Longitudinal Validation of a Specific Measure of Fear Avoidance in Athletes: Predicting Time from Injury to Return to Sports Competition

Abstract

Purpose We developed the Athlete Fear Avoidance Questionnaire (AFAQ) to measure fear avoidance in athletes. Previous fear avoidance scales were developed for the general population and have demonstrated significant predictive capabilities regarding rehabilitation. No research to date has examined the association between athlete fear avoidance as measured by the AFAQ and the rehabilitation time in athletes. Patients and Methods Fifty-nine athletes who were injured during sport season participated in the study (40 males and 19 females). At injury onset, all participants completed self-report functional questionnaires. In addition, we measured multiple aspects of fear avoidance including athlete fear avoidance (AFAQ), kinesiophobia (TSK), and pain catastrophizing (PCS). Finally, we assessed pain severity and interference, as well as depression. Once the athletes were able to return to competition all participants answered the questionnaires again. Pearson correlations and a regression analysis were used to identify relationships between function, psychological variables, pain, and return to competition time. Results The AFAQ yielded the strongest correlation with return to competition time ( r =0.544, p <0.001). In addition, function at initial injury time and pain interference were also significantly correlated with return to competition time ( r =0.442, p <0.001 and r =0.356, p =0.006 respectively). Athlete fear-avoidance combined with function at the time of injury explained 34% of the variance of return to competition time in the multivariate regression model ( p <0.001). Conclusion Athlete fear-avoidance as measured by the AFAQ is associated with rehabilitation time and returning to competition in injured athletes. Psychosocial factors including athlete fear avoidance may explain why some athletes take longer to rehabilitate than others and should be evaluated in athletes who are taking longer than anticipated to complete their rehabilitation. Reducing athlete fear avoidance may facilitate rehabilitation in future studies.

Athlete Fear Avoidance, Depression, and Anxiety Are Associated with Acute Concussion Symptoms in Athletes

“…Having a control group would have helped identify true concussion symptoms that are independent of the anxious nature of an injury. While previous studies such as those of Dover et al 2015 andTito et al 2023 have noted that elevated athlete fear avoidance has been associated with increased time to return to competition in injured athletes, athlete fear avoidance has not been correlated to nonconcussion-specific symptoms [20,39]. This is something that should be considered for future studies.…”

Lösungsorientierte Beratung in der Rehabilitation nach Sportverletzungen

“…Dies [12]. Ebenso gibt es Hinweise darauf, dass Kinesiophobie und Schmerzkatastrophisierung die Rehabilitation nach einer VKB-Rekonstruktion beeinträchtigen können [23].…”

Investigating the Mediating Role of Pain in the Relationship between Ankle Joint Position Sense and Balance Assessed Using Computerized Posturography in Individuals with Unilateral Chronic Ankle Instability: A Cross-Sectional Study

“…The fear-avoidance model is a well-established and widely accepted theoretical framework used to comprehend the intricate relationship between pain and physical activity [21]. It provides valuable insights into how individuals may respond to pain and modify their behaviors accordingly [21,22]. This model posits that individuals with pain may develop fear and avoidance behaviors towards activities that they believe may exacerbate their pain [23].…”