Date of Completion

Fear Avoidance Beliefs Questionnaire
Patient's name (or ref
Clinician Diagnosis
Patient's d.o.b
INSTRUCTIONS Here are some of the things other patients have told us about their pain. For each statement please circle the number from 0 to 6 to indicate how much physical activities such as bending, lifting, walking or driving affector would affect your back pain.
1.My pain was caused by physical activity.
0
1.
2.
3
4.
5
6
2.Physical activity makes my pain worse.
0
1.
2.
3
4.
5
6
3.hysical activity might harm my back.
0
1.
2.
3
4.
5
6
4.I should not do physical activities which (might) make my pain worse.
0
1.
2.
3
4.
5
6
5.I cannot do physical activities which (might) make my pain worse.
0
1.
2.
3
4.
5
6
The following statements are about how your normal work affects or would affect your back pain.
6.My pain was caused by my work or by an accident at work.
0
1.
2.
3
4.
5
6
7. My work aggravated my pain.
0
1.
2.
3
4.
5
6
8.I have a claim for compensation for my pain.
0
1.
2.
3
4.
5
6
9.My work is too heavy for me.
0
1.
2.
3
4.
5
6
10.My work makes or would make my pain worse.
0
1.
2.
3
4.
5
6

Thank you very much for completing all the questions in this questionnaire.

FAB-Q Score %

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SPORTS/PERFORMING ARTS MODULE
WORK MODULE

Reference: Waddell C, Newton M, Henderson I, et al. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993; 52:157-168.

Fritz JM, George S. Identifying Psychosocial Variables in Patients With Acute Work-Related Low Back Pain: The Importance of Fear-Avoidance Beliefs. Phys Ther. 2002; 82(10): 973-983.

Lethem J, Slade PD, Troup JDG, Bendey G. Outline of a fear avoidance model of exaggerated pain perceptions, Behav Res Ther. 1983;21:401-408.

Williamson E. Fear Avoidance Behavior Questionnaire. Austrailian Journal of Physiotherapy. 2006; 52: 149.

Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eck H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62: 36, 272.