Screening for Elevated Levels of Fear-Avoidance Beliefs Regarding Work or Physical Activities in People Receiving Outpatient Therapy

Abstract

The lack of differential item functioning in the FABQ scales in the sample tested in this study suggested that FABQ screening could be useful in routine clinical practice and allowed the development of single-item screening for fear-avoidance beliefs that accurately identified subjects with elevated levels of fear. Because screening was accurate and efficient, single IRT-based FABQ screening items are recommended to facilitate improved evaluation and care of heterogeneous populations of people receiving outpatient rehabilitation.

Developing a Wellness Program for People with Multiple Sclerosis

“…Use of CAT and single-item screens reduces the burden associated with assessments of multiple constructs. 7,10,21 Given our positive experience with the wellness program and the software used to collect the data, we recommend that complex data sets like the one described here be used to develop large of psychological distress did not decrease (adjusted least squares mean 72.4, SE 4.0) (P = .017).…”

“…33 Although the MSSE was not used to assess self-efficacy in the current study, the FABQ scale could provide insight into how people perceive fear related to performing physical activities, 10 which may be considered a proxy for self-efficacy. Our sample reported good improvement in functional status, fatigue, and perception of fear of performing physical activities.…”

“…Although no published articles describe use of the FABQ to assess people with MS, we have found that the FABQ is answered in a similar and valid manner by patients with neurologic and those with orthopedic impairments receiving outpatient therapy, regardless of whether patients have pain. 10 In addition, depression and somatization 11 are recognized as common confounders of clinical outcomes, 12 including in people with MS. 4 The point prevalence of major depression may be as high as 17% in patients seen by primary-care providers, yet some believe the prevalence of depressive disorders in people with MS is much higher. The prevalence of somatization is difficult to assess, but it is common in people with MS. 5,13 Likewise, fatigue is common in people with MS. 14 Fatigue is a complex clinical phenomenon, 15 in part because it is associated with depression, 16 physical functioning, and self-efficacy.…”

“…10 Briefly, Hart et al 10 assessed the original FABQ 8 items using modern psychometric methods 20 and identified one item that could be used to classify patients into elevated versus not elevated fear at intake. Starting with the stem "This is a statement other patients have made.…”

“…2 Efficient and precise methods of assessing patient-reported functional status have evolved, facilitating quantifica-classifying patients with elevated versus not elevated levels of fear-avoidance beliefs of physical activities. 10 For domains that have not been assessed using IRT methods or estimated using CAT applications, data were collected using computer data entry and original surveys, with plans for analysis using IRT methods in the future. Finally, computerized outcomes data collection can be integrated into electronic health record systems, facilitating assessments of which treatments are associated with better outcomes for specific individuals.…”