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.
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.
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
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.
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.
The FABQ measures beliefs about the relationship between pain, physical activity and work.
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
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
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.
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.
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.
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
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
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.”
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
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
Record whether the FABQ was completed:
independently
digitally
on paper
verbally
with assistance
This supports repeatability and helps interpret change over time.
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
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
Each item is rated from:
0: completely disagree
6: completely agree
The FABQ includes two main subscales.
The Physical Activity subscale is usually scored using items:
2
3
4
5
Score range:
0–24
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.
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
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
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.
Score range: 0–24
Higher score: stronger fear-avoidance beliefs about physical activity
Lower score: fewer fear-avoidance beliefs about physical activity
Score range: 0–42
Higher score: stronger fear-avoidance beliefs about work
Lower score: fewer fear-avoidance beliefs about work
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
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
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
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
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.”
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
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.
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
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.
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
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
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 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
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.
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
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
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
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 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
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
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
The FABQ measures fear-avoidance beliefs about physical activity and work, most commonly in low back pain contexts.
The FABQ has 16 items, each rated from 0 to 6.
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.
A higher score suggests stronger fear-avoidance beliefs about physical activity or work.
No. FABQ does not diagnose anxiety, depression or any psychological disorder. It measures beliefs about activity, work and pain.
Some resources describe a total score, but the subscales are generally more useful because Physical Activity and Work beliefs can differ.
FABQ-PA may be more useful for clients who are not working because the Work subscale may be less relevant.
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.
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.
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
