Psychometric Properties of Two Instruments Assessing Catastrophizing and Fear-Avoidance Behavior in Mild Traumatic Brain Injury

Objective: Psychometrically sound measures of catastrophizing about symptoms and fear avoidance behavior are needed to further applications of the fear-avoidance model in mild traumatic brain injury (mTBI) for research and clinical purposes. To this end, two questionnaires were adapted (minor), the Postconcussion Symptom Catastrophizing Scale (PCS-CS) and the Fear of Mental Activity Scale (FMA). This study aimed to investigate the factor structure, internal consistency, test-retest reliability, and concurrent and construct validity of two adapted questionnaires in a sample of participants with mTBI compared to participants with orthopedic injury and healthy adults. Method: One hundred eighty-five mTBI participants (40% female), 180 participants with orthopedic injury (55% female), and 116 healthy adults (55% female) participated in the study. All participants were assessed at two time points (2 weeks postinjury and 3 months) using self-reported questionnaires. Data were collected using online questionnaires. Results: Findings indicated a three-factor model (magnification, rumination, helplessness) with a higher order factor (catastrophizing) for the PCS-CS and a two-factor model (activity avoidance and somatic focus) for the FMA. The results showed strong internal consistency, good test-retest reliability, and good concurrent and convergent validity for the PCS-CS and FMA across all samples. Conclusions: This study has shown that the PCS-CS and FMA are psychometrically sound instruments and can be considered for valid and reliable assessment of catastrophizing about postconcussion like symptoms and fear-avoidance beliefs about mental activities. These instruments can be used in research and clinical practice applications of the fear-avoidance model and add to explanations of prolonged recovery after mTBI. Key Points Question: What are the psychometric properties (factor structure, reliability, validity) of two adapted questionnaires measuring catastrophizing (Postconcussion Symptom Catastrophizing Scale; PCS-CS) and fear-avoidance behavior (Fear of Mental Activity Scale; FMA) related to postconcussion symptoms after mild traumatic brain injury. Findings: The PCS-CS and FMA have good internal consistency, test-retest reliability, and concurrent and convergent validity. Importance: This study suggests that the PCS-CS and FMA are reliable and valid measures of catastrophizing about symptoms and fear-avoidance of mental activity after injury in participants wi