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Spanish Version of the Avoidance-Endurance Questionnaire: Factor Structure and Psychometric Properties

  • Gema T. Ruiz-Párraga (a1), Alicia E. López-Martínez (a1), Adina C. Rusu (a2) and Monika I. Hasenbring (a2)

Abstract

To analyze the factorial structure and psychometric properties of the Spanish adaptation of the AEQ, and to validate it by reporting relevant pain-related variables, which were not investigated in the original study. One hundred and fifty Spanish patients diagnosed with chronic back and neck pain were referred by physicians from different pain clinics in Spain; all the patients filled out the questionnaires at their clinic. A series of principal components analyses (PCA) was performed to develop the Spanish version of the AEQ. Reliability and validity were also calculated. The PCAs revealed five fear-avoidance scales (Kaiser-Meyer-Olkin measures were between .60 and .88, and Bartlett’s tests were significant, p < .01): the Depression scale (DS), Anxiety scale (AS), Catastrophizing scale (CS), Helplessness/hopelessness scale (HHS), and Avoidance of Social and Physical Activities scale (ASPAS), and three endurance-related responses scales: Pain Persistence Behaviour and Distraction scale (PPDS), Ignoring Pain scale (IPS), and Humor scale (HS). All the scales showed high internal consistency (α > .73) and suitable validity (p < .05). New results associated with pain-related cognitive/affective and behavioural responses are discussed. This instrument will probably help clinicians to identify Spanish patients at a high risk of chronicity and to develop treatments tailored to the different profiles in order to improve secondary and tertiary prevention in back and neck pain.

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Corresponding author

*Correspondence concerning this article should be addressed to Gema T. Ruiz Párraga. Facultad de Psicología. Universidad de Málaga. Campus de Teatinos s/n. 29071. Málaga (Spain). Phone: +34–952136697. Fax: +34–952131101. E-mail: gtruizparraga@uma.es

References

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Asmundson, G. J. G., Norton, P. J., & Norton, G. R. (1999). Beyond pain: The role of fear and avoidance in chronicity. Clinical Psychological Review, 19, 97119. http://dx.doi.org/10.1016/S0272-7358(98)00034-8
Boothby, J. L., Thorn, B. E., Stroud, M. W., & Jensen, M. P. (1999). Coping with pain. In Gatchel, R. J., & Turk, D. C. (Eds.), Psychosocial factors in pain. New York, NY: Guilford Press.
Breivik, H., Collett, B., Ventafrida, V., Cohen, R., & Gallacher, D. (2006). Survey of chronic pain in Europe: Prevalence, impact on daily life and treatment. European Journal of Pain, 10, 287333. http://doi.org/10.1016/j.ejpain.2005.06.009
Crombez, G., Eccleston, C., Van Damme, S., Vlaeyen, J. W. S., & Karoly, P. (2012). Fear-Avoidance model of chronic pain. The next generation. Clinical Journal of Pain, 2, 475483.
Crombez, G., Vlaeyen, J. W. S., Heuts, P. H. T. G., & Lysens, R. (1999). Pain-related fear is more disabling than pain itself: Evidence on the role of pain-related fear in chronic pain disability, Pain, 80, 329339. http://doi.org/10.1016/S0304-3959(98)00229-2
Davis, M. C., Zautra, A. J., & Smith, B. W. (2004). Chronic pain, stress, and the dynamics of affective differentiation. Journal of Personality, 72, 11331160. http://doi.org/10.1111/j.1467-6494.2004.00293.x
Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133, 581624. http://dx.doi.org/10.1037/0033-2909.133.4.581
Gómez-Perez, L., López-Martínez, A. E., & Ruiz-Párraga, G. T. (2011). Psychometric properties of the Spanish Version of the Tampa Scale for Kinesiophobia. The Journal of Pain, 12, 425435. http://doi.org/10.1016/j.jpain.2010.08.004
Hasenbring, M. I. (1994). Kiel Pain Inventory. Bern, Switzerland: Hans Huber Verlag.
Hasenbring, M. I. (2000). Attentional control of pain and the process of chronification. In Sandkühler, J., Bromm, B., & Gebhart, G. F. (Eds.), Progress in pain research. Elsevier Science B.V; 2000, Vol. 129, pp. 525534.
Hasenbring, M. I., Hallner, D., Klasen, B., Streitlein-Böhme, I., Willburger, R., & Rusche, H. (2012). Pain-related avoidance versus endurance in primary care patients with subacute back pain: Psychological characteristics and outcome at a 6-month follow-up. Pain, 153, 211217. http://doi.org/10.1016/j.pain.2011.10.019
Hasenbring, M. I., Hallner, D., & Rusu, A. C. (2009). Fear-avoidance and endurance-related responses to pain: Development and validation of the Avoidance-Endurance Questionnaire (AEQ). European Journal of Pain, 13, 620628. http://doi.org/10.1016/j.ejpain.2008.11.001
Hasenbring, M. I., Plaas, H., Fishbein, B., & Willburger, R. (2006). The relationship between activity and pain in patients 6 months after lumbar disc surgery: Do pain-related coping modes act as moderator variables? European Journal of Pain, 10, 701709. http://doi.org/10.1016/j.ejpain.2005.11.004
Hasenbring, M. I., & Verbunt, J. A. (2010). Fear-avoidance and endurance-related responses to pain: New models of behavior and their consequences for clinical practice. Clinical Journal of Pain, 26, 747753. http://doi.org/10.1097/AJP.0b013e3181e104f2
Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment theory: An experiential approach to behavior change. New York, NY: Guildford.
Haythornthwaite, J. A., Menefee, L. A., Heinberg, L. J., & Clark, M. R. (1998). Pain coping strategies predict perceived control over pain. Pain, 77, 3339. http://dx.doi.org/10.1016/S0304-3959(98)00078-5
Horn, J. L. (1965). A rationale and test for the number of factors in factor analysis. Psychometrica, 30, 179185. http://dx.doi.org/10.1007/BF02289447
Huijen, I. P. J., Kindermans, H. P. J., Seelen, H. A. M., Peters, M. L., Smeets, R. J. E. M., Serroyen, J., … Verbunt, J. A. (2011). Effects of self-discrepancies on activity-related behavior: Explaining disability and quality of life in patients with chronic low back pain. Pain, 152, 21652172. http://doi.org/10.1016/j.pain.2011.05.028
Jensen, J. N., Karpatschof, B., Labriola, M., & Albertsen, K. (2010). Do fear-avoidance beliefs play a role on the association betweeen low back pain and sickness absence? A prospective cohort study among female health care workers. Journal of Occupational and Envioronmental Medicine, 52, 8590.
Jensen, M. P., Turner, J. A., & Romano, J. M. (2001). Changes in beliefs, catastrophizing, and coping are associated with improvement in multidisciplinary pain treatment. Journal Consulting Clinical Psychology, 69, 655662. http://doi.org/10.1037//0022-006X.69.4.655
Jensen, M. P., Turner, J. A., Romano, J. M., & Fisher, L. D. (1999). Comparative reliability and validity of chronic pain intensity measures. Pain, 83, 157162. http://doi.org/10.1016/S0304-3959(99)00101-3
Jensen, M. P., Turner, J. A., Romano, J. M., & Karoly, P. (1991). Coping with chronic pain: A critical review of the literature. Pain, 47, 249283. http://doi.org/10.1016/0304-3959(91)90216-K
Kahneman, D. (1973). Attention and effort. Englewood Cliffs. NJ: Prentice Hall.
Kindermans, H. P. J., Roelofs, J., Goossens, M. E. J. B., Huijnen, I. P., Verbunt, J. A., & Vlaeyen, J. W. S. (2011). Activity patterns in chronic pain: Underlying dimensions and associations with disability and depressed mood. The Journal of Pain, 12, 10491058. http://doi.org/10.1016/j.jpain.2011.04.009
Kovacs, F. M., Llobera, J., Gil del Real, M. T., Abraira, V., Gestoso, M., & Fernández, C. (2002). Validation of the Spanish Version of the Roland Morris Questionnaire. Spine, 27, 538542. http://dx.doi.org/10.1097/00007632-200203010-00016
Kovacs, F. M., Muriel, A., Abraira, V., Medina, J. M., & Olabe, J. (2006). Psychometric characteristics of the Spanish Version of the FABQ. Spine, 31, 104110.
Leeuw, M., Goossens, M. E. J. B., Linton, S. J., Combrez, G., Boersma, K., & Vlaeyen, J. W. S. (2007). The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. Journal of Behavioral Medicine, 30, 7794. http://doi.org/10.1007/s10865-006-9085-0
Linton, S. J. (2000). A review of psychological risk factors in back and neck pain. Spine, 25, 11481156. http://dx.doi.org/10.1097/00007632-200005010-00017
McCracken, L. M., & Samuel, V. M. (2007). The role of avoidance, pacing, and other activity patterns in chronic pain. Pain, 130, 119125. http://dx.doi.org/10.1016/j.pain.2006.11.016
McCracken, L. M., Zayfert, C., & Gross, R. T. (1992). The pain anxiety symptoms scale: Development and validation of a scale to measure fear of pain. Pain, 50, 6773. http://doi.org/10.1016/0304-3959(92)90113-P
McWillians, L. A., Cox, B. J., & Enns, M. W. (2003). Mood and anxiety disorders associated with chronic pain: An examination in a nationally representative sample. Pain, 106, 127133. http://doi.org/10.1016/S0304-3959(03)00301-4
Ostelo, R. W. J. G., Deyo, R. A., Stratford, P., Waddell, G., Croft, P., von Korf, M., … de Vet, H. C. (2008). Interpreting change scores for pain and functional status in low back pain. Spine, 33, 9094. http://dx.doi.org/10.1097/BRS.0b013e31815e3a10
Peters, M. L., Sorbi, M. J., Kruise, D. A., Kerssens, J. J., Verhaak, P. F. M., & Bensing, J. M. (2000). Electronic diary assessment of pain. Disability and psychological adaptation in patients differing in duration of pain. Pain, 84, 181192. http://doi.org/10.1016/S0304-3959(99)00206-7
Pincus, T., Rusu, A., & Santos, R. (2008). Responsiveness and construct validity of the depression, ansiety, and positive outlook scale (DAPOS). Clinical Journal of Pain, 24, 431437.
Plaas, H., Sudhaus, S., Willburger, R., & Hasenbring, M. I. (2014). Physical activity and low back pain: The role of subgroups based on the avoidance-endurance model. Disability and Rehabilitation, 36, 749755. http://doi.org/10.3109/09638288.2013.814723
Polatin, P. B., Kimey, R. K., Gatchel, E. L., & Mayer, T. G. (1993). Psychiatric illness and chronic back pain. The mind and the spine-which goes first? Spine, 18, 6671.
Quintana, J. M., Padierna, A., Esteban, C., Arostegui, I., Bilbao, A., & Ruiz, I. (2003). Evaluation of the psychometric characteristics of the Spanish Version of the Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 107, 216221. http://doi.org/10.1034/j.1600-0447.2003.00062.x
Ramirez-Maestre, C., & Valdivia, Y. (2003). Evaluación del funcionamiento diario en pacientes con dolor crónico [Assessment of daily functioning in patients with chronic pain]. Psicología Conductual, 11, 283291.
Rusu, A. C., Burghardt, K., Kreddig, N., Wittenberg, R., & Hasenbring, M. I. (2011). Pain anxiety and kinesiophobia in back pain patients: Is fear of pain automatically related to avoidance or also to endurance? European Journal of Pain Supplements, 5, 258. http://doi.org/10.1016/S1754-3207(11)70891-4
Scholich, S. L., Hallner, D., Wittenberg, R. H., Rusu, A. C., & Hasenbring, M. I. (2011). Pilot study on pain response patterns in chronic low back pain. The influence of pain response patterns on quality of life, pain intensity and disability. Der Schmerz, 25, 184190. http://doi.org/10.1007/s00482-011-1023-6
Schrooten, M. G. S., Vlaeyen, J. W. S., & Morley, S. (2012). Psychological interventions for chronic pain: Reviewed within the context of goal pursuit. Pain Management, 2, 141150. http://doi.org/10.2217/pmt.12.2
Sudhaus, S., Held, S., Schoofs, D., Bültmann, J., Dück, I., Wolf, O. T., & Hasenbring, M. I. (2015). Associations between fear-avoidance and endurance responses to pain and salivary cortisol in the context of experimental pain induction. Psychoneuroendocrinology, 52, 195199. http://doi.org/10.1016/j.psyneuen.2014.11.011
Sullivan, M. J. L., Bishop, S. R.., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7, 524532. http://dx.doi.org/10.1037/1040-3590.7.4.524
Sullivan, M. J. L., Rouse, D., Bishop, S., & Johnston, S. (1997). Thought suppression, catastrophizing, and pain. Cognitive Therapy Research, 21, 555568.
Swinkels-Meewisse, I. E. J., Roelofs, J., Schouten, E. G. W., Verbeek, A. L. M., Oostendorp, R. A. B., & Vlaeyen, J. W S. (2006). Fear of movement / (re) injury predicting chronic disabling low back pain: A prospective inception cohort study. Spine, 31, 658664. http://doi.org/10.1097/01.brs.0000203709.65384.9d
Tabachnik, B. G., & Fidell, L. S. (2001). Using multivariate statistics (4th Ed). Boston, MA: Allyon and Bacon.
Verbunt, J. A., Seelen, H. A., Vlaeyen, J. W., van de Heijden, G. J., Heuts, P. H., Pons, K., & Knottnerus, J. A. (2003). Disuse and deconditioning in chronic low back pain: Concepts and hypotheses on contributing mechanisms. European Journal of Pain, 7, 921. http://doi.org/10.1016/S1090-3801(02)00071-X
Verbunt, J. A., Smeets, R. J., & Wittink, H. M. (2010). Cause or effect? Deconditioning and chronic low back pain. Pain, 149, 428430. http://doi.org/10.1016/j.pain.2010.01.020
Vlaeyen, J. W. S., Kole-Snijders, A. M., Boeren, R. G., & van Eek, (1995). Fear of movement/ (re)injury in chronic low back pain and its relation to behavioral performance. Pain, 62, 363372.
Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85, 317332. http://doi.org/10.1016/S0304-3959(99)00242-0
Wegner, D. M. (1994). Ironic processes of mental control. Psychological Review, 101, 3452. http://doi.org/10.1037/0033-295X.101.1.34
Weickgenant, A. L., Slater, M. A., Patterson, T. L., Atkison, J. H., Grant, I., & Garfin, S. R. (1993). Coping activities in low back pain: Relationship with depression. Pain, 53, 95103. http://doi.org/10.1016/0304-3959(93)90061-S
Woolf, C. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152, S2S15. http://doi.org/10.1016/j.pain.2010.09.030

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Spanish Version of the Avoidance-Endurance Questionnaire: Factor Structure and Psychometric Properties

  • Gema T. Ruiz-Párraga (a1), Alicia E. López-Martínez (a1), Adina C. Rusu (a2) and Monika I. Hasenbring (a2)

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