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A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
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Fear Avoidance after Concussion Tool (FACT): patient-reported outcome measure development and content validation
Liam J Sherwood1,2,3, Gill Cowen4,5,6, Mandy Vidovich7
1Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
BMJ Open Sport & Exercise Medicine
|November 14, 2025
Summary
A new tool, the Fear Avoidance after Concussion Tool (FACT), was developed to measure fear avoidance behavior after concussion. The FACT has content validity and consists of 28 items across seven domains.
Area of Science:
- Neuroscience
- Psychology
- Rehabilitation Medicine
Background:
- Patient-reported outcome measures (PROMs) are crucial for assessing recovery after concussion.
- Currently, no validated PROMs specifically address fear avoidance behavior following concussion.
- Fear avoidance behavior can significantly impact recovery and long-term outcomes.
Purpose of the Study:
- To develop a novel PROM to evaluate fear avoidance behavior after concussion.
- To assess the content validity of the newly developed PROM.
Main Methods:
- A qualitative study was employed for PROM development, involving semi-structured interviews with patients and professionals.
- Item generation involved compiling existing PROM items and expert/patient input.
- Content validity was assessed using a mixed-methods approach, including online surveys and interviews.
Main Results:
- The development process yielded 119 potential items across seven domains.
- Participants favored a short, simple, and clinically useful PROM.
- The final Fear Avoidance after Concussion Tool (FACT) comprises 28 items, with four items per domain, and demonstrates content validity.
- The seven domains of the FACT are: general, physical, psychological, hypervigilance, cognitive, social, and work.
Conclusions:
- The FACT has been successfully developed and validated for content, specifically targeting fear avoidance behavior post-concussion.
- Further research is recommended to evaluate other measurement properties of the FACT before widespread clinical implementation.
