The Fear-Avoidance Beliefs Questionnaire, or FABQ, is a 16-item patient-reported outcome measure used to assess beliefs about how physical activity and work may affect pain, most commonly in low back pain populations. It includes Physical Activity and Work subscales. Higher scores suggest stronger fear-avoidance beliefs, but the FABQ does not diagnose a psychological condition, confirm pain severity or determine readiness for work, training or sport on its own.

Introduction

Pain can influence how a client moves, works, trains and participates in daily life. In some people, beliefs about pain, movement or work may contribute to avoidance, reduced confidence and ongoing disability.

The Fear-Avoidance Beliefs Questionnaire, commonly called the FABQ, is a patient-reported outcome measure used to assess beliefs about how physical activity and work may influence pain.

It is commonly used for:

• low back pain assessment
• persistent low back pain monitoring
• return-to-work discussions
• movement confidence tracking
• pain education planning
• rehabilitation progress tracking
• psychosocial risk screening support
• broader biopsychosocial assessment

The FABQ has 16 items rated from 0 to 6. It includes two commonly reported subscales: Physical Activity and Work. The Physical Activity subscale ranges from 0 to 24, while the Work subscale ranges from 0 to 42. Higher scores indicate stronger fear-avoidance beliefs.  

Quick Summary

• Outcome measure: Fear-Avoidance Beliefs Questionnaire
• Abbreviation: FABQ
• Common use: Low back pain and musculoskeletal pain contexts
• Type: Patient-reported beliefs questionnaire
• Number of items: 16
• Item score: 0–6
• Main subscales: Physical Activity and Work
• FABQ-PA score range: 0–24
• FABQ-W score range: 0–42
• Higher score means: Stronger fear-avoidance beliefs
• Lower score means: Fewer reported fear-avoidance beliefs
• Best used for: Baseline assessment, education planning, monitoring beliefs over time and supporting biopsychosocial reasoning
• Key limitation: FABQ does not diagnose a psychological condition or clear someone for work, training or sport

What Is the Fear-Avoidance Beliefs Questionnaire?

The FABQ is a self-reported questionnaire that asks the client to rate beliefs about pain, physical activity and work.

It is most commonly associated with low back pain, but the Physical Activity subscale has also been investigated in other musculoskeletal populations.  

The FABQ includes:

• 16 total items
• 0–6 response scale
• Physical Activity subscale
• Work subscale
• higher scores indicating stronger fear-avoidance beliefs

The questionnaire focuses on beliefs, not diagnosis. It helps identify how strongly a client agrees with statements about activity, work and pain.

Why It Is Used

The FABQ is used because pain-related beliefs can influence function, participation and recovery.

A client may have improving strength or range of motion but still report:

• fear that movement will worsen pain
• concern that physical activity is unsafe
• reduced confidence with bending or lifting
• avoidance of work tasks
• fear of returning to normal activity
• difficulty progressing load
• worry that pain means harm
• reduced participation despite improving symptoms

The FABQ can help professionals:

• identify fear-avoidance beliefs
• support pain education conversations
• understand barriers to activity
• guide graded exposure planning
• monitor belief change over time
• support return-to-work reasoning
• combine psychological, physical and functional findings
• improve progress tracking in Measurz

The FABQ should support assessment reasoning. It should not be used to label the client or diagnose a psychological disorder.

What It Measures

The FABQ measures beliefs about the relationship between pain, physical activity and work.

Physical Activity Beliefs

The Physical Activity subscale reflects beliefs about whether movement or physical activity may cause, worsen or maintain pain.

It may provide context around:

• movement confidence
• fear of bending or lifting
• belief that activity is harmful
• avoidance of physical tasks
• readiness for graded activity
• pain education needs

Work Beliefs

The Work subscale reflects beliefs about work and pain.

It may provide context around:

• fear of work aggravating pain
• confidence returning to normal duties
• perceived work-related cause
• expectations about work capacity
• concerns about long-term work participation

Total Score

Some resources describe a total FABQ score out of 96, but the subscales are generally more clinically useful because the Physical Activity and Work domains can behave differently. A clinical commentary notes that the psychometric properties of the subscales are better established than the total FABQ, so using the subscales may be preferable.  

Who It Is Useful For

The FABQ may be useful for:

• exercise professionals
• rehabilitation practitioners
• workplace health professionals
• allied health support teams
• strength and conditioning coaches
• movement assessment professionals
• students learning outcome measures
• professionals using Measurz or MAT for structured progress tracking

It may be relevant for clients with:

• low back pain
• persistent musculoskeletal pain
• recurrent pain episodes
• work-related pain concerns
• reduced confidence with movement
• avoidance of bending, lifting or loading
• difficulty progressing activity
• fear of returning to work, training or sport

The FABQ was originally developed for low back pain, so interpretation is strongest in low back pain contexts. Use in other body regions should be documented and interpreted cautiously.

When to Use This Outcome Measure

Use the FABQ when you want to understand how beliefs about physical activity and work may be affecting function or participation.

It may be useful at:

• initial assessment
• onboarding
• reassessment
• persistent pain review
• return-to-work planning
• return-to-lifting planning
• return-to-training planning
• flare-up review
• education progress review

The FABQ is most useful when repeated over time using the same version and scoring method.

When Not to Use or When to Be Cautious

Use caution when:

• the client cannot complete the questionnaire independently
• language or literacy affects responses
• work items are not relevant to the client
• the client is not currently working
• the score is being used to label the client
• the result is interpreted without physical and functional context
• the measure is used outside low back pain without noting limitations
• the score is being treated as a pass/fail clearance decision

The FABQ should not be used to:

• diagnose anxiety or depression
• diagnose a psychological disorder
• diagnose pain severity
• confirm tissue damage
• determine whether pain is “real”
• clear someone for work, training or sport
• replace a full clinical conversation
• replace professional judgement

Equipment or Resources Required

• FABQ questionnaire
• Scoring guide or calculator
• Measurz recording workflow
• Client-reported symptom and function notes
• Baseline and retest dates
• Optional related measures, such as:
  • Oswestry Disability Index
  • Roland-Morris Disability Questionnaire
  • Quebec Back Pain Disability Scale
  • Pain Self-Efficacy Questionnaire
  • Tampa Scale for Kinesiophobia
  • Örebro Musculoskeletal Pain Screening Questionnaire
  • pain score
  • work exposure notes
  • movement confidence notes

Administration Protocol / Practice

Setup

Explain the purpose of the questionnaire before the client completes it.

Example wording:

“This questionnaire helps us understand your beliefs about how physical activity and work relate to your pain. It does not diagnose anything on its own, but it can help us plan education, activity progressions and monitoring.”

Format

The FABQ can be completed:

• on paper
• digitally
• independently
• verbally if assistance is needed
• before a session
• during reassessment
• as part of a Measurz workflow

Client Instructions

Ask the client to:

• read each statement carefully
• rate how much they agree with each statement
• use the 0–6 scale
• answer all items where possible
• ask for clarification if they do not understand wording
• complete the same version at each retest

Completion Method

Record whether the FABQ was completed:

• independently
• digitally
• on paper
• verbally
• with assistance

This supports repeatability and helps interpret change over time.

Assistance Rules

If assistance is needed:

• explain the instructions without leading the answer
• avoid telling the client which score to choose
• avoid challenging or correcting beliefs during completion
• record that assistance was provided
• use the same assistance approach at retest where possible

Missing Item Handling

Do not guess missing responses.

Because only selected items contribute to each subscale, missing items can affect scoring differently.

For best practice:

• record missing items
• record whether the missing item contributes to FABQ-PA or FABQ-W
• avoid calculating a subscale if a scoring item is missing unless the scoring guide allows it
• interpret incomplete scores cautiously

Scoring Process

Each item is rated from:

• 0: completely disagree
• 6: completely agree

The FABQ includes two main subscales.

Physical Activity Subscale

The Physical Activity subscale is usually scored using items:

• 2
• 3
• 4
• 5

Score range:

• 0–24

Work Subscale

The Work subscale is usually scored using items:

• 6
• 7
• 9
• 10
• 11
• 12
• 15

Score range:

• 0–42

Not every FABQ item contributes to the subscale scores, even though all items are completed.  

Retesting Considerations

Retest at meaningful points, such as:

• baseline
• after pain education
• after graded exposure progressions
• after return-to-work planning
• after a flare-up
• after increased training or work exposure
• discharge or progress review

For consistency, record:

• date
• current pain behaviour
• current work status
• current activity exposure
• recent flare-ups
• current confidence
• education or graded exposure stage
• changes in job duties or training demands

Safety Notes

The FABQ is a self-report questionnaire, so it does not create physical testing risk.

However, high or worsening fear-avoidance beliefs may suggest the need to:

• explore beliefs in conversation
• adjust education
• review graded exposure
• support pacing and confidence
• consider referral or collaboration when psychological distress appears significant

Scoring and Interpretation

The FABQ is usually interpreted using the Physical Activity and Work subscales.

Higher scores indicate stronger fear-avoidance beliefs.

Lower scores indicate fewer reported fear-avoidance beliefs.

FABQ-PA

• Score range: 0–24
• Higher score: stronger fear-avoidance beliefs about physical activity
• Lower score: fewer fear-avoidance beliefs about physical activity

FABQ-W

• Score range: 0–42
• Higher score: stronger fear-avoidance beliefs about work
• Lower score: fewer fear-avoidance beliefs about work

What a High FABQ-PA Score May Suggest

A high FABQ-PA score may suggest:

• concern that activity will increase pain
• concern that movement may be harmful
• reduced confidence with bending, lifting or walking
• avoidance of physical tasks
• need for pain education or graded exposure support

What a High FABQ-W Score May Suggest

A high FABQ-W score may suggest:

• concern that work will worsen pain
• reduced confidence with normal duties
• belief that work caused or maintains pain
• concern about returning to usual work
• need for workplace discussion or graded return planning

What a Low Score May Suggest

Lower scores may suggest:

• fewer fear-avoidance beliefs
• greater confidence with movement or work
• lower perceived threat from activity
• fewer belief-based barriers to progression

What the Score Does Not Prove

A FABQ score does not prove:

• diagnosis
• pain severity
• tissue damage
• psychological disorder
• effort level
• motivation
• readiness to return to work
• readiness to return to sport
• whether one intervention caused change

How to Explain the Result Safely

Example wording:

“Your FABQ score suggests you have some concerns about how activity may affect your pain. This does not mean anything is wrong with you psychologically. It gives us a useful starting point for education, graded activity and tracking confidence over time.”

What the Score May Mean in Different Client Populations

General Fitness Clients

For general fitness clients, the FABQ may help show whether pain-related beliefs are affecting:

• bending
• lifting
• walking
• gym training
• confidence with movement
• activity progression

Interpretation cautions:

• recent flare-ups may raise scores
• beliefs may change with education and exposure
• physical capacity should still be assessed

Sport and Performance Clients

For athletes, FABQ may help identify concerns about activity or loading, but it may not capture sport-specific fear fully.

Interpretation should also include:

• sport-specific confidence
• workload exposure
• return-to-training history
• pain response to sport tasks
• psychological readiness measures where relevant

A low FABQ score should not be treated as return-to-sport clearance on its own.

Workplace Clients

For workplace contexts, FABQ-W may be especially relevant.

It may help identify beliefs around:

• job demands
• lifting
• sitting
• standing
• driving
• repetitive tasks
• return-to-work confidence

Interpretation should also consider:

• job demands
• modified duties
• workplace support
• compensation context
• supervisor communication
• work capacity assessment

Clients Not Currently Working

FABQ-W may be less relevant or harder to interpret when the client:

• is retired
• is unemployed
• is a student
• is on leave
• does not have paid work duties
• has not attempted work tasks recently

In these cases, FABQ-PA may be more relevant. A clinical commentary notes that FABQ-PA may be more appropriate for people who do not work.  

Older Adults

For older adults, FABQ may help identify whether fear of movement is affecting participation.

Interpretation should consider:

• balance confidence
• falls concern
• comorbidities
• general strength
• walking tolerance
• social participation

Youth Clients

FABQ is more commonly used in adults with low back pain.

For youth clients, consider:

• comprehension
• school and sport demands
• parent or guardian influence
• whether a youth-specific measure may be more suitable

Persistent Pain Clients

For persistent pain, FABQ can help monitor beliefs that may influence activity avoidance and disability.

Interpretation should also consider:

• pain self-efficacy
• kinesiophobia
• mood and stress
• sleep
• work demands
• flare-up history
• participation goals

Meaningful Change, MCID, MDC and Responsiveness

Meaningful change helps determine whether a score change is likely to matter.

Key terms:

• MCID / MIC: the smallest change that may be meaningful to clients or professionals, depending on method used
• MDC: the amount of change likely needed to exceed measurement error
• SEM: estimated measurement error around a score
• Responsiveness: ability of the questionnaire to detect change over time

FABQ Meaningful Change Evidence

Meaningful change values for FABQ vary by population, language version and setting.

A 2020 study examined reliability, responsiveness and MCID for the two FABQ subscales in Italian adults with chronic non-specific low back pain undergoing multidisciplinary rehabilitation. The study noted that lack of responsiveness and MCID information had limited FABQ use for clinical and research purposes.  

Because MCID values are population-specific, they should not be applied universally to every client or setting.

Practical Interpretation

When interpreting FABQ change:

• compare FABQ-PA and FABQ-W separately to baseline
• check whether the work subscale is relevant
• consider whether change aligns with behaviour and activity exposure
• look for changes in confidence, pacing and participation
• compare with pain, disability and function measures
• avoid over-interpreting very small changes

When Values Are Uncertain

Reported meaningful change values may vary by:

• acute versus persistent pain
• low back pain versus other musculoskeletal conditions
• work status
• language version
• baseline score
• education approach
• follow-up timeframe
• rehabilitation setting

When no matching MCID, MDC or SEM exists, interpretation should rely more heavily on:

• baseline comparison
• repeated measurement
• client conversation
• activity exposure
• work participation
• disability scores
• professional judgement

Normative Data, Reference Values or Comparative Data

Universal FABQ normative values are limited.

The FABQ is best interpreted through:

• baseline comparison
• subscale pattern
• work relevance
• client goals
• activity exposure
• disability measures
• conversation about beliefs and confidence

Practical guidance:

• Lower scores generally suggest fewer fear-avoidance beliefs.
• Higher scores suggest stronger fear-avoidance beliefs.
• FABQ-PA and FABQ-W should be interpreted separately.
• FABQ-W should only be interpreted strongly when work items are relevant.
• Broad thresholds should not be used as strict pass/fail criteria.
• A high score should prompt supportive conversation, not judgement or labelling.

Comparison should consider:

• pain duration
• work status
• current activity exposure
• recent flare-ups
• injury beliefs
• education history
• language version
• cultural context
• job demands
• disability level

Reliability and Validity

The FABQ has post-2000 evidence supporting its use, especially in low back pain populations.

A clinical commentary in Australian Journal of Physiotherapy described the FABQ as useful for assessing fear-avoidance beliefs and noted that the subscales have better-established psychometric properties than the total score.  

The Shirley Ryan AbilityLab summary describes the FABQ as a 16-item self-reported questionnaire with items scored from 0 to 6 and identifies the Physical Activity and Work subscale scoring ranges.  

The FABQ-PA has also been studied outside low back pain. A shoulder impingement syndrome study evaluated test-retest reliability, measurement error, construct validity and responsiveness, noting that the FABQ-PA was originally developed for low back pain and that use in other musculoskeletal disorders had been sparsely evaluated.  

Reliability and validity are stronger when:

• the correct version is used
• the correct language version is used
• relevant subscales are scored
• missing items are handled consistently
• the same scoring method is repeated
• results are interpreted in context
• FABQ is paired with disability, function and pain measures

Interpret cautiously when:

• the client is not working and FABQ-W is scored
• the measure is used outside low back pain
• multiple items are missing
• the client has difficulty understanding statements
• the score is used to label the client
• the score is used as a stand-alone decision tool

Common Errors and Limitations

Common errors include:

• treating FABQ as a diagnosis
• using FABQ as psychological labelling
• using total score without subscale interpretation
• interpreting FABQ-W when work items are not relevant
• not recording work status
• not recording missing items
• using the score as return-to-work clearance
• using the score as return-to-sport clearance
• over-interpreting small changes
• failing to discuss results respectfully

Limitations include:

• originally developed for low back pain
• work subscale may not suit non-working clients
• self-report may be influenced by recent pain, stress or work context
• high scores do not prove poor motivation
• low scores do not guarantee readiness
• universal norms and cut-offs are limited
• meaningful change values vary by population
• should be paired with physical, functional and psychosocial assessment

Practical Applications

The FABQ may help professionals:

• document baseline fear-avoidance beliefs
• identify movement or work-related concerns
• guide pain education
• support graded exposure planning
• monitor belief change over time
• support return-to-work discussions
• improve client-centred communication
• strengthen Measurz reports

For fitness clients, FABQ can show whether pain-related beliefs are affecting bending, lifting, walking or gym participation.

For workplace clients, FABQ-W can help identify whether concerns about work are affecting return-to-duty confidence.

For persistent pain clients, FABQ can help monitor whether fear-avoidance beliefs change alongside activity exposure and disability scores.

For Measurz users, FABQ is most useful when combined with:

• Oswestry Disability Index
• Roland-Morris Disability Questionnaire
• Quebec Back Pain Disability Scale
• Pain Self-Efficacy Questionnaire
• Tampa Scale for Kinesiophobia
• pain score
• movement confidence notes
• activity exposure
• work participation notes

How to Record This in Measurz

Record:

• outcome measure name: Fear-Avoidance Beliefs Questionnaire / FABQ
• version used
• date completed
• completion method: paper, digital, interview or assisted
• language/version used
• condition or presentation being tracked
• work status
• current work duties or activity role
• FABQ Physical Activity subscale score
• FABQ Work subscale score
• total score if used
• score range:
  • FABQ-PA: 0–24
  • FABQ-W: 0–42
  • total if used: 0–96
• direction of scoring: higher score indicates stronger fear-avoidance beliefs
• missing items, if any
• assistance provided, if any
• current pain score, if relevant
• current disability score, if relevant
• current activity exposure
• current work exposure
• key fear-related statements or themes
• confidence or participation goals
• education or graded exposure plan notes
• baseline comparison
• MCID/MIC/MDC comparison where supported
• related physical assessment findings
• interpretation notes
• retest date
• referral or collaboration notes where appropriate

Record whether the main concern appears to be:

• physical activity belief dominant
• work belief dominant
• mixed physical activity and work concerns
• not work-relevant
• unclear due to incomplete responses

This improves:

• repeatability
• communication
• client education
• assessment reasoning
• monitoring over time
• team consistency
• reporting quality

Related Outcome Measures / Internal Links

• Oswestry Disability Questionnaire
• Quebec Back Pain Disability Scale
• Roland-Morris Lower Back Pain Disability Questionnaire
• Pain Self-Efficacy Questionnaire / PSEQ
• Tampa Scale for Kinesiophobia / TSK
• Örebro Musculoskeletal Pain Screening Questionnaire
• Spine Function Index-10
• Neck Disability Index
• Lower Extremity Functional Scale / LEFS

FAQs

What does the FABQ measure?

The FABQ measures fear-avoidance beliefs about physical activity and work, most commonly in low back pain contexts.

How many items are in the FABQ?

The FABQ has 16 items, each rated from 0 to 6.

How is the FABQ scored?

The Physical Activity subscale uses items 2–5 and ranges from 0 to 24. The Work subscale uses items 6, 7, 9, 10, 11, 12 and 15 and ranges from 0 to 42.  

Does a higher FABQ score mean worse fear avoidance?

A higher score suggests stronger fear-avoidance beliefs about physical activity or work.

Does FABQ diagnose anxiety or a psychological condition?

No. FABQ does not diagnose anxiety, depression or any psychological disorder. It measures beliefs about activity, work and pain.

Should the total FABQ score be used?

Some resources describe a total score, but the subscales are generally more useful because Physical Activity and Work beliefs can differ.  

Is FABQ useful if the client is not working?

FABQ-PA may be more useful for clients who are not working because the Work subscale may be less relevant.  

Can FABQ be used for return-to-work decisions?

It can support return-to-work reasoning, but it should not be the only decision measure. It should be combined with functional capacity, work demands, symptoms, confidence and professional judgement.

Key Takeaways

• The FABQ is a 16-item fear-avoidance beliefs questionnaire.
• It is most commonly used in low back pain contexts.
• Items are rated from 0 to 6.
• The Physical Activity subscale ranges from 0 to 24.
• The Work subscale ranges from 0 to 42.
• Higher scores suggest stronger fear-avoidance beliefs.
• FABQ does not diagnose a psychological condition or clear a client for work, training or sport.
• Measurz should record subscale scores, work status, missing items, activity exposure, work exposure, belief themes, baseline comparison and related physical findings.

References

Grotle, M., Vøllestad, N. K., & Brox, J. I. (2006). Clinical course and impact of fear-avoidance beliefs in low back pain: Prospective cohort study of acute and chronic low back pain. Spine, 31(9), 1038–1046. https://doi.org/10.1097/01.brs.0000214878.01709.0e

Lundberg, M., Styf, J., & Carlsson, S. G. (2004). A psychometric evaluation of the Tampa Scale for Kinesiophobia: From a physiotherapeutic perspective. Physiotherapy Theory and Practice, 20(2), 121–133. https://doi.org/10.1080/09593980490453002

Monticone, M., Frigau, L., Mola, F., Rocca, B., Giordano, A., Foti, C., & Vanti, C. (2020). Reliability, responsiveness and minimal clinically important difference of the two Fear Avoidance and Beliefs Questionnaire scales in Italian subjects with chronic low back pain undergoing multidisciplinary rehabilitation. European Journal of Physical and Rehabilitation Medicine, 56(5), 600–606. https://doi.org/10.23736/S1973-9087.20.06063-5

Mintken, P. E., Cleland, J. A., Whitman, J. M., & George, S. Z. (2010). Psychometric properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in patients with shoulder pain. Archives of Physical Medicine and Rehabilitation, 91(7), 1128–1136. https://doi.org/10.1016/j.apmr.2010.04.009

Shirley Ryan AbilityLab. (2024). Fear-Avoidance Beliefs Questionnaire. RehabMeasures Database. https://www.sralab.org/rehabilitation-measures/fear-avoidance-beliefs-questionnaire

Williamson, E. (2006). Fear Avoidance Beliefs Questionnaire. Australian Journal of Physiotherapy, 52(2), 149. https://doi.org/10.1016/S0004-9514(06)70052-6