Measurement instruments of pain-related avoidance in chronic pain: a systematic review of psychometric properties

Avoiding harmful events is adaptive in the short term but eventually may compromise functioning in daily life. Therefore, assessing pain-related avoidance is important in both pain research and treatment. Despite a variety of available measurement instruments, a systematic analysis of their quality and limitations is lacking. We evaluated the measurement properties of instruments used to assess pain-related avoidance in individuals with chronic pain. A systematic review following COSMIN guidelines was conducted (PROSPERO registration: CRD42020181461), including an electronic search of Cochrane, PsycArticles, PubMed, PubPsych, Scopus, and Web of Science as well as grey literature from inception to January 2024. Eligible studies were English, German, or French publications that explicitly claimed to evaluate one or more psychometric properties of measurement instruments assessing pain-related avoidance in adults with chronic pain. Of 703 screened records, 140 original articles were included, covering 20 self-reported questionnaires, one therapist-reported outcome measure, and one performance-based measure. Based on the current evidence, only the Brazilian Portuguese language version of the Chronic Pain Coping Inventory and the Italian version of the Chronic Pain Coping Inventory-42 fulfilled criteria to be recommended for use. Although the commonly used Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia were the most extensively studied, the study quality was mixed. The review further highlights extensive research on internal consistency, reliability, and construct validity but reveals a lack of high-quality evidence on measurement error and criterion validity. This work was supported by funding from the Flemish Government (METH/15/011).