HEALTH SERVICES RESEARCH SPINE Volume 37, Number 6, pp E374–E380 ©2012, Lippincott Williams & Wilkins E374 www.spinejournal.com March 2012 The Italian Version of the Fear-Avoidance Beliefs Questionnaire (FABQ-I) Cross-Cultural Adaptation, Factor Analysis, Reliability, Validity, and Sensitivity to Change Marco Monticone, MD, Paola Baiardi, PhD, Francesca Bonetti, PT , Silvano Ferrari, PT, Calogero Foti, MD , Paolo Pillastrini, PT, Barbara Rocca, PSY, Carla Vanti, PT, and Gustavo Zanoli, MD Study Design. Evaluation of the psychometric properties of a translated and culturally adapted questionnaire. Objective. Translating, culturally adapting, and validating the Italian version of the Fear-Avoidance Beliefs Questionnaire (FABQ-I) to allow its use with Italian-speaking patients with low-back pain (LBP). Summary of Background Data. Growing attention is being given to standardized outcome measures to improve interventions for LBP. A translated form of the FABQ has never been validated in Italian patients with LBP. Methods. The FABQ-I questionnaire was developed by means of forward-backward translation, a final review by an expert committee, and a test of the prefinal version to establish its correspondence with the original English version. The psychometric testing included factor analysis, reliability by internal consistency (Cronbach α) and test-retest reliability (intraclass coefficient correlation), convergent validity by comparing FABQ-I with the Italian version of the Tampa Scale of Kinesiophobia (TSK-I), and discriminant validity by comparing FABQ-I with a visual analogue L ow-back pain (LBP) is a frequent problem in the indus- trialized West, where it has a lifetime prevalence of 49% to 80%, and 2% to 7% of cases develop persistent prob- lems. 1 Chronic LBP can have deleterious effects on spinal abil- ities, thus limiting working and social activities, relationships, and mental and general health. 2 The growing body of evidence coming from the biopsy- chosocial model suggests that, together with decreased physi- cal activities, various psychosocial factors are important for the genesis and maintenance of chronic back symptoms, 3 and, among these, beliefs are crucial to control wrong emo- tions, dysfunctional cognition, physical sensations, and ill- ness behaviors. 4 Appropriate beliefs assessment is there- fore increasingly advocated in research studies and clinical practice, 5 and self-reported outcome measures seem to be the most applicable. 6 On the basis of such assumptions, Waddell et al 7 developed the Fear-Avoidance Beliefs Questionnaire (FABQ) in 1993, From the Physical Medicine and Rehabilitation Unit, Salvatore Maugeri Foundation Institute of Care and Research (IRCCS), Scientific Institute of Lissone, Milan, Italy (Dr Monticone); Scientific Institute of Pavia, Salvatore Maugeri Foundation IRCCS and Consorzio Valutazioni Biologiche e Farmacologiche, University of Pavia, Pavia, Italy (Dr Baiardi); Section of Occupational Medicine, Department of Internal Medicine, Geriatrics and Nephrology, University of Bologna, Bologna, Italy (Bonetti); Manual Therapy Sciences, University of Padua, Padua, Italy (Ferrari); Physical and Rehabilitation Medicine, Tor Vergata University of Rome, Rome, Italy (Dr. Foti); Section of Occupational Medicine, Department of Internal Medicine, Geriatrics and Nephrology, University of Bologna, Bologna, Italy (Pillastrini); Physical Medicine and Rehabilitation Unit, Salvatore Maugeri Foundation Institute of Care and Research (IRCCS), Scientific Institute of Lissone, Milan, Italy (Rocca); School of Physiotherapy, University of Bologna, Bologna, Italy (Vanti); and University of Ferrara and Casa di Cura SM Maddalena, Rome, Italy (Zanoli). Acknowledgment date: March 17, 2011. Revision date: July 20, 2011. Acceptance date: July 22,2011. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. Address correspondence and reprint requests to Marco Monticone, MD, Scientific Institute of Lissone, Via Monsignor Bernasconi, 16, 20035 Lissone (Milan); E-mail: marco.monticone@fsm.it scale, the Roland Morris Disability Questionnaire, and the Hospital Anxiety and Depression Scale (Pearson correlation). Results. It took 4 months to develop a shared version of the FABQ-I. The questionnaire was administered to 180 subjects and proved to be acceptable. Factor analysis revealed a 2-factor, 12- item solution (57% of explained variance). The questionnaire showed good internal consistency ( α = 0.822) and high test-retest reliability (intraclass coefficient correlation = 0.869). Convergent validity showed a moderate correlation with TSK-I ( r = 0.440), and discriminant validity showed moderate-poor correlations with a visual analogue scale ( r = 0.335), Roland Morris Disability Questionnaire ( r = 0.414), and Hospital Anxiety and Depression Scale ( r = 0.258 for the Anxiety score and r = 0.246 for the Depression score). The results of the psychometric analyses of the subscales were similar to those of the scale as a whole. Conclusion. The FABQ outcome measure was successfully translated into Italian and proved to have a good factorial structure and psychometric properties that replicated the results of other existing versions. Its use is recommended for research purposes. Key words: Fear-Avoidance Beliefs Questionnaire, Italian valida- tion, low-back pain, outcome measures, psychometric properties. Spine 2012;37:E374–E380 DOI: 10.1097/BRS.0b013e31822ff5a7 Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.