Validation of the Fremantle Perineal Awareness Questionnaire (FrePAQ) in women with Chronic Pelvic Pain

Background Chronic pelvic pain (CPP) affects up to 26% of women worldwide. While its pathophysiology is poorly understood, disturbances in body perception have been identified in various similar chronic musculoskeletal disorders. The Fremantle Perineal Awareness Questionnaire (FrePAQ) is a novel tool designed to specifically assess disturbed body perception in the pelvic region, but its structural validity and reliability require formal evaluation.

Patient partners with lived experience contributed to study design. Participants with (n=417 and without (n=277) chronic pelvic pain completed the FrePAQ at baseline, as well as one week later. We assessed the validity and reliability of the FrePAQ following COSMIN guidelines for Classical Test Theory.

The validated FrePAQ comprises a two-factor model, with a six-item Distress & Disconnection (D&D) subscale and a two-item Size & Shape (S&S) subscale. Confirmatory analysis showed excellent fit (CFI = .988; RMSEA = .048) and measurement invariance between diagnostic groups. Internal consistency was high (α = .838 CPP; .819 controls). Test–retest reliability was high for D&D (ICC = .863) and acceptable for S&S (ICC = .695). FrePAQ scores showed a weak-moderate correlation with pain scores (r = .234–.255), psychological distress (r = .226–.443), and functional impact (r = .172–.295), particularly for the D&D subscale.

The FrePAQ is a reliable and valid instrument to measure perineal perceptual disturbances in CPP. Future research will evaluate the tool’s potential to support phenotyping and guide individualised interventions. Improved understanding of body perception disturbance in CPP can enhance diagnosis and treatment precision. Perspective This article validates the Fremantle Perineal Awareness Questionnaire (FrePAQ), the first measure of perineal body perception disturbance in chronic pelvic pain. The findings support body perception disturbance as a clinically relevant feature of chronic pelvic pain and provide a foundation for future research exploring its role in phenotyping, treatment selection, and treatment response. Competing Interest Statement JB is a co-director of the Pelvic Pain Network and lectures regarding physiotherapy for pelvic pain. NOC is a member of the Cochrane Central Editorial Board. Between 2020 and 2023 Neil was Co-ordinating Editor of the Cochrane Pain, Palliative and Supportive Care group, whose activities were funded by an infrastructure grant from the UK National Institute of Health and Care Research (NIHR). He is the Chair of the International Association for the Study of Pain (IASP) Methodology, Evidence Synthesis and Implementation special interest group (MESISIG) and has held a grant from the ERA-NET Neuron Co-Fund. BMW, KJC and EK have nothing to declare Clinical Protocols Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The College of Health, Medicine and Life Sciences Research Ethics Committee of Brunel University of London gave ethical approval for this work [47793-MHR-Jul/2024- 51960-2]. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Ethical approval for this study was provided by the College of Health, Medicine and Life Sciences Research Ethics Committee, Brunel University of London [47793-MHR-Jul/2024-51960-2]. Data Availability All data produced are available online at OSF. https://osf.io/utzjd/overview?view_only=390feb2cd84b49deaddf4341aeb508f4