1 Physical Medicine and Rehabilitation, Department Medical Sciences and Public Health, University of Cagliari.
2 Neurorehabilitation Unit, Department Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy.
3 PERFORM Centre, Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montréal, QE, Canada.
4 Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Constance Lethbridge Centre, CIUSSS du Centre-Ouest-de-l'Île-de Montréal, QE, Canada.
5 Motor Sciences degree courses, Faculty of Medicine, University of Cagliari, Cagliari, Italy.
6 Bioengineering Unit, Institute of Veruno (NO), ICS Maugeri, IRCCS, Italy.
7 Physical Medicine and Rehabilitation Unit, Institute of Tradate (VA), ICS Maugeri, IRCCS, Italy.

The aim of this study was to translate, culturally adapt and validate an Italian version of the Athlete Fear Avoidance Questionnaire (AFAQ-I). We conducted a cross-sectional evaluation of the psychometric properties of the AFAQ-I in university athletes with musculoskeletal injuries, culturally adapting it in accordance with international standards. Psychometric evaluation included the assessment of structural validity (exploratory factor analysis), internal consistency (Cronbach's alpha and inter-item correlation), test-retest reliability [intraclass correlation coefficient, (ICC) (2,1)], measurement error and minimum detectable change (MDC). To examine construct validity, we compared (Spearman ?) the AFAQ-I with a numerical pain rating scale (NPRS), the Pain Catastrophizing Scale (PCS) and the Fear Avoidance Beliefs Questionnaire (FABQ) subscales [FABQ-Physical Activity (FABQ-PA) and FABQ-Work (FABQ-W)]. The AFAQ-I was administered to 133 university athletes with musculoskeletal injuries (95 males and 38 females; mean age 25 years, SD 5; mean average pain duration 5.6 months, SD 8.7). Factor analysis revealed an acceptable 1-factor 10-item solution (explained common variance at minimum rank factor analysis: 0.74) although a couple of items (#6 and 9) presented low factor loadings, suggesting the presence of a small secondary dimension. Cronbach's alpha was 0.78 and the average inter-item correlation was 0.27. ICC (2,1) was 0.95 and the MDC was 4.4 points. As hypothesized a priori, the AFAQ-I moderately correlated with NPRS (? = 0.42), PCS (? = 0.59), FABQ-PA (? = 0.40) and FABQ-W (? = 0.34). In conclusion, the AFAQ-I is a valid Italian translation of AFAQ that demonstrates acceptable psychometric properties. However, we recommend further analysis of the construct definition of the AFAQ and additional examination of its structural validity.