Cross-cultural adaptation and validation of the Athlete Fear Avoidance Questionnaire in Italian university athletes with musculoskeletal injuries

Assessing individual-level measurement precision of the Short Physical Performance Battery using the test information function

The Short Physical Performance Battery (SPPB) is a commonly used tool to assess lower extremity function, composed of three assessments (standing balance, gait speed, and chair stand). While its validity for group-level decisions has been positively demonstrated, the measurement precision at the individual level needs more clarification. We aimed to examine the SPPB's psychometric characteristics including its conditional measurement precision with Rasch methods in a sample of elderly patients admitted to cardiac rehabilitation. We analyzed prospectively collected SPPB data from 637 patients aged ≥75 years, admitted to our cardiac rehabilitation department (January 2018-July 2019). After classical Rasch analysis, we calculated the test information function to examine the measurement precision of the SPPB along the score continuum. The mean SPPB score was 6.3 points (SD 3.4) (potential range 0-12). Our results confirmed the SPPB unidimensionality (variance attributable to the main factor: 84.8%), appropriate functioning of rating scale categories, internal construct validity (infit and outfit mean-square statistics: 0.90-1.09), and no item local dependence (residual correlations <0.2). However, the measurement precision at the individual level was quite limited (SE >  0.94 logits): the confidence intervals for true scores were, at best, about one-third of the score range (four points). This limited measurement precision increases the risk of inappropriate clinical decisions about individuals in diagnostic classification or change assessment. Therefore, further research of high methodological quality is warranted on this point. Moreover, a clearer distinction between group-level vs. individual-level indicators of change is necessary.

Translation, cross-cultural adaptation, and validation of the Athlete Fear Avoidance Questionnaire (AFAQ) into Brazilian Portuguese

Background

Psychological factors play an important role in the adequate return of an athlete to sport. Our aim was to perform the translation, cross-cultural adaptation, and validation of the Athlete Fear Avoidance Questionnaire (AFAQ) into Brazilian Portuguese.

Methods

We performed the translation and cross-cultural adaptation and evaluated the structural validity, construct validity, and test–retest reliability. In addition to the AFAQ, we used the Numerical Pain Scale (NPS), Pain-Related Catastrophizing Thoughts Scale (PCTS), Self-Estimated Functional Inability because of Pain Questionnaire for athletes (SEFIP-sport), and Hospital Anxiety and Depression Scale (HADS). We used the exploratory factor analysis (EFA) to analyze the internal structure of the AFAQ. We used the Spearman’s correlation coefficient (rho) to determine the magnitude of correlation between the AFAQ and the other instruments. We evaluated the test–retest reliability and internal consistency by means of intraclass correlation coefficient (ICC) and Cronbach’s alpha, respectively.

Results

No adaptation was necessary to produce the AFAQ version in Brazilian Portuguese. We included 160 participants in the study. We identified the one-dimensionality of the AFAQ through the EFA with the implementation of parallel analysis (KMO = 0.83, p < 0.001 in Bartlett's Sphericity test). In construct validity, the magnitudes of correlation between the AFAQ and the other instruments ranged from 0.257 to 0.548. We identified adequate reliability (ICC = 0.85) and internal consistency (Cronbach’s alpha = 0.90).

Conclusion

The Brazilian version of the AFAQ with one domain and 10 items has adequate measurement properties in injured professional and recreational athletes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05951-0.