Translation, Cross-Cultural Adaptation, Reliability, and Validity of the Tamil Version of Fear-Avoidance Beliefs Questionnaire in Chronic Low Back Pain

Abstract

Background: Excessive fear of movement, restricted physical activity, and cognitive distortions are frequently found with chronic low back pain (CLBP) subjects. The Fear-Avoidance Beliefs Questionnaire (FABQ) is the most well-founded and often used tool to measure fear and avoidance beliefs in CLBP subjects. In India, there is a diversity of culture, educational level, and language. So, there is a need to translate FABQ into the regional language Tamil, which will improve understanding of FABQ and reduce the language barrier of the Tamil population. Objective: To translate, cross-cultural adapt, and investigate the psychometric properties of the Tamil version of FABQ in CLBP subjects. Materials & Methods: The standard translation and adaptation guideline was used to translate FABQ into Tamil version FABQ. CLBP subjects referred to a low back rehabilitation program in an outpatient clinic took part in this study. They completed a FABQ-Tamil questionnaire [includes subscales for Physical Activity (FABQ-PA) and Work (FABQ-W)], pain rating visual analog scale and the Roland- Morris Disability Questionnaire (RMDQ)-Tamil version, on two occasions five days apart. Test-retest reliability, internal consistency and validity were evaluated. Results: Fifty CLBP subjects participated with a mean age of 39.94 (± 15.55) years. Convergent validity analysis displayed a moderate correlation between FABQ-PA and VAS (r = 0.63); FABQ-W and VAS (r = 0.64). Divergent validity analysis demonstrated a moderate correlation between FABQ-PA and RMDQ (r = 0.69) and a good correlation between FABQ-W and RMDQ (r = 0.85). The test-retest reliability was high; the intra-class correlation coefficients of FABQ-PA and FABQ-W were ICC-0.90 and 0.94, respectively. Cronbach's alpha for the FABQ-PA and FABQ-W were 0.87 and 0.92, demonstrating high internal consistency. Conclusion: The findings of this study demonstrated that the FABQ-Tamil version questionnaire is a reliable and valid measure of fear of pain and fear-avoidance beliefs in the Tamil-speaking CLBP subject.