felaketleştirme Ölçeği (PCS) ve Korkudan Kaçınma İnançları Anketi (FABQ) alt ölçekleri (FABQ -Fiziksel Aktivite (FABQ-PA) ve FABQ -İş (FABQ-W)) kullanılmıştır.
Bulgular: AFAQ-TR'nin ICC (2,1) değeri 0,912 (%95 CI: 0,878-0,937), SEM ve MDC değerleri ise sırasıyla 2,61 ve 7,23 olarak bulunmuştur. Faktör analizi bulguları, AFAQ-TR'nin iki faktörlü ve 10 maddelik bir çözüme sahip olduğunu göstermiştir. Önceden varsayıldığı gibi AFAQ-TR, NPRS (r=0,207; p=0,013), PCS (r=0,723; p<0,001), FABQ-PA (r=0,539; p<0,001) ve FABQ-W (r=0,530; p<0,001) ile orta düzeyde bir korelasyon göstermiştir. Sporcuların hiçbiri hem genel hem de madde başına ulaşılabilecek maksimum veya minimum puanları karşılamamıştır. Dolayısıyla, taban veya tavan etkisi görülmemiştir.
Sonuç: AFAQ-TR, Türkçe konuşan sporcular için güvenilir, geçerli ve uygulanabilir bir ankettir. Klinisyenlerin sporcularda korku-kaçınma değişkenlerini değerlendirmek için AFAQ-TR'yi kullanmaları önerilmektedir.
Keywords
Korku-kaçınma Korku-kaçınma davranış modeli Atletik yaralanmalar Psikometri Rehabilitasyon Kültürlerarası adaptasyon
References
- Ivarsson A, Johnson U, Andersen MB, et al. Psychosocial factors and sport injuries: meta-analyses for prediction and prevention. Sports Med. 2017;47:353-365.
- Garrick JG, Requa RK. Sports and fitness activities: the negative consequences. J Am Acad Orthop Sur. 2003;11:439-443.
- Crossman J. Psychological rehabilitation from sports injuries. Sports Med. 1997;23:333-339.
- Bianco T, Malo S, Orlick T. Sport injury and illness: Elite skiers describe their experiences. Res Q Exercıse Sport. 1999;70:157-169.
- Gould D, Bridges D, Udry E, et al. Stress sources encountered when rehabilitating from season-ending ski injuries. Sport Psychol. 1997;11(4):361-378.
- Kvist J, Ek A, Sporrstedt K, Good L. Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg Sport Tr A. 2005;13:393-397.
- Taylor J, Taylor S. Psychological approaches to sports injury rehabilitation. Lippincott:Williams & Wilkins; 1997.
- Cozzi AL, Dunn KL, Harding JL, et al. Kinesiophobia after anterior cruciate ligament reconstruction in physically active individuals. J Sport Rehabil. 2015;24:434-439.
- Nippert AH, Smith AM. Psychologic stress related to injury and impact on sport performance. Phys Med Reh Clin N. 2008;19:399-418.
- Porter DA, May BD, Berney T. Functional outcome after operative treatment for ankle fractures in young athletes: a retrospective case series. Foot Ankle Int. 2008;29:887-894.
- Vibe Fersum K, O'Sullivan P, Skouen J, et al. Efficacy of classification‐based cognitive functional therapy in patients with non‐specific chronic low back pain: A randomized controlled trial. Eur J Pain. 2013;17:916-928.
- Vlaeyen JW, Kole-Snijders AM, Boeren RG, et al. H. Fear of movement/(re) injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62:363-372.
- Walker N, Thatcher J, Lavallee D. Psychological responses to injury in competitive sport: a critical review. J R Soc Promot Health. 2007;127:174-180.
- Gignac MA, Cao X, Ramanathan S, et al. Perceived personal importance of exercise and fears of re-injury: a longitudinal study of psychological factors related to activity after anterior cruciate ligament reconstruction. BMC Sports Sci Med Rehabil. 2015;7:1-9.
- Hartigan EH, Lynch AD, Logerstedt DS, et al. Kinesiophobia after anterior cruciate ligament rupture and reconstruction: noncopers versus potential copers. J Orthop Sports Phys Ther. 2013;43:821-832.
- Langford JL, Webster KE, Feller JA. A prospective longitudinal study to assess psychological changes following anterior cruciate ligament reconstruction surgery. Brit J Sport Med. 2009;43:377-378.
- Wiese‐Bjornstal DM. Psychology and socioculture affect injury risk, response, and recovery in high‐intensity athletes: a consensus statement. Scand J Med Sci Spor. 2010;20:103-111.
- Meyers MC, Bourgeois AE, Stewart S, et al. Predicting pain response in athletes: Development and assessment of the Sports Inventory for Pain. Int J Sport Exerc Ps. 1992;14:249-261.
- Glazer DD. Development and preliminary validation of the Injury-Psychological Readiness to Return to Sport (I-PRRS) scale. J Athl Training. 2009;44:185-189.
- Dover G, Amar V. Development and validation of the athlete fear avoidance questionnaire. J Athl Training. 2015;50:634-642.
- Waddell G, Newton M, Henderson I, et al. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52:157-168.
- Franchignoni F, Giordano A, Ferriero G, et al. Measurement precision of the Pain Catastrophizing Scale and its short forms in chronic low back pain. Sci Rep-Uk. 2022;12:12042.
- Monticone M, Dover G, Massidda M, et al. Cross-cultural adaptation and validation of the Athlete Fear Avoidance Questionnaire in Italian university athletes with musculoskeletal injuries. Int J Rehabil Res. 2022;45:223-229.
- Farrar JT, Young Jr JP, LaMoreaux L,et al. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149-158.
- Monticone M, Baiardi P, Bonetti F, et al. The Italian version of the Fear-Avoidance Beliefs Questionnaire (FABQ-I): cross-cultural adaptation, factor analysis, reliability, validity, and sensitivity to change. Spine. 2012;37:E374-E380.
- Sullivan MJ. The pain catastrophizing scale: user manual. Montreal: McGill University. 2009;1:36.
- Stratford PW. Estimating the standard error of measurement from reliability studies. Physiother Can. 2004;56:27-30.
- Boateng GO, Neilands TB, Frongillo EA, et al. Best practices for developing and validating scales for health, social, and behavioral research: a primer. Front Public Health. 2018;6:149.
- Williams B, Onsman A, Brown T. Exploratory factor analysis: A five-step guide for novices. Australas J Paramed. 2010;8:1-13.
- Bonett DG. Sample size requirements for estimating intraclass correlations with desired precision. Stat Med. 2002;21:1331-1335.
- Reis-Junior JR, Bassi-Dibai D, Morais DN, et al. Translation, cross-cultural adaptation, and validation of the Athlete Fear Avoidance Questionnaire (AFAQ) into Brazilian Portuguese. BMC Musculoskel Dis. 2022;23(1):974.
- Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15:155-163.
- Darnall BD, Sturgeon JA, Cook KF, et al. Development and validation of a daily pain catastrophizing scale. J Pain Res. 2017;18:1139-1149.
- O’Connor S, Moran K, Sheridan A, et al. Fear avoidance after injury and readiness to return to sport in collegiate male and female Gaelic games players. Sports Health. 2021;13:532-539.
- DiSanti J, Lisee C, Erickson K, et al. Perceptions of rehabilitation and return to sport among high school athletes with anterior cruciate ligament reconstruction: a qualitative research study. J Orthop Sports Phys Ther. 2018;48:951-959.
- Monticone M, Ambrosini E, Rocca B, et al. Multimodal exercises integrated with cognitive-behavioural therapy improve disability of patients with failed back surgery syndrome: a randomized controlled trial with one-year follow-up. Disabil Rehabil. 2022;44:3422-3429.
- O’Keeffe S, Chéilleachair NN, O’Connor S. Fear avoidance following musculoskeletal injury in male adolescent gaelic footballers. J Sport Rehabil. 2019;29:413-419.
Details
| Primary Language | English |
|---|---|
| Subjects | Physiotherapy |
| Journal Section | Articles |
| Authors | |
| Publication Date | August 1, 2025 |
| Submission Date | September 26, 2024 |
| Acceptance Date | December 16, 2024 |
| Published in Issue | Year 2025 Volume: 12 Issue: 2 |
