New Insights into Fear-Avoidance Assessment: Edith Cowan University's Concussion Tool

Edith Cowan University researchers have developed the Fear Avoidance after Concussion Tool (FACT), a clinician-facing questionnaire designed to identify fear-avoidance behaviors that can prolong recovery after concussion. Scoped to capture concussion-specific psychological drivers of inactivity, FACT assesses patient-reported responses tied to daily tasks, sport, work and symptom-triggered avoidance. As a brief, targeted screen, FACT can promptly flag patients for behavioral intervention and inform graded return-to-activity decisions within the same visit.

FACT measures multiple domains that map directly to rehabilitation choices: activity avoidance, fear of symptom exacerbation, return-to-activity anxiety and symptom catastrophizing. Items are worded for concussion experiences rather than borrowed from non-specific injury instruments, so responses reflect cognitive and behavioral barriers unique to concussion recovery. Clinicians can translate domain patterns into practical decisions—who needs early graded exposure, who requires psychological input, and which activity prescriptions to modify—closing a consistent gap in concussion assessment by providing targeted behavioral data that was previously unmeasured.

Early validation and recognition have begun for the FACT, with initial content-validation and feasibility work reported alongside conference acknowledgement—early validation and conference recognition. Pilot observations describe the questionnaire as acceptable to patients, feasible within routine outpatient workflows, and informative to clinicians without imposing meaningful time burden. That evidence places FACT at an early-validation stage and highlights the need for larger clinical-population studies and formal psychometric testing before broad clinical uptake.

The questionnaire comprises 28 items, requires about five minutes to complete, and can be administered by a clinician, therapist or trained assistant during an assessment or follow-up visit. Placed early in the care pathway or used when recovery stalls, FACT scores can triage patients to graded exposure programs, trigger referral to psychological services, or guide incremental changes to activity and return-to-play prescriptions. Integrating FACT into routine visits is likely to make behavioral risk profiling operationally feasible and to improve targeted management decisions during the clinical encounter.

Key Takeaways:

• FACT is a 28-item, ~5-minute concussion-specific questionnaire designed to detect activity avoidance, symptom-exacerbation fear, return-to-activity anxiety, and catastrophizing.
• Initial content validation and feasibility work plus conference recognition support early clinical relevance but require larger psychometric studies for widespread adoption.
• FACT can be administered in routine visits to triage for graded exposure, psychological referral, or modification of activity prescriptions, enabling targeted rehabilitation decisions.