Assessing fear in patients with cervical pain: Development and validation of the Pictorial Fear of Activity Scale-Cervical (PFActS-C)

The fear avoidance model (FAM) postulates that fear of pain or reinjury is a risk factor for persistent pain and disability, because it leads to the avoidance of physical activity. Research on the FAM has not yielded consistent results, which may be attributed to the model itself, but could also be a product of the way fear of movement is assessed. Studies of the FAM have measured fear using verbal scales consisting of items that are often vague and have only an indirect relationship with fear. This study reports on the development of a Pictorial Fear of Activity Scale-Cervical (PFActS-C). The instrument consists of a set of photographs depicting movements in which four factors that determine biomechanical demands on the neck are systematically varied - Direction of Movement, Arm Position, Weight Bearing, and Extremity of Movement. Patients (n = 355) who had been involved in motor vehicle collisions with minimal symptoms (n = 143) and moderate to severe symptoms (n = 212) rated their fear of engaging in a set of activities depicted in the PFActS-C. Based on a principle components analysis, a 19 item measure was developed. Internal consistency (alpha = .98), stability over time (n = 44, IntraClass Correlation = .72), and construct validity were all good to excellent. The results indicate that the PFActS-C may be a useful tool for assessing fear of movement in patients with cervical pain. Research is needed to confirm the factor structure of the PFActS-C and to assess the generalizability of the results to other samples with neck pain.