Questionnaires Developed at PRIDE
Overview
Self-report questionnaires are often used for initial patient assessment and for measuring treatment effects and responsiveness. Three unique clinical questionnaires, the Central Sensitization Inventory (CSI), the Fear-Avoidance Components Scale (FACS), and the Pain Disability Questionnaire (PDQ) have been developed and validated at PRIDE. All patients who enter the PRIDE functional restoration program complete a comprehensive self-report test battery, including these three measures, at admission, and all those who finish the program complete an identical battery at discharge.
Central Sensitization Inventory (CSI)
Central Sensitization (CS) is a neurophysiological phenomenon in which central nervous system neurons become hyper-excitable, resulting in abnormal and intense enhancement of pain. Central Sensitivity Syndrome (CSS) is a newly proposed category for a group of inter-related disorders for which CS is a common etiology, including the following:
- Fibromyalgia
- Myofascial Pain Syndrome
- Chronic Fatigue Syndrome
- Temporomandibular Joint Disorder
- Irritable Bowel Syndrome
- Migraine/Tension Type Headaches
- Restless Leg Syndrome
- Multiple Chemical Sensitivity
Download Symptom Severity Calculator
CSI Symptom Severity CalculatorDownload CSI
Arabic- Chinese – Traditional Version
- Danish
Dutch- English
- Finnish
- French
- German
- Greek
- Gujarati
- Italian
- Japanese
- Kannada ಅನುಬಂಧ ಅ
- Korean
- Nepali
- Persian
- Polish
- Brazilian Portuguese
- Portuguese (European)
- Russian
- Serbian
- Spanish (Mexican/Central American)
- Spanish (European)
- Swedish
- Turkish
- Thai
- Ukrainian
The Central Sensitization Inventory (CSI) was developed to assess the overlapping health-related symptom dimensions of CS/CSSs. Part A has 25 items scored from 0 to 4. Total scores range from 0-100. Part B (which is not scored) asks if one has previously been diagnosed with one or more specific disorders, including seven separate CSSs and three CSS-related disorders. The CSI has now been translated, and psychometrically validated, in a number of different languages.
The CSI was initially introduced in 2012. In its initial psychometric evaluation, the CSI was found to have a high degree of test-retest reliability and internal consistency (Pearson’s r = .82; Cronbach’s alpha= .88). Subsequent validation studies revealed that CSI scores were highly correlated with the presence of one or more CSSs in patients referred to a psychiatric chronic pain management clinic. Additional analyses determined that a cut-off score of 40 out of 100 on the CSI produced good sensitivity (81%) in correctly identifying a group of CSS patients, and acceptable specificity (75%) in correctly identifying a group of non-patient comparison subjects. More recently, severity levels have been proposed, in order to provide more useful information to clinicians and researchers in assessing a patient’s CS/CSS-related symptoms and documenting meaningful clinical changes in response to treatment. The following severity ranges have been recommended: Subclinical = 0 to 29; Mild = 30 to 39; Moderate = 40 to 49; Severe = 50 to 59; and Extreme = 60 to 100.
Supporting References:
User’s Manual:
Neblett R. (2018). The Central Sensitization Inventory: A User’s Manual. Journal of Applied Biobehavioral Research. 23(2):e12123. https://doi.org/10.1111/jabr.12123
Systematic Review:
Scerbo T, Colasurdo J, Dunn S, Unger J, Nijs J, Cook C. (2018). Measurement Properties of the Central Sensitization Inventory: A Systematic Review. Pain Practice. Apr;18(4):544-554.
Multi-Country Factor Analysis:
Cuesta-Vargas AI, Neblett R, Chiarotto A, Kregel J, Nijs J, van Wilgen CP, Pitance L, Knezevic A, Gatchel RJ, Mayer TG, Viti C, Roldan-Jiménez C, Testa M, Caumo W, Jeremic-Knezevic M, Luciano JV. (2018). Dimensionality and Reliability of the Central Sensitization Inventory (CSI) in a Pooled Multi-Country Sample. Journal of Pain. Mar;19(3):317-329.
English version (CSI-En):
- Mayer TG, Neblett R, Cohen H, Howard KJ, Choi YH, Williams MJ, Perez Y, Gatchel RJ. (2012). The development and psychometric validation of the central sensitization inventory. Pain Practice. April; 12(4):276-85.
- Neblett, R, Choi, Y, Hartzell, M, Williams, M, Cohen, H, Mayer, TG, Gatchel, RJ (2013). Establishing clinically relevant cutoff scores for the Central Sensitization Inventory (CSI). The Journal of Pain. May; 14(5): 438-445.
- Neblett R, Hartzell M, Cohen H, Mayer T, Williams M, Choi Y, Gatchel R. (2015). Ability of the Central Sensitization Inventory to Identify Central Sensitivity Syndromes in an Outpatient Chronic Pain Sample. Clinical Journal of Pain. April; 31(4): 323-332.
- Neblett R; Hartzell M; Mayer TG; Cohen H; Gatchel RJ. (2016). Establishing Clinically Relevant Severity Levels for the Central Sensitization Inventory. Pain Practice: The Official Journal Of World Institute Of Pain. Feb;17(2):166-175.
- Neblett R, Hartzell MM, Williams M, Bevers KR, Mayer TG, Gatchel RJ (2017). Use of the central sensitization inventory (CSI) as a treatment outcome measure for chronic spinal pain disorder patients in a functional restoration program. The Spine Journal. Feb;17(2):166-175.
- Neblett R & Mayer TG. (2017.The Central Sensitization Inventory (CSI): Some Background and Current Trends. The Spine Journal. Nov;17(11):1766-1767.
Mexican/Central American Spanish CSI:
Developed at PRIDE (2012)
European Spanish (CSI-Sp):
Developed by Antonio I Cuesta-Vargas, PhD, and colleagues, Cátedra de Fisioterapia, Departamento de Fisioterapia, Universidad de Malaga, Andalucia Tech, Instituto Investigacion de Biomédica de Malaga (IBIMA) Grupo de Clinimetria (F-14). Av/ Arquitecto Peñalosa s/n (Teatinos Campus Expansion) 29009 Malaga (Spain)
Cuesta-Vargas AI, Roldan-Jimenez C, Neblett R, Gatchel RJ. (2016) Cross-cultural adaptation and validity of the Spanish central sensitization inventory. Springerplus, Oct;5(1):1837.
French (CSI-Fr):
Developed by Laurent Pitance, PhD, and colleagues, Clinical research institute (IREC), Université Catholique de Louvain, Oral and maxillo-facial Surgery Department and Cliniques Universitaires Saint-Luc, Brussels.
Pitance, L., Piraux, E., Lannoy, B., Meeus, M., Berquin, A., Eeckhout, C., … & Roussel, N. (2016). Cross cultural adaptation, reliability and validity of the French version of the central sensitization inventory. Manual Therapy, 25, e83-e84.
Dutch (CSI-D):
Developed by Professor Cornelis Paul van Wilgen, PT, PhD. Vrije Universiteit Brussel · Faculty of Physical Education and Physiotherapy; Jeroen Kregel, PhD Ghent University, Gent · Department of Rehabilitation Sciences and Physiotherapy; Professor Jo Nijs, PT, MT, PhD Vrije Universiteit Brussel, Brussels · Physiotherapy, Human Physiology & Anatomy (KIMA); and colleagues.
Kregel J, Vuijk PJ, Descheemaeker F, Keizer, D., van der Noord, R., Nijs, J., … & van Wilgen, P. (2016).The Dutch Central Sensitization Inventory (CSI): Factor Analysis, Discriminative Power and Test-Retest Reliability. Clin J Pain, Jul;32(7):624-30.
Gujarati (CSI-G):
Developed by Dr. Dibyendunarayan Bid, PT, and colleagues, The Sarvajanik College of Physiotherapy, Rampura, Surat.
Bid Dibyendunarayan D, Soni Neela C, Rathod Priyanshu V, Thangamani Ramalingam A. (2016). Content Validity and Test-Retest Reliability of the Gujarati Version of the Central Sensitization Inventory. NJIRM, 7(5):18-24.
Brazilian Portuguese (CSI-BP):
Developed by Wolnei Caumo M.D. PhD, and colleagues, Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA), Laboratory of Pain and Neuromodulation at UFRGS,Porto Alegre, Brazil; and Surgery Department, School of Medicine, UFRGS, Porto Alegre, Brazil.
Caumo W, Ruehlman LS, Karoly P, et al. (2017). Cross-Cultural Adaptation and Validation of the Central Sensitization Inventory for a Brazilian Population and its relationship with the function of descending pain modulatory system and with the serum BDNF. J Pain Res, Sep;10:2109-2122.
European Portuguese (CSI-Por)
Developed by Rosa Andias and Anabela Silva, School of Health Sciences, University of Aveiro, Aveiro, Portugal; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro, Aveiro, Portugal.
Andias R & Silva A G (2020). Cross‐cultural adaptation and psychometric properties of the European Portuguese version of the Central Sensitization Inventory in adolescents with musculoskeletal chronic pain. Pain Practice, 20(5), 480-490.
Serbian (CSI-Serb):
Developed by Aleksandar Knezevic, MD, PhD, and colleagues, Faculty of Medicine, University of Novi Sad, Serbia and Medical Rehabilitation Clinic, Clinical Centre of Vojvodina, Novi Sad, Serbia.
Knezevic A, Neblett R, Jeremic-Knezevic M, et al. (2018). Cross cultural adaptation and psychometric validation of the Serbian version of the central sensitization inventory (CSI). Pain Practice: The Official Journal of World Institute of Pain, Apr;18(4):463-472.
Knezevic, A, Neblett, R, Colovic, P, et al. (2020). Convergent and discriminant validity of the Serbian version of the Central Sensitization Inventory. Pain Practice: The Official Journal of World Institute of Pain, Sep;20(7):724-736
Japanese (CSI-J):
Developed by Tomohiko Nishigami, PT, PhD, and colleagues, The Sansom Institute for Health Research, The University of South Australia, School of Health Sciences, City East Campus, Adelaide, SA.
Tanaka K, Nishigami T, Mibu A, Manfuku M, Yono S, Shinohara Y, Tanabe A, Ono R. (2017).Validation of the Japanese version of the Central Sensitization Inventory in patients with musculoskeletal disorders. PLoS One, Dec 7;12(12).
Italian (CSI-I):
Developed by Alessandro Chiarotto, MSc, and colleagues, Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam; The Netherlands and Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands; and Amsterdam Public Health, Amsterdam, The Netherlands.
Chiarotto A, Viti C, Sulli A, Cutolo M, Testa M, Piscitelli D. (2018). Cross-cultural adaptation and validity of the Italian version of the Central Sensitization Inventory. Musculoskeletal Science and Practice, 37, 20-28.
Polish (CSI-Pol):
Developed by Beata Tarnacka, MD, PhD, and colleagues, Department of Rehabilitation at the Medical University of Warsaw, Poland.
Turczyn, P, Kosińska, B, Janikowska-Hołoweńko, D, Malec-Milewska, M., Marszalec, N, Maleszka, P, & Tarnacka, B. (2019). Translation and cross-cultural adaptation of the Polish Central Sensitization Inventory. Reumatologia, 57(3), 129-34.
Greek (CSI-Gr):
Developed by Prof Eleni Kapreli PT, MSc, PhD, Paraskevi Bilika, PT, MSc student, Post-graduate Program in Advanced Physiotherapy, Clinical Exercise Physiology and Rehabilitation Laboratory, Physiotherapy Department, Technological Education Institute of Sterea Ellada, Lamia, Greece; Dr Georgios Georgoudis PT, MSc, PhD, Musculoskeletal & Chest Physiotherapy Laboratory, Physiotherapy Department, University of West Attika, Athens, Greece; Randy Neblett MA, LPC, BCB, PRIDE (Productive Rehabilitation Institute of Dallas for Ergonomics) Research Foundation, USA.
Bilika, P, Neblett, R, Georgoudis, G, Dimitriadis, Z, Fandridis, E, Strimpakos, N, & Kapreli, E. (2020). Cross‐cultural adaptation and psychometric properties of the Greek version of the Central Sensitization Inventory. Pain Practice: The Official Journal of World Institute of Pain, Feb;20(2):188-196. DOI: 10.1111/papr.12843
German (CSI-Ge):
Klute M, Laekeman M, Kuss K, Petzke F, Dieterich A, Leha A, Neblett R, Ehrhardt S, Ulma J, Schäfer A (2021). Cross-cultural adaptation and validation of the German Central Sensitization Inventory (CSI-GE). BMC Musculoskeletal Disorders Aug 18; 22(1):708. https://doi.org/10.1186/s12891-021-04481-5
Laekeman M, Ehrhardt S, Kuss K, Petzke F, Dieterich A, Neblett R, Schäfer A (2019) Expert and Patient perspectives on the cross-cultural translation and adaptation of the Central Sensitization Inventory into German. ePoster EFIC Congress Valencia, September. Morressier. https://doi.org/10.26226/MORRESSIER.5D4434D306F5C40FC448474D
Turkish (CSI-Turk):
Developed by Prof Dr Murat Birtane and colleagues, Trakya University Medical Faculty Physical Medicine and Rehabilitation Department, Edirne Turkey.
Düzce Keleş E, Birtane M, Ekuklu G, Kılınçer C, Çalıyurt O, & Taştekin N. (2022). Validity and reliability of the Turkish version of the central sensitization inventory. Arch Rheumatol 37(4):518-526. doi:10.46497/ArchRheumatol.2022.8665
Nepali (CSI-NP):
Developed by Saurab Sharma and colleagues Department of Physiotherapy, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel Hospital, Kavre, Nepal.
Sharma, S., Jha, J., Pathak, A., & Neblett, R. (2020). Translation, cross-cultural adaptation, and measurement properties of the Nepali version of the central sensitization inventory (CSI). BMC neurology, 20(1), 1-10.
Swedish (CSI-Swe):
Developed by Irina Midenfjord, MS & Magnus Simrén, MD PhD, and colleagues, Dept of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Midenfjord, I., Grinsvall, C., Koj, P., Carnerup, I., Törnblom, H., & Simrén, M. (2021). Central sensitization and severity of gastrointestinal symptoms in irritable bowel syndrome, chronic pain syndromes, and inflammatory bowel disease. Neurogastroenterology & Motility, e14156. https://doi.org/10.1111/nmo.14156
Finnish (CSI-Fin):
Developed by Jani Mikkonen D.C., DACNB, Ph.D., University of Eastern Finland; Hannu Luomajoki, Ph.D., Professor of Physiotherapy, Department of Health, Zürich University of Applied Sciences, Winterthur, Switzerland; Olavi Airaksinen M.D., Ph.D., Professor of Physical and Rehabilitation Medicine (PRM), University of Eastern Finland; Ville Leinonen M.D., Ph.D., Professor of Neurosurgery, University of Eastern Finland.
Mikkonen J, Luomajoki H, Airaksinen O, Neblett R, Selander T, & Leinonen V. (2021). Cross-cultural adaptation and validation of the Finnish version of the central sensitization inventory and its relationship with dizziness and postural control. BMC Neurology, 21(1), 1-15. https://doi.org/10.1186/s12883-021-02151-6
Danish (CSI-Dan):
Developed by Professor Søren O’Neill, D.C., Ph.D, M. Rehab.; Henrik Hein Lauridsen, D.C., MSc., Ph.D.; Johanne Brinch Filtenborg, MSc.; Casper Glissmann Nim, MSc.; Liam Holm, BSc.; Spinecenter of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark; University of Southern Denmark, Odense, Denmark.
Holm, L. A., Nim, C. G., Lauridsen, H. H., Filtenborg, J. B., & O’Neill, S. F. (2022). Convergent validity of the central sensitization inventory and experimental testing of pain sensitivity. Scandinavian Journal of Pain, 22(3), 597-613. https://doi.org/10.1515/sjpain-2021-0090
Korean (CSI-Kor):
Developed by Man Soo Kim, MD, PhD, and colleagues , Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
Kim, M. S., Koh, I. J., Kim, C. K., Choi, K. Y., Kim, C. Y., & In, Y. (2020). Cross-cultural adaptation and validation of the Korean version of the Central Sensitization Inventory in patients undergoing total knee arthroplasty for knee osteoarthritis. Plos one, 15(12), e0242912.
Russian (CSI-R):
Developed by Oleg Esin, MD, PhD, and colleagues, Kazan (Volga region) Federal University, Russia, Tatarstan Republic, Kazan.
Esin OR, Gorobets EA, Khairullin IKh, Esin RG, Gamirova RG, Shamsutdinova RF, Fedorenko AI, Faskhutdinova AT, Khakimova AR. Central Sensitization Inventory — a Russian version. S.S. Korsakov Journal of Neurology and Psychiatry = Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2020;120(6):51–56. (In Russ.). https://doi.org/10.17116/jnevro202012006151
Persian (CSI-Per):
Developed by Karim Noorollahzadeh, Ph.D candidate of Physical therapy, Department of Physical therapy, Tarbiat Modares University, Tehran, Iran; Sedighe Kahrizi, Associated profosser of Physical therapy, Department of Physical therapy, Tarbiat Modares University, Tehran, Iran; and Mohammad Gholami-Fesharaki, Assistance Professor of Biostatistics, Department of Biostatistics, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran.
Noorollahzadeh K, Kahrizi S, Fesharaki MG, Majid Heidarian M, Neblett R, Behzadipour S (2020). Cross-cultural adaptation and psychometric validation of the Persian version of the central sensitization inventory. MSK Science and Practice, 51, 102314. DOI: 10.1016/j.msksp.2020.102314
Arabic (CSI-Ar):
Developed by Mohammad A. Madi, PT. PhD and colleagues, Department of Physical therapy and Occupational Therapy, The Hashemite University, Zarqa, Jordan
Madi, M., Hamzeh, H., Abujaber, S., & Altubasi, I. (2021). Cross cultural adaptation, validity, and reliability of Central Sensitization Inventory in Arabic language. Disability and Rehabilitation, 1-9. https://doi.org/10.1080/09638288.2021.2006322
Hungarian (CSI-Hun):
Developed by Szilvia Ambrus, DMD, and colleagues, Semmelweis University, Hungary and University Hospitals Leuven, Belgium.
(Psychometric validation is currently in progress)
Thai (CSI-Thai)
Developed by Taweewat Wiangkham, PhD, MRes AHR, BS PT (hons), Cert. ICH GCP and colleagues, Department of Physical Therapy, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, 65000, Thailand.
Wiangkham, T., Phungwattanakul, N., Rinpol, T., Somsiri, A., Mainoiy, S., Bannathong, T., … & Neblett, R. (2022). Central Sensitisation Inventory-Thai version: translation, cross-cultural adaptation, and psychometric evaluation in chronic non-specific neck pain. Disability and Rehabilitation, 1-8. doi: 10.1080/09638288.2022.2149863
Chinese – Simplified Version for China:
Liang D, Yu X, Guo X, Zhang J, Jiang R. Cross-cultural adaptation and validation of the Chinese version of the short-form of the Central Sensitization Inventory (CSI-9) in patients with chronic pain: A single-center study. PLoS One. 2023 Mar 16;18(3):e0282419. doi: 10.1371/journal.pone.0282419. PMID: 36928443; PMCID: PMC10019621.
Xu C, Yao S, Wei W, Zhang H, Ma J, Shang L. (2023). Cross-cultural adaptation and validation for central sensitization inventory: based on Chinese patients undergoing total knee arthroplasty for knee osteoarthritis. J Orthop Surg Res. 13;18(1):960. doi: 10.1186/s13018-023-04375-3. PMID: 38093300; PMCID: PMC10717624.
Chinese – Traditional Version for Taiwan and Hong Kong:
Developed by Yuling Wang, Rehabilitation Medicine Center, The Sixth Affiliated Hospital of Sun Yat-sen University; Wing Yuk Ip, The University of Hong Kong, Department of Orthopaedics & Traumatology; and colleagues, in the People’s Republic of China.
Feng, B., Hu, X., Lu, W. W., Wang, Y., & Ip, W. Y. (2022). Cultural validation of the Chinese central sensitization inventory in patients with chronic pain and its predictive ability of comorbid central sensitivity syndromes. Journal of Pain Research, 15;15:467-477. doi: 10.2147/JPR.S348842. PMID: 35210847; PMCID: PMC8857991.
Marathi (CSI-Mar):
Developed by Dr. Ashwini Kale, MPTh, Associate Professor, MGM’s Institute Of Physiotherapy Aurangabad, Maharashtra, INDIA
(Psychometric validation is currently in progress)
Kannada (CSI-Kan):
Developed by Nidhi S. and colleagues at Srinivas University, Mangalore, India
(Psychometric validation is currently in progress)
Czech (CSI-Czech):
Developed by Tomas Kavka and colleagues, Motol University Hospital and Second Medical Faculty at Charles University, Prague, Czech Republic
(Psychometric validation is currently in progress)
Tamil (CSI-Tamil):
Developed by A.Thangamani Ramalingam and colleagues, Sarvajanik college of physiotherapy, Rampura, chadda-ole, Surat, India
(Psychometric validation is currently in progress)
Indonesian (CSI-Ind):
Developed by Dr. Magdalena Surjaningsih Halim, Saraswati E., Ribka R., Reyhania A. & Rifdah A., Atma Jaya Catholic University of Indonesia, Jakarta
(Psychometric validation is currently in progress)
Ukrainian (CSI-Ukr):
Developed by M. Stanislavchuk, Prof., D.M.S. and V. Bombela, MD., Chair of Internal Medicine #1, National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
Stanislavchuk M, Bombela V, Shkarivskyy Y. Translation, Cross-Cultural Adaptation and Validation of the Central Sensitization Inventory for Patients with Rheumatoid Arthritis. Lviv clinical bulletin 2022, 1(37)-2(38): 21-27.
Hebrew (CSI-Heb):
Developed by Simon Vulfsons, M.D. and colleagues, Rambam Institute for Pain Medicine, in Haifa Israel.
Hindi (CSI-Hin):
Developed by Chinmay jain, Postgraduate student, Dr. Prem V, PT, Ph.D. Associate Professor, and Dr. Karvannan H, Ph.d. PT Associate Professor, Manipal College of Health Professions, Manipal Academy of Higher Education, Bangalore, India.
Fear Avoidance Components Scale (FACS)
Pain-related avoidance of activities, due to fear of increased pain or (re)injury, is a common problem for people with painful medical conditions. Fear-avoidance (FA) can lead to decreased functioning and to disability from activities of daily living. Though other self-report measures of FA are available, they have been criticized for not adequately evaluating all important components of FA. The Fear-Avoidance Components Scale (FACS), originally introduced in 2015, is a new measure of FA that attempts to improve on these earlier instruments by comprehensively evaluating important cognitive, behavioral, and affective components of FA in patients with painful medical conditions.
The FACS has 20 items, scored on a 6-point Likert scale, for a total score range of 0 to 100. Total scores indicate one of the following severity levels: Subclinical (0-20); Mild (21-40); Moderate (41-60); Severe (61-80); and Extreme (81-100). In its initial published validation study, the FACS demonstrated strong test-retest reliability (Pearson r between .9 and .94) and internal consistency (Cronbach’s alpha between .89 and .92). The FACS severity levels corresponded well with score distributions from different subject populations with painful medical conditions. Subjects with the highest level of functioning, and presumably the lowest disability and FA, scored in the lower FACS severity levels. Subjects with the lowest levels of functioning, and presumably the highest disability and FA, scored in the higher FACS severity levels. In addition, strong associations were found among FACS scores and other FA-related psychosocial patient-reported outcome variables and objective lifting performance variables in a chronic musculoskeletal pain disorder population admitted to an interdisciplinary functional restoration program.
Supporting References:
English version (FACS-En):
Neblett R, Mayer TG, Hartzell MM, Williams MJ, Gatchel RJ. The fear-avoidance components scale (FACS): Development and psychometric evaluation of a new measure of pain-related fear avoidance. Pain Practice: The Official Journal Of World Institute Of Pain. 2016 Apr; 16 (4):435-50.
Neblett R, Mayer TG, Williams M, Asih S, Cuesta-Vargas AI, Hartzell MM, Gatchel RJ. (2017). The fear-avoidance components scale (FACS): Responsiveness and functional restoration treatment outcomes in a chronic musculoskeletal pain disorder (CMPD) population. Clinical Journal of Pain. Dec;33(12):1088–1099.
European Spanish (FACS-Sp):
Developed by Antonio I Cuesta-Vargas, PhD, and colleagues, Cátedra de Fisioterapia, Departamento de Fisioterapia, Universidad de Malaga, Andalucia Tech, Instituto Investigacion de Biomédica de Malaga (IBIMA) Grupo de Clinimetria (F-14). Av/ Arquitecto Peñalosa s/n (Teatinos Campus Expansion) 29009 Malaga (Spain)
Cuesta-Vargas, AI, Roldan-Jimenez C, Neblett R, Gatchel RJ. (2020). Cross-cultural adaptation and validity of the Spanish Fear Avoidance Components Scale and clinical implications in primary care. BMC Family Practice, 21(44), 1-9. https://doi.org/10.1186/s12875-020-01116-x
Serbian (FACS-Serb):
Developed by Aleksandar Knezevic, MD, PhD, and colleagues, Faculty of Medicine, University of Novi Sad, Serbia and Medical Rehabilitation Clinic, Clinical Centre of Vojvodina, Novi Sad, Serbia.
Knezevic A, Neblett R, Gatchel RJ, Jeremic-Knezevic M, Bugarski-Ignjatovic V, Tomasevic-Todorovic S, Boskovic K, Cuesta-Vargas A (2018). Psychometric validation of the Serbian version of the Fear Avoidance Component Scale (FACS). PLOS ONE 13(9): e0204311. https://doi.org/10.1371/journal.pone.0204311
Dutch (FACS-Du):
Developed by Liesbet De Baets and colleagues, REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.
De Baets L, Matheve T, Mingels S, Bruijnes A, Van Goethem A, Huybrechts X, Neblett R, Timmermansa A, Janssens L. (2020). The Development and Measurement Properties of the Dutch Version of the Fear-Avoidance Component Scale in Persons with Low Back and Shoulder Pain. Submitted for publication.
Gujarati (FACS-G):
Developed by Dr. Dibyendunarayan Bid, PT, and colleagues, The Sarvajanik College of Physiotherapy, Rampura, Surat
Bid Dibyendunarayan D, Neblett R, Thangamani Ramalingam A, Patel Charmy J, Patel Karishma N, Patel Rinkal L, Narola Shama J, Sailor Vyoma V. (2020). Cross-Cultural Adaptation, Reliability, and Validity of the Gujarati Fear-Avoidance Components Scale. Physiotherapy – The Journal of Indian Association of Physiotherapists, 14(2) 98.
Brazilian Portuguese (FACS-Br):
Developed by Thais Cristina Chaves PhD and colleagues, Department of Physical Therapy, Federal University of São Carlos, UFSCar, São Carlos, Brazil.
Martins Silva GZ, de Lira MR, Garcêz LR, George SZ, Neblett R, Pezolato A, Lima TC, Chaves TC (2024). Measurement properties of two questionnaires assessing fear-avoidance in patients with chronic low back pain. Eval Health Prof. Jul 22:1632787241264588. doi: 10.1177/01632787241264588. Epub ahead of print.
Persian (FACS-Per):
Developed by Afshin Aghazadeh, Sohani, Soheil Mansour and Mohamad Parnianpour, Iran University of Medical Sciences, Tehran, Iran
(Psychometric evaluation is currently in progress)
Turkish (FACS-Turk):
Developed by Kadir Turan PhD student, Zübeyir Sarı, PT, PhD, and colleagues, Marmara University, Department of Physical Therapy and Rehabilitation, Istanbul, Turkey
Turan K, Sarı Z, Özden F. 2023. Psychometric properties of the Turkish version of the fear avoidance components scale in patients with chronic pain related to musculoskeletal disorders. Wien Klin Wochenschr. doi: 10.1007/s00508-023-02224-1. Epub ahead of print. PMID: 37278855.
French (FACS-Fr):
Developed by Guillaume Leonard, Arnaud Duport, and colleagues, Faculty of Medicine and Health Sciences and Research Center on Aging, Université de Sherbrooke, Sherbrooke, QC, Canada
Duport A, Bédard S, Raynauld C, Bordeleau M, Neblett R, Balg F, Devanne H & Léonard G. (2023). Cross-cultural translation and psychometric validation of the French version of the Fear-Avoidance Components Scale (FACS). Plos one, 18(10), e0288899.
Arabic (FACS-A):
Developed by Abdullah Alqarni and colleagues, Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University and King Abdulazizi University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
Alqarni, A., Othman, R., Alabasi, U., Khan, F., Alhamed, A., Nogali, S., & Neblett, R. (2024). Translation, cross-cultural adaptation, and measurement properties of the Arabic version of the fear avoidance components scale. Disability and Rehabilitation, 1–5. https://doi.org/10.1080/09638288.2024.2362946
Simplified Chinese for China (FACS-China):
Developed by Zhongyi Tu (Mars) PT, MSc., The First People’s Hospital of Baiyin, Baiyin, 730900, China, and Junfang Miao, MSc, RN, Yanzhao Zhang, OT, MSc.; Zhaohui Yang, MD.; and Rui Xu, MSc, RN, Department of Rehabilitation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
(Submitted for publication)
Traditional Chinese for Taiwan (FACS-Taiwan)
Developed by Dr. Yi-Fen Shih and colleagues, from National Yang Ming Chiao Tung University, Taiwan
(Psychometric evaluation is currently in progress)
Korean (FACS-Kor):
Developed by Professor Se-jin Hong and colleagues, Gachon University, and Professor Kyounghae Kim and colleagues, Korea University, Seoul, Republic of Korea
(Psychometric validation is currently in progress)
Ukrainian (FACS-Ukr)
Developed by Vitalii Bombela, PhD student, and colleagues, Department of Internal Medicine № 1, National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
(Psychometric validation is currently in progress)
Pain Disability Questionnaire (PDQ)
The PDQ is a self-report questionnaire designed to measure functional disability in patients with pain disorders involving the neuromuscluloskeletal system. The PDQ has demonstrated excellent psychometric properties, including test-retest reliability coefficients ranging from 0.94 to 0.98 and a Cronbach’s alpha coefficient of 0.96. In fact, the PDQ has been shown to have better psychometric properties than other similar self-report disability questionnaires that have been reported in the literature. In addition, higher PDQ scores, both before and after functional restoration treatment, have been shown to be predictive of poorer socioeconomic outcomes one-year after treatment discharge, including poorer rates of work return and retention.
The PDQ uses a visual analog scale, scored from 0 to 10, for each of the 15 items. Add the items to determine a Total Functional Disability score, which ranges from 0 to 150. Five functional disability severity levels have been recommended to aid clinical interpretation: Mild = 1 – 40; Moderate = 41 -70; Severe = 71 – 100; Very Severe = 101 – 130; and Extreme = 131 – 150. Two subscale scores can also be determined. The score total from items 1, 2, 3, 4, 5, 6, 7, 12, 13 indicate a Functional Status Component (FSC), and the score total from items 8, 9, 10, 11, 14, and 15 indicate a Psychosocial Component (PC).
Supporting References:
- Anagnostis C, Gatchel R, Mayer T. (2004). The Pain Disability Questionnaire: A New Psychometrically Sound Measure for Chronic Musculo-skeletal Disorders. SPINE. October; 29(20): 2290-2302.
- Gatchel R, Mayer T, Theodore B. (2006). The Pain Disability Questionnaire: Relationship to One-Year Functional and Psychosocial Rehabilitation Outcomes. The Journal of Occupational Rehabilitation. March; 16(1): 75-94.
- Giordano, P. C. M., Alexandre, N. M. C., Rodrigues, R. C. M., & Coluci, M. Z. O. (2012). The Pain Disability Questionnaire: a reliability and validity study. Revista latino-americana de enfermagem, 20(1), 76-83.
- Yoon, J., Choi, K. H., Kim, T. W., Yang, S. Y., & Sim, M. K. (2013). Reliability and validity of the Korean version of the pain disability questionnaire. Annals of rehabilitation medicine, 37(6), 814.
- Knezevic A, Colovic P, Jeremic‐Knezevic M, Demesi-Drljan C, Simic-Panic D, and Neblett R. (2021) Assessing the Functional Status of Patients with Chronic Pain—Cross Cultural Adaptation and Psychometric Properties of the Serbian Version of the Pain Disability Questionnaire. International Journal of Environmental Research and Public Health, 18, 6911. https://doi.org/10.3390/ijerph18136911
PRIDE’s physical therapists (PTs) use the FCE results to create individualized exercise programs for each patient. A significant emphasis is placed on regaining flexibility through one-on-one therapist instruction and yoga-based stretch classes. Advanced exercise equipment is used for targeted muscle strengthening, with a specific focus on the injured or affected body parts.
Occupational Therapy (OT) at PRIDE focuses on whole-body physical conditioning, with simulated functional tasks, designed to prepare patients with physical disabilities to successfully return to important activities of daily living, including work duties.
Margareta Shea, RN, FNP
