Athlete Fear Avoidance Questionnaire: Cross-cultural Adaptation and Validation in Italian Athletes With Musculoskeletal Injuries

Abstract Background. The aim of this study was to translate, culturally adapt and validate an Italian version of the Athlete Fear Avoidance Questionnaire (AFAQ-I).Methods. We conducted a cross-sectional evaluation of the psychometric properties of the AFAQ-I in athletes with musculoskeletal injuries, culturally adapting it in accordance with international standards. Psychometric evaluation included exploratory factor analysis, reliability (internal consistency [Cronbach’s alpha], inter-item correlation, and test–retest reliability [intra-class correlation coefficient]). To examine construct validity, we compared (Spearman rank correlation) the AFAQ-I with a numerical pain rating scale (NPRS), the Pain Catastrophizing Scale (PCS), and the Fear Avoidance Beliefs Questionnaire subscales (Physical Activity, FABQ-PA; and Work, FABQ-W). We evaluated sensitivity to change through the minimum detectable change (MDC).Results. The AFAQ-I was administered to 133 university athletes with musculoskeletal injuries (26 females, mean age 25.3 ± 5 years, mean average pain duration 5.6 ± 8.7 months), and resulted acceptable. Factor analysis revealed a 1-factor 10-item solution (explained variance: 53%). Internal consistency was 0.78; average inter-item correlation 0.27; test–retest reliability ICC(2,1) 0.95. As hypothesized a priori, construct validity showed moderate correlations of the AFAQ-I with NPRS (ρ = 0.42), PCS (ρ = 0.59), FABQ-PA (ρ = 0.40) and FABQ-W (ρ = 0.34). The MDC was 4.42 points.Conclusion. The AFAQ-I is a valid Italian translation of AFAQ and demonstrates acceptable psychometric properties. We can recommend its use for clinical and research purposes.