Identifying Patient Fear-Avoidance Beliefs by Physical Therapists Managing Patients With Low Back Pain
Identifying Patient Fear-Avoidance Beliefs by Physical Therapists Managing Patients With Low Back Pain
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DOI：
10.2519/jospt.2010.3381
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发表时间：
2010-12-01
影响因子：
6.1
通讯作者：
George, Steven Z.
中科院分区：
文献类型：
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作者：
Calley, Darren;Jackson, Steven;George, Steven Z.
研究设计：Cross-sectional.OBJECTIVES:通过比较治疗师对患者恐惧回避信念问卷（FABQ）、坦帕运动恐惧量表11项（TSK-11）和疼痛灾难化量表（PCS）的评估，评估物理治疗师识别腰痛患者恐惧回避信念的准确性。比较治疗师对感知患者恐惧回避的评级和关于身体活动和伤害的2项问卷的同时效度，以及恐惧回避的临床测量（FABQ，TSK-11，PCS），用数字疼痛评定量表（NPRS）评估的疼痛强度，和用奥斯韦斯特里残疾问卷（ODQ）评估的残疾。需要考虑社会心理因素，以确定患者的残疾和慢性腰痛的风险已经得到很好的记录。然而，物理治疗师的能力，以确定恐惧回避的信念，使用直接observation.METHODS：8个物理治疗师和80例腰痛患者从3个物理治疗诊所参加了这项研究。患者完成FABQ、TSK-11、PCS、ODQ、NPRS和二分2项恐惧回避筛选问卷。在初步评估后，物理治疗师将感知到的患者恐惧回避评定为0至10级，并记录2种对他们评级的影响。斯皮尔曼相关性和独立t检验确定了治疗师0-10评级和2-项目筛选与恐惧回避和临床measurements.RESULTS的关联水平：治疗师评级的感知患者恐惧回避有公平到中度的评分者间的可靠性（ICC2.1 = 0.663）。治疗师评分与FABQ或TSK-11评分没有强相关性。相反，他们意外地与ODQ和PCS分数有更强的关联。两个2项筛选问题与FABQ体力活动分数，而体力活动问题的恐惧也与FABQ工作，TSK-11，PCS和ODQ scores.CONCLUSION：治疗师的评级感知患者恐惧回避与自我报告的恐惧回避分数，显示治疗师的判断和常用的恐惧回避措施之间的潜在脱节。相反，治疗师评级与疼痛灾难化和残疾之间存在较小但具有统计学意义的相关性，这一发现可能支持治疗师无法区分恐惧回避和其他因素。基于对体力活动和伤害的恐惧的2项筛选问题显示出识别FABQ体力活动评分升高的潜力。证据等级：鉴别诊断，2b级。J Orthop Sports PhysTher 2010;40（12）：774-783。doi：10.2519/jospt.2010.3381
STUDY DESIGN: Cross-sectional.OBJECTIVES: To evaluate the accuracy with which physical therapists identify fear-avoidance beliefs in patients with low back pain by comparing therapist ratings of perceived patient fear-avoidance to the Fear-Avoidance Beliefs Questionnaire (FABQ), Tampa Scale of Kinesiophobia 11-item (TSK-11), and Pain Catastrophizing Scale (PCS). To compare the concurrent validity of therapist ratings of perceived patient fear-avoidance and a 2-item questionnaire on fear of physical activity and harm, with clinical measures of fear-avoidance (FABQ, TSK-11, PCS), pain intensity as assessed with a numeric pain rating scale (NPRS), and disability as assessed with the Oswestry Disability Questionnaire (ODQ).BACKGROUND: The need to consider psychosocial factors for identifying patients at risk for disability and chronic low back pain has been well documented. Yet the ability of physical therapists to identify fear-avoidance beliefs using direct observation has not been studied.METHODS: Eight physical therapists and 80 patients with low back pain from 3 physical therapy clinics participated in the study. Patients completed the FABQ, TSK-11, PCS, ODQ, NPRS, and a dichotomous 2-item fear-avoidance screening questionnaire. Following the initial evaluation, physical therapists rated perceived patient fear-avoidance on a 0-to-10 scale and recorded 2 influences on their ratings. Spearman correlation and independent t tests determined the level of association of therapist 0-to-10 ratings and 2-item screening with fear-avoidance and clinical measures.RESULTS: Therapist ratings of perceived patient fear-avoidance had fair to moderate interrater reliability (ICC2.1 = 0.663). Therapist ratings did not strongly correlate with FABQ or TSK-11 scores. Instead, they unexpectedly had stronger associations with ODQ and PCS scores. Both 2-item screening questions were associated with FABQ-physical activity scores, while the fear of physical activity question was also associated with FABQ-work, TSK-11, PCS, and ODQ scores.CONCLUSION: Therapists' ratings of perceived patient fear-avoidance were not associated with self-reported fear-avoidance scores, showing a potential disconnect between therapist judgments and commonly used fear-avoidance measures. Instead, therapist ratings had small but statistically significant correlations with pain catastrophizing and disability, findings that may support therapists' inability to discriminate fear-avoidance from these other factors. The 2-item screening questions based on fear of physical activity and harm showed potential to identify elevated FABQ physical activity scores.LEVEL OF EVIDENCE: Differential diagnosis, level 2b. J Orthop Sports Phys Ther 2010;40(12):774-783. doi:10.2519/jospt.2010.3381