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Noémie Tito, Erica Porter, Tristan Castonguay, Geoffrey Dover Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, CanadaCorrespondence: Geoffrey Dover, Department of Health, Kinesiology, and Applied Physiology, Concordia University, 7141 Sherbrooke Street West, Montreal, QC, Canada, Tel +1 514 848 2424 Ext 3304, Fax +1 514 848 8681, Email geoffrey.dover@concordia.caPurpose: 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.Keywords: catastrophizing, kinesiophobia, psychosocial factors, rehabilitation

The aim of this study was to translate, culturally adapt and validate an Italian version of the Athlete Fear Avoidance Questionnaire (AFAQ-I). We conducted a cross-sectional evaluation of the psychometric properties of the AFAQ-I in university athletes with musculoskeletal injuries, culturally adapting it in accordance with international standards. Psychometric evaluation included the assessment of structural validity (exploratory factor analysis), internal consistency (Cronbach's alpha and inter-item correlation), test-retest reliability [intraclass correlation coefficient, (ICC) (2,1)], measurement error and minimum detectable change (MDC). To examine construct validity, we compared (Spearman ρ) the AFAQ-I with a numerical pain rating scale (NPRS), the Pain Catastrophizing Scale (PCS) and the Fear Avoidance Beliefs Questionnaire (FABQ) subscales [FABQ-Physical Activity (FABQ-PA) and FABQ-Work (FABQ-W)]. The AFAQ-I was administered to 133 university athletes with musculoskeletal injuries (95 males and 38 females; mean age 25 years, SD 5; mean average pain duration 5.6 months, SD 8.7). Factor analysis revealed an acceptable 1-factor 10-item solution (explained common variance at minimum rank factor analysis: 0.74) although a couple of items (#6 and 9) presented low factor loadings, suggesting the presence of a small secondary dimension. Cronbach's alpha was 0.78 and the average inter-item correlation was 0.27. ICC (2,1) was 0.95 and the MDC was 4.4 points. As hypothesized a priori, the AFAQ-I moderately correlated with NPRS (ρ = 0.42), PCS (ρ = 0.59), FABQ-PA (ρ = 0.40) and FABQ-W (ρ = 0.34). In conclusion, the AFAQ-I is a valid Italian translation of AFAQ that demonstrates acceptable psychometric properties. However, we recommend further analysis of the construct definition of the AFAQ and additional examination of its structural validity.

Background. The aim of this study was to translate, culturally adapt and validate an Italian version of the Athlete Fear Avoidance Questionnaire (AFAQ-I).Methods. We conducted a cross-sectional evaluation of the psychometric properties of the AFAQ-I in athletes with musculoskeletal injuries, culturally adapting it in accordance with international standards. Psychometric evaluation included exploratory factor analysis, reliability (internal consistency [Cronbach’s alpha], inter-item correlation, and test–retest reliability [intra-class correlation coefficient]). To examine construct validity, we compared (Spearman rank correlation) the AFAQ-I with a numerical pain rating scale (NPRS), the Pain Catastrophizing Scale (PCS), and the Fear Avoidance Beliefs Questionnaire subscales (Physical Activity, FABQ-PA; and Work, FABQ-W). We evaluated sensitivity to change through the minimum detectable change (MDC).Results. The AFAQ-I was administered to 133 university athletes with musculoskeletal injuries (26 females, mean age 25.3 ± 5 years, mean average pain duration 5.6 ± 8.7 months), and resulted acceptable. Factor analysis revealed a 1-factor 10-item solution (explained variance: 53%). Internal consistency was 0.78; average inter-item correlation 0.27; test–retest reliability ICC(2,1) 0.95. As hypothesized a priori, construct validity showed moderate correlations of the AFAQ-I with NPRS (ρ = 0.42), PCS (ρ = 0.59), FABQ-PA (ρ = 0.40) and FABQ-W (ρ = 0.34). The MDC was 4.42 points.Conclusion. The AFAQ-I is a valid Italian translation of AFAQ and demonstrates acceptable psychometric properties. We can recommend its use for clinical and research purposes.

To understand the variable response to pain, researchers have examined the change in cardiovascular measures to a uniform painful stimulation. Pain catastrophizing is the tendency to magnify or exaggerate pain sensations, and it affects the outcome of rehabilitation in a clinical setting. Its effect on cardiovascular changes during a painful stimulus is unclear. Twenty-four healthy human participants completed the study. All participants completed a cold pressor test while subjective pain intensity was measured with a numeric pain scale from 0-10. Continuous cardiac output measurements were obtained with finger-pulse plethysmograph waveform analysis. The measurements included systolic and diastolic blood pressure, heart rate averaged over 30 s intervals. Pain catastrophizing and anxiety were assessed using the pain catastrophizing scale (PCS), and Spielberger's State-Trait Anxiety Inventories, respectively. Peak pain was correlated to pain catastrophizing (r = 0.628, p 0.01). There was a strong correlation between change in heart rate (HR) and subjective peak pain (r = 0.805, p 0.01), total PCS (r = 0.474, p 0.05), and the helplessness subscale of the PCS (r = 0.457, p 0.05). Peak pain and catastrophizing explained a significant amount of the variance for the change in HR during the cold pressor test (R

To understand the variable response to pain, researchers have examined the change in cardiovascular measures to a uniform painful stimulation. Pain catastrophizing is the tendency to magnify or exaggerate pain sensations, and it affects the outcome of rehabilitation in a clinical setting. Its effect on cardiovascular changes during a painful stimulus is unclear. Twenty-four healthy human participants completed the study. All participants completed a cold pressor test while subjective pain intensity was measured with a numeric pain scale from 0–10. Continuous cardiac output measurements were obtained with finger-pulse plethysmograph waveform analysis. The measurements included systolic and diastolic blood pressure, heart rate averaged over 30 s intervals. Pain catastrophizing and anxiety were assessed using the pain catastrophizing scale (PCS), and Spielberger’s State-Trait Anxiety Inventories, respectively. Peak pain was correlated to pain catastrophizing (r = 0.628, p

Context: Athletes are often exposed to pain due to injury and competition. There is preliminary evidence that cardiovascular measures could be an objective measure of pain, but the cardiovascular response can be influenced by psychological factors such as catastrophizing. Objectives: The purpose of our study was to use a painful cold pressor test to measure the relationship between catastrophizing, pain, and cardiovascular variables in athletes. Design: Pre-post test. Setting: We completed all measures in a laboratory setting. Participants: Thirty-six male rugby athletes participated in the study. Main outcome measures: We measured catastrophizing with the Pain Catastrophizing Scale and pain with a Numeric Pain Rating Scale. Cardiovascular measures included heart rate, systolic, and diastolic blood pressure, and heart rate variability. Results: During the cold pressor test, participants experienced a significant increase in pain (0 to 4.1±2.2), systolic blood pressure (126.7±16.5mm Hg to 149.7±23.4mm Hg), diastolic blood pressure (76.9±8.3mm Hg to 91.9±11.5mm Hg) and heart rate variability (from 0.0164ms±0.0121 to 0.0400ms±0.0323) (all p

Uni-lateral muscle soreness is common yet the effects on gait or electromyographic (EMG) activity are unknown. The purpose of our study was to induce delayed onset muscle soreness (DOMS) in the knee flexor group and measure the resultant change in EMG activity and knee motion during gait. Nine healthy subjects participated in the study. Measures of function, evoked tenderness of the biceps femoris, as well as knee angle, and EMG activity during gait were assessed prior and 48 h after an eccentric exercise protocol. DOMS was induced unilaterally in the knee flexors using an isokinetic dynamometer and subjects exercised until they could not generate 50% of their maximal voluntary isometric contraction (MVIC). There was a significant decrease in biceps femoris activity after DOMS during the last phase of gait. Moreover, there was a day × phase interaction for gastrocnemius activity with the last two phases displaying an increase in activity. There was no significant change in knee angle during gait. The decrease in biceps femoris activity as well as the increase in gastrocnemius activity could be evidence of a protective mechanism designed to decrease activity of the sore muscle while increasing the activity of a synergistic muscle.

To determine the effects of a cryotherapy treatment on shoulder proprioception.Crossover design with repeated measures.University athletic training and sports medicine research laboratory.Thirty healthy subjects (15 women, 15 men).A 30-minute cryotherapy treatment.Joint position sense was measured in the dominant shoulder by using an inclinometer before and after receiving 30 minutes of either no ice or a 1-kg ice bag application. Skin temperature was measured below the tip of the acromion process and recorded every 5 minutes for the entire 30 minutes and immediately after testing. Three different types of error scores were calculated for data analyses and used to determine proprioception.Separate analyses of absolute, constant, and variable error failed to identify changes in shoulder joint proprioception as a function of the cryotherapy application.Application of an ice bag to the shoulder does not impair joint position sense. The control of proprioception at the shoulder may be more complex than at other joints in the body. Clinical implications may involve modifying rehabilitation considerations when managing shoulder injuries.

OBJECTIVE: To determine the reliability of 2 common measures of proprioception. DESIGN AND SETTING: Joint position sense (JPS) and force reproduction (FR) were measured in the dominant shoulder using internal-rotation (IR) and external-rotation (ER) target angles on 2 consecutive days. SUBJECTS: Thirty-one healthy subjects (age = 22.0 +/- 2.8 years, height = 171.8 +/- 9.2 cm, mass = 69.5 +/- 15.9 kg) who did not regularly compete in overhand sports volunteered to participate in the study. MEASUREMENTS: Error scores were calculated at 2 target angles by averaging the absolute difference of 3 trials of JPS and FR. Reliability was determined by comparing the error scores obtained on 2 consecutive days. RESULTS: The inclinometer was found to be a reliable instrument as both intertester (.999) and intratester (.999) intraclass correlation coefficients were high. The JPS and FR measurements were also found to be reliable, with intraclass correlation coefficients ranging from.978 to.984. No differences were observed between trials for either measure. CONCLUSIONS: The inclinometer was a reliable instrument and can provide an affordable and accurate measure of range of motion and JPS. Both JPS and FR were also reliable measures of proprioception in the shoulder. Further research is needed to identify the specific mechanism of proprioception during these tasks.