Cross-cultural translation, adaptation, and validation of the Chinese versions of the athlete fear avoidance questionnaire and fear of return to sport scale.

Authors

Siqi Liu, Young-Eun Noh, Almir Vieira Dibai-Filho, André Pontes-Silva, Tong Zhou, Yunxi Zhang

Published in

BMC sports science, medicine & rehabilitation. Jul 04, 2026. Epub Jul 04, 2026.

Abstract

Sports injuries not only impose periods of physical rest, but they can also provoke negative psychological responses, particularly fear, that can delay return to sport (RTS) and elevate reinjury risk. Although various instruments, including the Athlete Fear Avoidance Questionnaire (AFAQ) and the Fear of Return to Sport Scale (FRESS), are available to assess such fear-related factors, validated Simplified-Chinese versions have not yet been developed.
This study conducted a systematic cross-cultural translation and psychometric validation of the AFAQ and the FRESS into Chinese (AFAQ-Ch and FRESS-Ch), following established international guidelines. Phase 1, which involved 30 athletes who had sustained an injury within the previous year (age: M = 20.6, SD = 2.4), comprised forward-backward translation, an expert panel review, and a face validity evaluation. Phase 2 assessed internal consistency, test-retest reliability, structural validity, and convergent validity among a larger sample of 204 Chinese injured athletes (age: M = 21.4, SD = 3.2), using the Simplified-Chinese Tampa Scale for Kinesiophobia (SC-TSK) and the Injury-Psychological Readiness to Return to Sport Scale (I-PRRS-Ch) as theoretically related comparison instruments.
Both the AFAQ-Ch and the FRESS-Ch demonstrated acceptable internal consistency (Cronbach's α = 0.748 and 0.736, respectively) and acceptable test-retest reliability. The AFAQ-Ch showed good test-retest reliability, with an intraclass correlation coefficient (ICC) of 0.855 (95% CI [0.790, 0.900], F[96, 96] = 12.759, p < .001), whereas the FRESS-Ch demonstrated moderate test-retest reliability, with an ICC of 0.729 (95% CI [0.620, 0.810], F[96, 96] = 6.372, p < .001). Confirmatory factor analysis supported the structural validity of the AFAQ-Ch and FRESS-Ch, with acceptable model fit for the AFAQ-Ch and generally acceptable fit for the FRESS-Ch. Evidence of convergent validity was demonstrated through significant correlations. A significant moderate positive correlation was observed between the AFAQ-Ch and the FRESS-Ch (r = .484, p < .001).
These findings indicate that the AFAQ-Ch and the FRESS-Ch can be reliably used in clinical and research settings to assess fear among Chinese-speaking athletes following injury.

PMID:
42401965
Bibliographic data and abstract were imported from PubMed on 05 Jul 2026.

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