Normative Data for the Fear Avoidance Behavior After Traumatic Brain Injury Questionnaire in a Clinical Sample of Adults With Mild TBI

Molly Cairncross; Chantel T Debert; Cindy Hunt; Mark T Bayley; Paul Comper; Tharshini Chandra; Noah D Silverberg

doi:10.1097/HTR.0000000000000669

Normative Data for the Fear Avoidance Behavior After Traumatic Brain Injury Questionnaire in a Clinical Sample of Adults With Mild TBI

J Head Trauma Rehabil. 2021 Sep-Oct;36(5):E355-E362. doi: 10.1097/HTR.0000000000000669.

Authors

Molly Cairncross¹, Chantel T Debert, Cindy Hunt, Mark T Bayley, Paul Comper, Tharshini Chandra, Noah D Silverberg

Affiliation

¹ Department of Psychology, University of British Columbia, and Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada (Drs Cairncross and Silverberg); Department of Clinical Neurosciences, Division of Physical Medicine and Rehabilitation, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada (Dr Debert); Head Injury Clinic, Trauma & Neurosurgery Program, St Michael's Hospital, Toronto Canada (Dr Hunt); Hull-Ellis Concussion and Research Clinic, Toronto Rehabilitation Institute, University Health Network-KITE Research Institute, Toronto, Canada (Drs Bayley and Comper and Ms Chandra); Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada (Dr Bayley); and Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada (Dr Comper).

PMID: 33741828
DOI: 10.1097/HTR.0000000000000669

Abstract

Objective: Fear avoidance behavior after a concussion or mild traumatic brain injury (mTBI) is associated with a number of adverse outcomes, such as higher symptom burden, emotional distress, and disability. The Fear Avoidance Behavior after Traumatic Brain Injury Questionnaire (FAB-TBI) is a recently developed and validated self-report measure of fear avoidance after mTBI. The objective of this study was to derive clinical normative data for the FAB-TBI. To determine whether demographic stratification was necessary and to further support clinical interpretation, we also explored associations between fear avoidance behavior and demographic and injury variables.

Setting: Five concussion clinics in Canada.

Participants: Adults who sustained an mTBI (N = 563).

Design: Cross-sectional.

Main measures: Participants completed the Fear Avoidance Behavior after Traumatic Brain Injury Questionnaire (FAB-TBI) and measures of postconcussion symptom burden (Rivermead Postconcussion Symptoms Questionnaire, Sport Concussion Assessment Tool-5) at clinic intake.

Results: Generalized linear modeling revealed that females reported more fear avoidance than males (95% CI = 0.66 to 2.75), indicating that FAB-TBI normative data should be stratified by sex. Differences between recruitment sites on FAB-TBI scores were reduced but not eliminated by controlling for potential confounds. Loss of consciousness (95% CI =0.61 to 2.76) and higher postconcussion symptom burden (95% CI = 0.79 to 1.03) were also associated with higher FAB-TBI scores, but time since injury was not (95% = CI -0.4 to 0.03). Tables to convert FAB-TBI raw scores to Rasch scores to percentiles are presented.

Conclusion: These findings support clinical interpretation of the FAB-TBI and further study of fear avoidance after mTBI.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Avoidance Learning
Brain Concussion* / diagnosis
Brain Injuries, Traumatic*
Cross-Sectional Studies
Fear
Female
Humans
Male
Post-Concussion Syndrome*
Surveys and Questionnaires