Abstract
Objective No valid patient-reported outcome measures (PROMs) exist to evaluate fear avoidance behaviour following concussion. This study developed a new PROM to evaluate fear avoidance behaviour following concussion and assessed the PROM content validity. Design PROM development was performed using a qualitative study, and content validation was performed using a mixed-methods approach. Methods The development phase consisted of compiling potentially relevant items (eg, questions) from other PROMs proposed to measure fear avoidance before proceeding to a series of one-on-one semistructured interviews with patient and professional participants. The content validity (relevance, comprehensibility and comprehensiveness) of the PROM was first assessed by professional participants using an online survey, before further assessment by patient participants during one-on-one semistructured interviews. Results For PROM development, seven patient participants (n=4 men) and seven professional participants (n=4 men) from six clinical professions were included, who generated 119 potentially relevant items under seven distinct domains. Key themes that emerged during development were a strong preference for a short PROM, with a simple scale, that has clinical utility. 38 professional participants (47% women) and seven patient participants completed the content validation. Thus, the final PROM (Fear Avoidance after Concussion Tool or FACT) has content validity, consists of 28 items, with four items per domain. The seven domains of the FACT are: general, physical, psychological, hypervigilance, cognitive, social and work. Conclusion The FACT has been developed to evaluate fear avoidance behaviour following concussion and has content validity. Future research should evaluate other measurement properties before implementation.
Keywords
Fear avoidance, concussion, patient-reported outcome measures, content validity, qualitative study, mixed-methods approach
Document Type
Journal Article
Date of Publication
11-11-2025
Article Number
e002811
Volume
11
Issue
4
Publication Title
BMJ Open Sport and Exercise Medicine
Publisher
BMJ Publishing Group
School
Nutrition and Health Innovation Research Institute / School of Medical and Health Sciences
Funding Information
LJS is supported by an Australian Government Research Training Program (RTP) Scholarship. MCM is supported by a Raine Medical Research Foundation Priming Grant (RPG035-2023), an NHMRC Partnership Project (GNT2035789) and a Future Health Research Innovation Fund Major Research Application Support Grant.
Funding received from the National Health and Medical Research Council (NHMRC)
GNT2035789
Administering Institution
Edith Cowan University
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Recommended Citation
Sherwood, L. J., Cowen, G., Vidovich, M., Hasleby, J., & Patricios, J. (2025). Fear Avoidance after Concussion Tool (FACT): Patient-reported outcome measure development and content validation. BMJ Open Sport & Exercise Medicine, 11(4), Article e002811. https://doi.org/10.1136/bmjsem-2025-002811
Comments
Sherwood, L. J., Cowen, G., Vidovich, M., Hasleby, J., & Patricios, J. (2025). Fear Avoidance after Concussion Tool (FACT): Patient-reported outcome measure development and content validation. BMJ Open Sport & Exercise Medicine, 11(4), e002811. https://doi.org/10.1136/bmjsem-2025-002811