Cultural Adaptation and Validation of the Athlete Fear-Avoidance Questionnaire in Arabic: Preliminary Analysis of Fear-Avoidance in ACL-Reconstructed Recreational Players

Background: The Athlete Fear-Avoidance Questionnaire (AFAQ) is a validated instrument that measures athletes’ fear and avoidance behaviors after an injury, particularly regarding their sporting activities. Purpose: This study aimed to adapt and validate the AFAQ for Arabic-speaking recreational players (AFAQ-Arabic) after anterior cruciate ligament reconstruction (ACLR). Study Design: Cohort study; level of evidence: 3. Methods: The AFAQ underwent translation and cross-cultural adaptation according to the Beaton guidelines. A total of 104 male recreational players who had undergone ACLR completed the AFAQ-Arabic, the Fear-Avoidance Belief Questionnaire (FABQ), and the Numerical Pain Scale (NPS). To assess test-retest reliability, a subset of 38 recreational players were asked to complete the AFAQ-Arabic twice, 1 week apart. Statistical tests were conducted to test the internal consistency, reliability, and convergent validity of the AFAQ-Arabic. Results: The AFAQ-Arabic demonstrated high internal consistency (Cronbach alpha, 0.854) and excellent test-retest reliability (intraclass correlation coefficient, 0.885) (95% CI, 0.784-0.942; P <.001). Minimal floor (4.8% scoring the minimum) and ceiling effects (1% scoring the maximum) were observed. Convergent validity showed significant positive weak correlations between the AFAQ-Arabic and (1) the FABQ-Physical Activity (r = 0.340; P <.01), (2) the FABQ-Work (r = 0.272; P <.01), and (3) the NPS (r = 0.383; P <.01). Cross-cultural adaptation of the AFAQ-Arabic revealed linguistic and cultural relevance. Conclusion: Our study demonstrated that the AFAQ-Arabic was a reliable and valid tool for assessing fear avoidance in Arabic-speaking recreational players after ACLR. Future studies are needed to measure athlete fear-avoidance in injured Arabic-speaking athletes to understand its psychological aspects in rehabilitation and potentially aid in tailored interventions for improving outcomes.