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Francesca Genoese, Shelby Baez and Johanna M. Hoch

of injury-related fear. 7 Injury-related fear is a specific psychological impairment that may include fear of movement, fear of reinjury, or fear-avoidance beliefs. 8 Kinesiophobia, which is fear of movement as a result of vulnerability to reinjury, 9 has been frequently examined as a contextual

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Megan N. Houston, Johanna M. Hoch and Matthew C. Hoch

, and fear-avoidance beliefs. Currently, the only way to measure such fears is through patient-reported outcomes. For more than 3 decades, the Tampa Scale of Kinesiophobia (TSK) and Fear-Avoidance Beliefs Questionnaire (FABQ) have been the predominant instruments used to measure injury-related fear. The

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Johanna M. Hoch, Megan N. Houston, Shelby E. Baez and Matthew C. Hoch

this population. The most commonly assessed contextual factor in this population to date has been fear of reinjury. 4 , 6 – 9 However, there is a paucity of literature that examines additional contextual factors related to injury-related fear, such as fear-avoidance beliefs (FAB). FAB, specific to a

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TaeYeong Kim, JaeHyuk Lee, SeJun Oh, Seungmin Kim and BumChul Yoon

determine whether SHR exercise in the treatment of patients with cLBP reduced patients’ pain, improved functional disabilities, and improved fear-avoidance beliefs after the treatment period better than stabilization exercises with suspension. Methods Study Design The study design was a randomized

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Emily R. Hunt, Shelby E. Baez, Anne D. Olson, Timothy A. Butterfield and Esther Dupont-Versteegden

understanding of its benefits and justify its use clinically. A model that is frequently used to explain chronic pain development after musculoskeletal injury is the Fear-Avoidance Model. 4 Theory-based research using the Fear-Avoidance Model indicates that patients with higher fear-avoidance beliefs are less

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Johanna M. Hoch, Cori W. Sinnott, Kendall P. Robinson, William O. Perkins and Jonathan W. Hartman

where 1 represents “no problem” and 5 “severe problem”. 5 The total score ranges from 0–64 where 0 indicates no disablement and 64 indicates severe disablement. 5 The Fear-Avoidance Belief Questionnaire The Fear-Avoidance Belief Questionnaire (FABQ) is a 16-item dimension-specific PROM which was

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Megan N. Houston, Johanna M. Hoch, Bonnie L. Van Lunen and Matthew C. Hoch


Health-related quality of life (HRQOL) is a broad term for the impact of injury or illness on physical, psychological, and social health dimensions. Injury has been associated with decreased HRQOL in athletes. However, the influence of injury history, participation status, time since last injury, and injury severity on HRQOL remains unclear.


To compare HRQOL in collegiate athletes based on injury history, participation status, time since last injury, and injury severity and to examine relationships between HRQOL outcomes.




3 National Collegiate Athletic Association (NCAA) institutions.


467 collegiate athletes (199 males, 268 females; 19.5 ± 1.3 y, 173.9 ± 10.5 cm, 71.9 ± 13.6 kg) were recruited from NCAA Division I (n = 299) and Division III (n = 168) institutions. Athletes were included regardless of participation status, which created a diverse sample of current and past injury histories.

Main Outcome Measures:

During a single session, participants completed an injury history form, the Disablement in the Physically Active Scale (DPA), and the Fear-Avoidance Beliefs Questionnaire (FABQ). Dependent variables included DPA-Physical Summary Component (DPA-PSC), DPA-Mental Summary Component (DPA-MSC), and FABQ Scores.


HRQOL differences were detected between groups based on injury history, participation status, and time since last injury. No differences were detected for injury severity. A moderate correlation was identified between the DPA-PSC and FABQ (rs = 0.503, P < .001) and a weak relationship was identified between the DPA-MSC and FABQ (rs = 0.266, P < .001).


Injury negatively influenced HRQOL in athletes with a current injury. While those individuals participating injured reported better HRQOL than the athletes sidelined due to injury, deficits were still present and should be monitored to ensure a complete recovery. Identifying the patient’s perception of impairment will help facilitate evidencebased treatment and rehabilitation strategies that target the physical and psychosocial aspects of health.

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MUST TAKE THIS QUIZ ONLINE. 1. In the Critically Appraised Topic (CAT) by Genoese et al., what is the term used that is defined as a fear of pain that causes avoidance of behaviors that could cause pain? a. fear-avoidance belief b. fear of movement c. fear of reinjury d. kinesiophobia 2. In this CAT

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circumference 15. According to the biopsychosocial model reported on by Hunt et al., the interaction between biological, psychological, and social factors can influence health outcomes, such as the pain experience. a. True b. False 16. Fear-avoidance beliefs are a result of fear of pain and/or reinjury that

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Johanna M. Hoch, Shelby E. Baez, Robert J. Cramer and Matthew C. Hoch

instruments that assess psychosocial contextual factors that may impact the health condition, such as fear of reinjury and fear-avoidance beliefs. Houston et al 8 utilized both the Fear-Avoidance Beliefs Questionnaire 26 and the Tampa Scale of Kinesiophobia-11 27 and found significant differences with