The reliability and validity of a measure of perceived functional capacity for work in chronic back pain

Pain Self-Efficacy Can Improve During a Visit With an Orthopedic Surgeon

BACKGROUND

Greater pain self-efficacy (PSE) is associated with reduced pain, fewer limitations, and increased quality of life after treatment for orthopedic conditions. The aims of this study were to (1) assess if PSE improves during a visit with an orthopedic surgeon and (2) identify modifiable visit factors that are associated with an increase in PSE.

MATERIALS AND METHODS

We performed a prospective observational study of orthopedic clinic visits at a multispecialty clinic from February to May 2022. New patients who presented to one of six orthopedic surgeons were approached for the study. Patients who provided consent completed a pre-visit questionnaire including the Pain Self-Efficacy Questionnaire (PSEQ) and demographic questions. A trained research member recorded the five-item Observing Patient Involvement in Decision Making Instrument (OPTION-5) score, number of questions asked, and visit duration. Immediately after the visit, patients completed a post-visit questionnaire consisting of the PSEQ and Perceived Involvement in Care Scale (PICS).

RESULTS

Of 132 patients enrolled, 61 (46%) had improved PSE after the orthopedic visit, with 38 (29%) having improvement above a clinically significant threshold. There were no significant differences between patients with increased PSE and those without increased PSE when comparing the PICS, OPTION-5, questions asked, or visit duration.

CONCLUSION

Almost half of the patients had improvement in PSE during an orthopedic visit. The causal pathway to how to improve PSE and the durability of the improved PSE have implications in strategies to improve patient outcomes in orthopedic surgery, such as communication methods and shared decision-making. Future research can focus on studying different interventions that facilitate improving PSE. [Orthopedics. 2024;47(4):e197-e203.].

Characteristics of patients with myofascial pain syndrome of the low back

The objective of this study is to determine characteristics of patients with myofascial pain syndrome (MPS) of the low back and the degree to which the low back pain in the patients examined can be attributed to MPS. Twenty-five subjects with myofascial trigger point(s) [MTrP(s)] on the low back participated in this cross-sectional study. The location, number, and type of selected MTrPs were identified by palpation and verified by ultrasound. Pain pressure threshold, physical function, and other self-reported outcomes were measured. Significant differences were found in Group 1 (Active), 2 (Latent), 3 (Atypical, no twitching but with spontaneous pain), and 4 (Atypical, no twitching and no spontaneous pain) of participants in the number of MTrPs, current pain, and worst pain in the past 24 h (p = .001-.01). There were interaction effects between spontaneous pain and twitching response on reports of physical function, current pain, and worst pain (p = .002-.04). Participants in Group 3 reported lower levels of physical function, and higher levels of current pain and worst pain compared to those in Group 4. Participants in Group 1 and 2 had similar levels of physical function, current pain, and worst pain. The number of MTrPs is most closely associated with the level of pain. Spontaneous pain report seems to be a decisive factor associated with poor physical function; however, twitching response is not.

Systemic pro- and anti-inflammatory profiles in acute non-specific low back pain: An exploratory longitudinal study of the relationship to six-month outcome

OBJECTIVES

Pro-inflammatory molecules are thought to underpin the development of chronic low back pain (LBP). Although research has begun to explore the association between pro-inflammatory molecules in acute LBP and long-term outcome, no study has explored the role of anti-inflammatory molecules. We aimed to explore whether levels of systemic pro- and anti-inflammatory molecules 1) changed over a period of six months from the onset of acute LBP; 2) differed between people who were recovered (N = 11) and unrecovered (N = 24) from their episode of LBP at six months; 3) baseline psychological factors were related to inflammatory molecule serum concentrations at baseline, three and six months.

METHODS

We retrospectively included participants with acute LBP included from a larger prospective trial and examined blood samples for the measurement of pro- and anti-inflammatory molecules and measures of pain, disability, and psychological factors at baseline, three and six months.

RESULTS

The serum concentrations of pro- and anti-inflammatory molecules did not differ over time when compared between participants who recovered and those who did not recover at six-month follow-up. At three months, the unrecovered group had higher interleukin (IL)-8 and IL-10 serum concentrations than the recovered group. Baseline psychological factors were not related to inflammatory molecules at any time point.

DISCUSSION

This exploratory study showed that levels of systemic inflammatory molecules did not change over the course of LBP, irrespective of whether people were recovered or unrecovered at six months. There was no relationship between acute-stage psychological factors and systemic inflammatory molecules. Further investigation is needed to elucidate the contribution of pro- and anti-inflammatory molecules to long-term LBP outcome.

Pain Self-Efficacy (PSEQ) score of <22 is associated with daily opioid use, back pain, disability, and PROMIS scores in patients presenting for spine surgery

BACKGROUND CONTEXT

Pain self-efficacy, or the belief that one can carry out activities despite pain, has been shown to be associated with back and neck pain severity. However, the literature correlating psychosocial factors to opioid use, barriers to proper opioid use, and Patient-Reported Outcome Measurement Information System (PROMIS) scores is sparse.

PURPOSE

The primary aim of this study was to determine whether pain self-efficacy is associated with daily opioid use in patients presenting for spine surgery. The secondary aim was to determine whether there exists a threshold self-efficacy score that is predictive of daily preoperative opioid use and subsequently to correlate this threshold score with opioid beliefs, disability, resilience, patient activation, and PROMIS scores.

PATIENT SAMPLE

Five hundred seventy-eight elective spine surgery patients (286 females; mean age of 55 years) from a single institution were included in this study.

STUDY DESIGN/SETTING

Retrospective review of prospectively collected data.

OUTCOME MEASURES

PROMIS scores, daily opioid use, opioid beliefs, disability, patient activation, resilience.

METHODS

Elective spine surgery patients at a single institution completed questionnaires preoperatively. Pain self-efficacy was measured by the Pain Self-Efficacy Questionnaire (PSEQ). Threshold linear regression with Bayesian information criteria was utilized to identify the optimal threshold associated with daily opioid use. Multivariable analysis controlled for age, sex, education, income, and Oswestry Disability Index (ODI) and PROMIS-29, version 2 scores.

RESULTS

Of 578 patients, 100 (17.3%) reported daily opioid use. Threshold regression identified a PSEQ cutoff score of <22 as predictive of daily opioid use. On multivariable logistic regression, patients with a PSEQ score <22 had two times greater odds of being daily opioid users than those with a score ≥22. Further, PSEQ <22 was associated with lower patient activation; increased leg and back pain; higher ODI; higher PROMIS pain, fatigue, depression, and sleep scores; and lower PROMIS physical function and social satisfaction scores (p<.05 for all).

CONCLUSIONS

In patients presenting for elective spine surgery, a PSEQ score of <22 is associated with twice the odds of reporting daily opioid use. Further, this threshold is associated with greater pain, disability, fatigue, and depression. A PSEQ score <22 can identify patients at high risk for daily opioid use and can guide targeted rehabilitation to optimize postoperative quality of life.

Psychosocial Predictors of Chronic Pain 12 Months After Surgical Fixation for Lower Extremity Fracture: A Prospective Study

OBJECTIVE

Pain is a common outcome after lower extremity fracture (LEF) requiring surgical fixation. Although psychosocial characteristics have meaningful associations with adverse outcomes, no studies have evaluated how psychosocial characteristics throughout recovery are associated with pain outcomes. The primary purpose of this study was to determine whether psychosocial characteristics are early risk factors for pain outcomes in patients following LEF who have no history of chronic pain.

METHODS

Participants, 122 patients with a LEF, consented to this single-center, prospective cohort study. Measurements of depression, pain self-efficacy, pain catastrophizing, and fear of movement were completed at 1 week, 6 weeks, 3 months, 6 months, and 12 months after LEF. Chronic pain development and pain intensity were assessed at 12 months. Univariate analyses assessing the difference between means and corresponding effect sizes were evaluated between those individuals with and without chronic pain at 12 months. Separate logistic and linear regression models using psychosocial scores at each time point were used to determine the association with the development of chronic pain and pain intensity, respectively.

RESULTS

Of 114 patients (93.4%) who completed the study, 51 (45%) reported chronic pain at 12 months. In the univariate analysis, all psychosocial variables at 6 weeks, 3 months, 6 months, and 12 months were significantly different between those with and those without chronic pain at 12 months (Cohen d range = 0.84 to 1.65). In the multivariate regression models, all psychosocial variables at 6 weeks, 3 months, and 6 months were associated with chronic pain development (odds ratio range = 1.04 to 1.22) and pain intensity (β range = .05 to .14) at 12 months.

CONCLUSION

Psychosocial scores as early as 6 weeks after surgery are associated with pain outcomes 12 months after LEF.

IMPACT

Physical therapists should consider adding psychosocial screening throughout recovery after LEF to identify patients at increased risk for long-term pain outcomes.

Reproducibility of improvements in patient-reported functional ability following functional capacity evaluation

Background

Performance of functional capacity evaluation (FCE) may affect patients, self-efficacy to complete physical activity tasks. First evidence from a diagnostic before-after study indicates a significant increase of patient-reported functional ability. Our study set out to test the reproducibility of these results.

Methods

Patients with musculoskeletal trauma and an unclear return to work prognosis were recruited in a trauma rehabilitation center in Lower Austria. We included patient cohorts of three consecutive years (2016: n = 161, 2017: n = 140; 2018: n = 151). Our primary outcome was patient-reported functional ability, measured using the Spinal Function Sort (SFS). SFS scores were assessed before and after performing an FCE to describe the change in patient-reported functional ability (cohort study). We investigated whether the change in SFS scores observed after performing an FCE in our first cohort could be replicated in subsequent cohorts.

Results

Demographic data (gender, age and time after trauma) did not differ significantly between the three patient cohorts. Correlation analysis showed highly associated before and after SFS scores in each cohort (2016: r_s = 0.84, 95% CI: 0.79 to 0.89; 2017: r_s = 0.85, 95% CI: 0.81 to 0.91; 2018: r_s = 0.86, 95% CI: 0.82 to 0.91). Improvements in SFS scores were consistent across the cohorts, with overlapping 95% confidence intervals (2016: 14.8, 95% CI: 11.3 to 18.2; 2017: 14.8, 95% CI: 11.5 to 18.0; 2018: 15.2, 95% CI: 12.0 to 18.4). Similarity in SFS scores and SFS differences were also supported by non-significant Kruskal–Wallis H tests (before FCE: p = 0.517; after FCE: p = 0.531; SFS differences: p = 0.931).

Conclusions

A significant increase in patient-reported functional ability after FCE was found in the original study and the results could be reproduced in two subsequent cohorts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05208-w.

Health-Enabling Technologies for Telerehabilitation of the Shoulder: A Feasibility and User Acceptance Study

Background  After discharge from a rehabilitation center the continuation of therapy is necessary to secure already achieved healing progress and sustain (re-)integration into working life. To this end, home-based exercise programs are frequently prescribed. However, many patients do not perform their exercises as frequently as prescribed or even with incorrect movements. The telerehabilitation system AGT-Reha was developed to support patients with shoulder diseases during their home-based aftercare rehabilitation.

Objectives  The presented pilot study AGT-Reha-P2 evaluates the technical feasibility and user acceptance of the home-based telerehabilitation system AGT-Reha.

Methods  A nonblinded, nonrandomized exploratory feasibility study was conducted over a 2-year period in patients' homes. Twelve patients completed a 3-month telerehabilitation exercise program with AGT-Reha. Primary outcome measures are the satisfying technical functionality and user acceptance assessed by technical parameters, structured interviews, and a four-dimensional questionnaire. Secondary endpoints are the medical rehabilitation success measured by the active range of motion and the shoulder function (pain and disability) assessed by employing the Neutral-0 Method and the standardized questionnaire “Shoulder Pain and Disability Index” (SPADI), respectively. To prepare an efficacy trial, various standardized questionnaires were included in the study to measure ability to work, capacity to work, and subjective prognosis of work capacity. The participants have been assessed at three measurement points: prebaseline (admission to rehabilitation center), baseline (discharge from rehabilitation center), and posttherapy.

Results  Six participants used the first version of AGT-Reha, while six other patients used an improved version. Despite minor technical problems, all participants successfully trained on their own with AGT-Reha at home. On average, participants trained at least once per day during their training period. Five of the 12 participants showed clinically relevant improvements of shoulder function (improved SPADI score > 11). The work-related parameters suggested a positive impact. All participants would recommend the system, ten participants would likely reuse it, and seven participants would have wanted to continue their use after 3 months.

Conclusion  The findings show that home-based training with AGT-Reha is feasible and well accepted. Outcomes of SPADI indicate the effectiveness of aftercare with AGT-Reha. A controlled clinical trial to test this hypothesis will be conducted with a larger number of participants.

Pain-related Self-efficacy Among People With Back Pain: A Systematic Review of Assessment Tools

BACKGROUND

Before an intervention can be implemented to improve pain-related self-efficacy, assessment is required. The aim of the present study was to provide a systematic review on which self-efficacy scales are being used among patients with back pain and to evaluate their psychometric properties.

METHODS

A systematic search was executed in January 2019 and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 checklist served as a guide for conducting the study. Electronic databases included Cinahl, Medline, PubMed, PsycINFO, PSYNDEX, and SportDiscus. Publications in English or German language that focused on the adult patient population with back pain and which provided validation or reliability measures on pain-related self-efficacy were included.

RESULTS

A total of 3512 records were identified resulting in 671 documents after duplicates were removed. A total of 233 studies were screened full-text, and a total of 47 studies addressing 19 different measures of pain-related self-efficacy were included in the quality analysis. The most commonly used instruments were the Pain Self-Efficacy Questionnaire and the Chronic Pain Self-Efficacy Scale. All studies reported internal consistency, but many studies lacked other aspects of reliability and validity.

CONCLUSIONS

Further research should focus on assessing validity and interpretability of these questionnaires, especially in pain-related target groups. Researchers should select questionnaires that are most appropriate for their study aims and the back pain population and contribute to further validation of these scales to best predict future behavior and develop intervention programs. This systematic review aids selection of pain-related assessment tools in back pain both in research and practice.

Pilot Trial of the Reboot Online Program: An Internet-Delivered, Multidisciplinary Pain Management Program for Chronic Pain

Objectives

Chronic pain causes significant disability and psychological distress, but barriers often prevent people with pain from engaging in traditional face-to-face pain management programs. Accessible, feasible, and effective alternative treatment options are needed.

Methods

A prospective, feasibility pilot study was conducted to trial a novel, multidisciplinary online pain management program: the "Reboot Online" program. Twenty participants experiencing pain of at least three months duration were recruited. All participants were enrolled in the "Reboot Online" program, consisting of eight online lessons completed over 16 weeks. Lessons incorporated multidisciplinary input from medical pain specialists, physiotherapists, and psychologists. Participants were assessed at pretreatment, posttreatment, and follow-up using a suite of outcome measures examining pain, disability, catastrophising, self-efficacy, mood, and psychological distress.

Results

13 participants completed the program (65% adherence). Following treatment, the participants had significantly improved scores on measures of pain-related disability, self-efficacy, catastrophising thoughts, acceptance of pain, symptoms of depression, and general psychological distress. These findings were retained at three months posttreatment. Participants also reported high levels of acceptability and satisfaction with the program.

Discussion

This study provides pilot evidence for the feasibility, acceptability, and effectiveness of an online, multidisciplinary pain program: "Reboot Online." Future investigations will focus on conducting a randomised controlled trial of this innovative and promising treatment for chronic pain. This trial is registered with ACTRN12615000660583.

iPeer2Peer program: a pilot feasibility study in adolescents with chronic pain

Adolescents with chronic pain are often socially isolated, having never met others with chronic pain, and often feel misunderstood by healthy peers. Adolescence is a sensitive period for developing one's sense of self and autonomy, which often occurs in the context of peer relationships. This developmental process is disrupted in adolescents when their chronic pain interferes with their social interactions. Peer mentoring is proposed as a developmentally timely intervention. The aim of this study is to develop and test the feasibility, acceptability, and impact of the iPeer2Peer program. The iPeer2Peer program is a tailored peer mentorship program that provides modeling and reinforcement by peers (trained young adults with chronic pain aged 18-25 years who have learned to successfully manage their pain). This program aimed to enhance self-management of chronic pain in adolescents through 10 Skype video calls over the course of 8 weeks. A pilot randomized controlled trial design using waitlist controls was used in an adolescent chronic pain sample. Twenty-eight adolescents aged 14.8 ± 1.6 years (93% female) completed the trial (intervention: n = 12; control n = 16). Three adolescents completed the intervention after completing their participation in the control arm. The iPeer2Peer program was feasible and acceptable, provided the adolescents were given more time to complete all 10 calls. When compared with controls, adolescents who completed the iPeer2Peer program had significant improvement in self-management skills and their coping efforts were more successful. The iPeer2Peer program is a promising peer mentoring intervention that complements standard care for adolescents with chronic pain.

Assessment of Psychosocial Factors in Functional Capacity Evaluation of Clients with Chronic Back Pain

Psychosocial factors have been shown to be major determinants in the return to work of individuals with chronic back pain. It is important, therefore, for occupational therapists to have an understanding of these factors and to include an evaluation of them when assessing function for work.

This article presents an overview of the influence of some of these factors on function and, in particular, return to work in individuals with chronic back pain. It also provides an introduction to tools occupational therapists may use to assess these factors within a comprehensive functional capacity evaluation. Variables discussed include perceived disability, expectation of return to work, self-efficacy, perceived effort, pain intensity, pain location and pain behaviour. Consideration is given to the reliability and validity of the tools reviewed.

Development of a Modified Version of the Spinal Function Sort (M-SFS): A Mixed Method Approach

Purpose To develop a modified version of the spinal function sort (M-SFS) by measuring work-related self-efficacy beliefs in patients with chronic low back pain. Methods A mixed method design consisting of three different methods (M1-3) was performed. In semi-structured interviews participants were asked how often they performed the activities of the 50 SFS items in 1 week, and which spinal postures and movements were associated with their back pain (M1). Quantitative analysis of previously obtained SFS data investigated internal consistency, unidimensionality, item response, and floor and ceiling effect (M2). Experts rated the SFS items based on their relevance (M3). The findings from these methods were used within a final scoring system for item reduction. Results From semi-structured interviews with 17 participants, eight new items emerged (M1). Quantitative analysis of 565 data sets (M2) revealed very high internal consistency of all items (Cronbach's alpha = 0.98) indicating item redundancy; unidimensionality of the SFS was supported by principal component analysis; good item response was confirmed by Rasch analysis; and a floor effect of four items depicting very heavy material handling was found. Experts agreed on 8 out of the 50 SFS as relevant (M3). From the original SFS, 12 items met the predefined summary score of 9. Conclusions A modified version of the SFS with 20 items has been developed. Feasibility, reliability and validity of this modified version must be tested before it can be used in clinical practice.

Improving the self-management of chronic pain: COping with persistent Pain, Effectiveness Research in Self-management (COPERS)

Background

Chronic musculoskeletal pain is a common problem that is difficult to treat. Self-management support interventions may help people to manage this condition better; however, there is limited evidence showing that they improve clinical outcomes. Our overarching research question was ‘Does a self-management support programme improve outcomes for people living with chronic musculoskeletal pain?’.

Aim

To develop, evaluate and test the clinical effectiveness and cost-effectiveness of a theoretically grounded self-management support intervention for people living with chronic musculoskeletal pain.

Methods

In phase 1 we carried out two systematic reviews to synthesise the evidence base for self-management course content and delivery styles likely to help those with chronic pain. We also considered the psychological theories that might underpin behaviour change and pain management principles. Informed by these data we developed the Coping with persistent Pain, Evaluation Research in Self-management (COPERS) intervention, a group intervention delivered over 3 days with a top-up session after 2 weeks. It was led by two trained facilitators: a health-care professional and a layperson with experience of chronic pain. To ensure that we measured the most appropriate outcomes we reviewed the literature on potential outcome domains and measures and consulted widely with patients, tutors and experts. In a feasibility study we demonstrated that we could deliver the COPERS intervention in English and, to increase the generalisability of our findings, also in Sylheti for the Bangladeshi community. In phase 2 we ran a randomised controlled trial to test the clinical effectiveness and cost-effectiveness of adding the COPERS intervention to a best usual care package (usual care plus a relaxation CD and a pain toolkit leaflet). We recruited adults with chronic musculoskeletal pain largely from primary care and musculoskeletal physiotherapy services in two localities: east London and Coventry/Warwickshire. We collected follow-up data at 12 weeks (self-efficacy only) and 6 and 12 months. Our primary outcome was pain-related disability (Chronic Pain Grade disability subscale) at 12 months. We also measured costs, health utility (European Quality of Life-5 Dimensions), anxiety, depression [Hospital Anxiety and Depression Scale (HADS)], coping, pain acceptance and social integration. Data on the use of NHS services by participants were extracted from NHS electronic records.

Results

We recruited 703 participants with a mean age of 60 years (range 19–94 years); 81% were white and 67% were female. Depression and anxiety symptoms were common, with mean HADS depression and anxiety scores of 7.4 [standard deviation (SD) 4.1] and 9.2 (SD 4.6), respectively. Intervention participants received 85% of the course content. At 12 months there was no difference between treatment groups in our primary outcome of pain-related disability [difference –1.0 intervention vs. control, 95% confidence interval (CI) –4.9 to 3.0]. However, self-efficacy, anxiety, depression, pain acceptance and social integration all improved more in the intervention group at 6 months. At 1 year these differences remained for depression (–0.7, 95% CI –1.2 to –0.2) and social integration (0.8, 95% CI, 0.4 to 1.2). The COPERS intervention had a high probability (87%) of being cost-effective compared with usual care at a threshold of £30,000 per quality-adjusted life-year.

Conclusions

Although the COPERS intervention did not affect our primary outcome of pain-related disability, it improved psychological well-being and is likely to be cost-effective according to current National Institute for Health and Care Excellence criteria. The COPERS intervention could be used as a substitute for less well-evidenced (and more expensive) pain self-management programmes. Effective interventions to improve hard outcomes in chronic pain patients, such as disability, are still needed.

Trial registration

Current Controlled Trials ISRCTN22714229.

Funding

The project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 14. See the NIHR Journals Library website for further project information.

Self-Beliefs about Pain and Occupational Performance: A Comparison of Two Measures Used in a Pain Management Program

This study evaluated the relationship between pain self-efficacy, occupational performance, and satisfaction with performance in clients with chronic pain who participated in a hospital-based pain management program. Self-efficacy was measured using the Pain Self-Efficacy Questionnaire (Nicholas, 1988). Occupational performance and satisfaction were measured using the Canadian Occupational Performance Measure (Law et al., 1998). Data were collected from 64 clients who completed both measures before and after a 3-week pain management program. Results of the study demonstrated a positive difference between pain self-efficacy and occupational performance ( t = 4.43, df = 62, p < .05), and between pain self-efficacy and satisfaction ( t = 4.02, df = 62, p < .05). This research suggests that therapy should address the beliefs of clients about their abilities to perform occupations when living with chronic pain (Strong, 1995) and reinforces the use of the Pain Self-Efficacy Questionnaire and Canadian Occupational Performance Measure as reliable and valid assessment measures for those with chronic pain.

Cognitive Coping Style and the Effectiveness of Distraction or Sensation-Focused Instructions in Chronic Pain Patients

AIM

This study set out to investigate whether cognitive coping strategies that match participants' preferred coping style effectively reduce pain intensity and situational anxiety in a population of people with chronic pain.

METHOD

Chronic pain patients (N = 43) completed questionnaires on coping style, pain intensity, self-efficacy, and situational/trait anxiety. Participants were classified as Monitors (n = 16) or Blunters (n = 19) based on their Miller Behavioural Style Scale score. Participants were then provided with an audiotaped intervention in which they were instructed to focus on pain sensations or to engage in a distraction task and then to rate the pain intensity and their anxiety during and after the attentional focus and distraction conditions. The two interventions were each completed by all participants, having been presented in counterbalanced order.

RESULTS

Findings revealed that Monitors' level of anxiety decreased following a congruent (i.e., sensation-focused) intervention. No effects were obtained in terms of perceived pain. For blunters, however, their perceived levels of anxiety and pain did not attenuate following a congruent, distraction-focused intervention.

CONCLUSION

Among persons experiencing chronic pain, tailoring coping strategies to match an individual's preferred coping style--in particular, those with a high level of monitoring--may enhance the benefit of psychological approaches to management of anxiety.

Development and Validation of a Pain Behavior Assessment in Patients with Chronic Low Back Pain

PURPOSE

High levels of pain behavior adversely affect the success of multidisciplinary rehabilitation of patients with chronic nonspecific low back pain (CNSLBP). Functional capacity evaluation (FCE) assessment should detect high levels of pain behavior to prevent the inclusion of unsuitable patients to functional rehabilitation programs. The aim of this study was to develop a Pain Behavior Assessment (PBA) and to evaluate its construct validity.

METHODS

The PBA was developed by experts in the field and is literature-based. Inclusion criteria for participants of the validation study were: CNSLBP, age 20-60 years, referral for fitness-for-work evaluation. The PBA was applied by physiotherapists during FCE. Rasch analysis was performed to evaluate the construct validity of the PBA. Internal consistency was indicated by the person separation index (PSI), which corresponds to Cronbach's alpha.

RESULTS

145 male (72.5%) and 55 female patients were included. Rasch analysis removed 11 items due to misfit and redundancy, resulting in a final PBA of 41 items. Item mean fit residual was -0.33 (SD 1.06) and total item Chi square 100.39 (df = 82, p = 0.08). The PSI value was 0.83. DIF analysis for age and gender revealed no bias.

CONCLUSIONS

The PBA is a valid assessment tool to describe pain behavior in CNSLBP patients. The high PSI-value justifies the use of the PBA in individuals. The PBA may help to screen patients for high levels of pain behavior.

Measurement Properties of the Spinal Function Sort in Patients with Sub-acute Whiplash-Associated Disorders

PURPOSE

To extensively analyze the measurement properties the Spinal Function Sort (SFS) in patients with sub-acute whiplash-associated disorders (WAD).

METHODS

Three-hundred-two patients with WAD were recruited from an outpatient work rehabilitation center. Internal consistency was assessed by Cronbach's α. Construct validity was tested based on eight a priori hypotheses. Structural validity was measured with principal component analysis (PCA). Test-retest reliability and agreement was evaluated in a sub sample (n = 32) using intraclass correlation coefficient (ICC) and limits of agreement (LoA). The predictive validity of SFS for future work status at 1, 3, 6, and 12 months follow-up was determined by area under the curve (AUC) of receiver operating characteristics. Non-return to work (N-RTW) was defined with two cut-off points: workcapacity <50 and <100 %.

RESULTS

N-RTW decreased from 50%, 1 month follow-up, to 14%, 12 months follow-up. Cronbach's α was 0.98, PCA revealed evidence for unidimensionality. ICC was 0.86, LoA was ±33 points. Seven out of eight hypotheses for construct validity were not rejected. AUC reduced with a longer follow-up from 0.71 for 1 month to 0.61 at 12 months, for cut-off point <50%. For cut-off point <100% these values were 0.71 and 0.59.

CONCLUSION

In patients with sub-acute WAD test-retest reliability, internal consistency, construct- and structural validity of the SFS were adequate. LoA were substantial. Sensitivity to accurately predict N-RTW was poor. The predictive validity of the SFS for N-RTW of patients with sub-acute WAD from an outpatient work rehabilitation setting was only sufficient for the short term (1 month).

Development and evaluation of short forms of the Pain Catastrophizing Scale and the Pain Self-efficacy Questionnaire

BACKGROUND

To facilitate efficient screening and reduce the length of comprehensive self-report batteries, a four-item short form of the Pain Catastrophizing Scale (PCS) and a two-item short form of the Pain Self-Efficacy Questionnaire (PSEQ) have been developed and evaluated in samples of patients with arm and upper extremity pain.

AIMS

The first aim of this study was to evaluate these short forms in a heterogeneous sample of patients seeking treatment for chronic musculoskeletal pain, using a priori criteria for determining adequate internal consistency, construct validity and sensitivity to change. In addition, the findings of past studies were used to identify items suitable for new and potentially stronger short forms of these measures.

METHOD

Data were provided by 280 patients who completed the original PCS and PSEQ as part of an interdisciplinary rehabilitation programme.

RESULTS

The previously developed four-item PCS and the newly developed six-item short form of the PCS both met the internal consistency and construct validity criteria. They did not meet the criterion regarding sensitivity to change. However, similar to what was obtained using the original PCS, large effect sizes were found when using these short forms to examine pre-treatment to post-treatment changes in catastrophizing. For the PSEQ, the new four-item short form was clearly superior to the other alternatives and met all three criteria.

CONCLUSION

The strongest short forms of the PCS and PSEQ could facilitate the assessment of pain catastrophizing and self-efficacy in situations in which the use of the longer original measures is not feasible.

Injured workers' construction of expectations of return to work with sub-acute back pain: the role of perceived uncertainty

INTRODUCTION

Little is known about the formation of expectations of return to work (RTW) from the perspective of injured workers with back injuries. This modified grounded theory study uses a biopsychosocial approach that considers the workers' complex social circumstances, to unpack the multidimensional construct of expectations of RTW from the injured worker's perspective.

METHOD

Initial semi-structured interviews were conducted with 18 individuals with sub-acute back pain, who were off work between 3 and 6 months. Follow-up interviews were conducted with 7 participants for the purposes of member checking. The interview data was coded, compared and analyzed over the course of data collection, until saturation was reached.

RESULTS

Data analysis revealed that expectations of return-to-work are constructed based on perceived uncertainty which subsumes five inter-related categories (1) perceived lack of control over the return-to-work process, (2) perceived lack of recognition by others of the impact of the injury, (3) perceived inability to perform the pre-injury job, (4) fear of re-injury, and (5) perceived need for workplace accommodations. Expectations, once formed, were influenced by the worker's experience of coping with perceived uncertainty.

CONCLUSION

Perceived uncertainty plays a key role in injured workers' formation of expectations of return-to-work. Implications are discussed regarding how this perceived uncertainty plays a role in the development of (re)injury prevention and rehabilitation programs. The importance of further research on perceived uncertainty is presented, along with potential future research considerations.

The pain self-efficacy questionnaire: Taking pain into account

Self-efficacy beliefs in people with chronic pain have been assessed either by reference to confidence in ability to perform specific tasks or to confidence in performing more generalised constructs like coping with pain. Both approaches reflect aspects of the original conceptualisations of self-efficacy and both have proved useful, but it is noteworthy that confidence in performing activities in the context of pain is rarely addressed. An important element in the original formulations of self-efficacy referred to persistence in the face of obstacles and aversive experiences. In this context, self-efficacy beliefs for people experiencing chronic pain might be expected to incorporate not just the expectation that a person could perform a particular behaviour or task, but also their confidence in being able to do it despite their pain. This aspect of the self-efficacy construct has been included in a measure for people with chronic pain, the Pain Self-Efficacy Questionnaire (PSEQ). The accumulated evidence from a number of published studies and a confirmatory analysis with a large cohort of heterogeneous chronic pain patients attending a pain management program provide support for the PSEQ's original psychometric properties developed with a sample of chronic low back pain patients. The importance of taking the context of pain into account in the assessment of self-efficacy beliefs in pain populations and the ways in which this measure can be used to improve the assessment of people experiencing chronic pain, before and after treatment, are examined.

Illness perceptions and work participation: a systematic review

Purpose

Self-regulatory processes play an important role in mediating between the disease and the health outcomes, and potentially also work outcomes. This systematic review aims to explore the relationship between illness perceptions and work participation in patients with somatic diseases and complaints.

Methods

The bibliographic databases Medline, PsycINFO and Embase were searched from inception to March 2008. Included were cross-sectional or longitudinal studies, patients with somatic diseases or complaints, illness perceptions based on at least four dimensions of the common sense model of self-regulation, and work participation.

Results

Two longitudinal and two cross-sectional studies selected for this review report statistically significant findings for one or more illness perception dimensions in patients with various complaints and illnesses, although some dimensions are significant in one study but not in another. Overall, non-working patients perceived more serious consequences, expected their illness to last a longer time, and reported more symptoms and more emotional responses as a result of their illness. Alternatively, working patients had a stronger belief in the controllability of their condition and a better understanding of their disease.

Conclusions

The limited number of studies in this review suggests that illness perceptions play a role in the work participation of patients with somatic diseases or complaints, although it is not clear how strong this relationship is and which illness perception dimensions are most useful. Identifying individuals with maladaptive illness perceptions and targeting interventions toward changing these perceptions are promising developments in improving work participation.

Test-Retest Reliability of the GAPP Functional Capacity Evaluation in Healthy Adults

Background. Functional capacity evaluations are commonly used in work rehabilitation practice to assess a person's capacity to perform work-related activities. Purpose. This study examined the test-retest reliability of participants' performance and administrator ratings using the Gibson Approach to Functional Capacity Evaluation (GAPP FCE). Methods. Forty-eight healthy adults were evaluated twice on 12 recommended core items of the GAPP FCE and rated for overall performance. Findings. The ICCs and 95% CIs for the Physical Level of Work and Alternative Physical Level of Work Ratings were 0.93 (0.87-0.96) and 0.86 (0.72-0.93) respectively. The ICCs for the core item-level ratings ranged from 0.15 to 0.94, and the ICCs for the actual loads handled in the manual handling items ranged from 0.88 to 0.95. Implications. The stability of an overall physical level of work rating shows potential for use in functional capacity evaluation practice and research. Further research is needed to investigate other measurement properties of the GAPP FCE using populations with injury or disability.

A review of assessment tools of illness representations: are these adapted for a work disability prevention context?

INTRODUCTION

Musculoskeletal disorders are among the main causes of short- and long-term disability.

AIM

Identify the methods for assessing multidimensional components of illness representations.

METHODS

An electronic literature search (French, English) from 1980 to the present was conducted in medical, paramedical and social science databases using predetermined key words. After screening titles and abstracts based on a specific set of criteria, sixty-four articles were reviewed.

RESULTS

Qualitative approaches for assessing illness representation were found mainly in the fields of anthropology and sociology and were based on the explanatory models of illness. The interviews reviewed were: the Short Explanatory Model Interview, the Explanatory Model of Illness Catalogue and the McGill Illness Narrative Interview. Quantitative approaches were found in the health psychology field and used the following self-administered questionnaires: the Survey of Pain Attitudes, the Pain Beliefs and Perceptions Inventory, the Pain Beliefs Questionnaire, the Fear-Avoidance Beliefs Questionnaire, the Implicit Model of Illness Questionnaire, the Illness Perception Questionnaire, including its derivatives, and the Illness Cognition Questionnaire.

CONCLUSION

This review shows the actual use and existence of multiple interviews and questionnaires in assessing multidimensional illness representations. All have been used and/or tested in a medical context but none have been tested in a work disability context. Further research will be needed to determine their suitability for use in a work disability context.

What do the numbers mean? Normative data in chronic pain measures

Although self-reported measures play a central role in the assessment of pain and its treatment, it has long been recognized that interpretation of these measures is severely limited by the absence of normative data. Despite that, relatively few of the measures used in pain clinics or research studies have normative data for reference. Using a pain centre sample (n=6124), this paper describes the development of a normative dataset on a number of commonly used pain-related measures. The measures cover many of the key dimensions in pain assessment, including pain severity/quality, disability (physical functioning), and mood (emotional functioning). Measures of different cognitive and coping constructs are also included. Mean scores are reported for each measure according to age group, gender, pain site, as well as percentiles for different scores for patients with chronic low back pain. The potential uses for datasets of this type include the assessment and evaluation of individual cases, as well as the interpretation of published clinical trials. It is also argued that future systematic reviews of pain treatments should include consideration of such patient characteristics as pain levels, disability and mood in the studies reviewed rather than pain site and chronicity alone.

Does systematic graded exposure in vivo enhance outcomes in multidisciplinary chronic pain management groups?

OBJECTIVES

Graded exposure in vivo (GEXP) treatment has been successfully used to reduce levels of pain-related fear and disability in some chronic pain patients, but its effectiveness has not been evaluated in general clinical settings using group-design studies. The purpose of this study was to determine if the systematic incorporation of GEXP into a multidisciplinary chronic pain management group (PMG) treatment program would result in better treatment outcomes than usual PMG treatment.

METHODS

One hundred forty-three chronic pain patients who were assessed as suitable for an outpatient multidisciplinary chronic PMG program were randomly allocated to 3 experimental conditions; usual PMG, PMG incorporating systematic graded exposure, and wait-list control.

RESULTS

The clinical outcomes of the 2 treatment conditions were not significantly different, suggesting that the systematic incorporation of GEXP into a multidisciplinary PMG program did not result in better treatment outcomes than usual PMG treatment. Both group treatment programs were associated with significant treatment effects when compared with the wait-list control on measures of pain intensity, fear of movement/(re)injury, pain self-efficacy, activity level, and depression. No treatment effects were found on self-report measures of pain disability or anxiety.

DISCUSSION

The addition of systematic graded exposure into a multidisciplinary chronic pain management program did not result in better clinical outcomes than the usual group treatment program. The validity of GEXP to the broader population of chronic pain patients warrants further investigation.

Psychosocial aspects of injured workers' returning to work (RTW) in Hong Kong

INTRODUCTION

This study was designed to explore the psychosocial aspects of injured workers, their self-perceived capacity and how these factors influence their success in Return To Work (RTW).

METHOD

Seventy-five subjects were recruited from the Hong Kong Workers' Health Centre and were assessed on three occasions consisting of interviews and four self-rated instruments including the Chinese Lam's Assessment of Employment Readiness (C-LASER), the SF-36 health survey, the Chinese State Trait and the Anxiety Inventory (C-STAI).

RESULTS

Results showed that the contemplation and pre-contemplation sub-scores of C-LASER appeared to be the determining factors in predicting subjects' return-to-work status. Subjects who were more "ready for action" (the Actioners) were found to have significantly higher confidence and advocacy in job seeking than the Pre-Contemplators. Their employment readiness was shown to be affected by psychosocial factors such as perceived functioning and bodily pain,

DISCUSSION

From this study, the injured workers' employment readiness appeared to associate with their RTW outcomes. Further studies would be needed to find out how the employment readiness of injured workers could be enhanced.

Validation of the Chinese Version of Pain Self-Efficacy Questionnaire

BACKGROUND

Self-efficacy is a person's belief in his or her ability to perform a certain behavior that achieves a desired outcome. Belief in self-efficacy influences the use of pain-coping strategies, physical and psychological function, and rehabilitation outcome in chronic pain patients. We conducted this prospective study to validate the psychometric properties of a Chinese version of the Pain Self-Efficacy Questionnaire (PSEQ-HK).

METHODS

A previously translated PSEQ-HK was evaluated with the author's consent. Forward-backward translation was conducted, followed by critical appraisal by an expert panel. Reliability was examined by completing the PSEQ-HK twice over a 1-wk interval. One-hundred-twenty Chinese patients with chronic nonmalignant pain were asked to self-complete a set of health-related instruments in Chinese: Numeric Pain Rating Scale, Hospital Anxiety and Depression Scale, Roland-Morris Disability Questionnaire, Pain Catastrophizing Scale, and Medical Outcome Study Short-Form 36 (SF36) Health Survey.

RESULTS

PSEQ-HK had good retest reliability (intraclass correlation coefficient 0.75) and high internal consistency (Cronbach's alpha 0.93). Exploratory factor analysis showed a one-factor model that accounted for 61% of the total variance, with minimal factor loading of 0.69. It was significantly correlated with the Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and five domains of SF36 (bodily pain, vitality, social functioning, role emotion, and mental health). Moderate correlations were observed with Roland-Morris Disability Questionnaire and two domains of SF36 (role physical, general health). It had no correlation with pain score and medication use.

CONCLUSIONS

PSEQ-HK is a reliable Chinese clinical assessment tool with satisfactory psychometric properties. Our results provided preliminary support for the construct validity of PSEQ-HK in a heterogeneous Chinese population with chronic nonmalignant pain.

Chronic pain couples: Perceived marital interactions and pain behaviours

Patient adjustment to chronic pain is well known to be influenced by the spouse and his or her response to patient expressions of pain. However, these responses do not occur in a vacuum, and the aim of the present study was to investigate patient-spouse interactions in chronic pain in detail. Ninety-five patient-spouse dyads completed questionnaires relating to mood, marital satisfaction and communication, and 80 couples also took part in semi-structured interviews. Data were analysed using quantitative and qualitative methods. Results showed that spouses of chronic pain patients reported engaging in a far wider repertoire of responses to pain behaviours than has been recognised to date. New response categories of 'hostile-solicitous' and 'observe only' were identified. Patients generally interpreted solicitous responses less favourably than spouse responses which encouraged task persistence. Male spouses identified fewer pain-related situations than female spouses but were more likely to report responding solicitously to patient pain behaviours. Marital satisfaction was significantly higher in patients who rated themselves as talking more frequently about their pain. Spouse perceived frequency of pain talk was not related to spouse marital satisfaction. There were no gender differences in marital satisfaction. The results of this study challenge some of the assumptions that have been held regarding chronic pain patient-spouse interactions.

Personality and pain-related beliefs/coping strategies: a prospective study

OBJECTIVES

The ways in which people adjust to chronic pain has been partly attributed to pre-existing personality traits, but most evidence to date is from cross-sectional studies and mainly with arthritis groups. The present study examined the effects of 5 personality dimensions on measures of pain-related beliefs and catastrophizing assessed 9 months apart with a heterogeneous chronic pain sample.

METHOD

One hundred forty-five patients with chronic pain presenting to a hospital pain center completed the NEO-Personality Inventory-Revised, 3 measures of pain related beliefs, the catastrophizing scale of the Coping Strategy Questionnaire, and a 0 to 10 pain scale. Nine months from the initial assessment, patients completed the same measures, apart from the NEO-Personality Inventory-Revised.

RESULTS

Of the 5 personality dimensions studied, only neuroticism was related to the pain-related variables. Multiple hierarchical regression analyses revealed that neuroticism was a significant predictor of residualized change in pain self-efficacy beliefs and pain control appraisals over the time of the study, after controlling for initial values of both constructs. However, the effects were small, suggesting that other factors play a role in the determination of such beliefs, in addition to neuroticism. In contrast, neuroticism was not a significant predictor of residualized change in catastrophizing responses over the same period. The findings provide partial support for the hypothesis that pre-existing personality traits place some patients at risk for poor adjustment to chronic pain.

Functional capacity evaluation as a performance measure: evidence for a new approach for clients with chronic back pain

OBJECTIVES

To report the research and development of a new approach to Functional Capacity Evaluation, the Gibson Approach to Functional Capacity Evaluation (GAPP FCE) for chronic back pain clients.

METHODS

Four studies, including pilot and feasibility testing, expert review, and preliminary interrater reliability examination, are described here. Participants included 7 healthy young adults and 19 rehabilitation clients with back pain who underwent assessment using the GAPP FCE. Thirteen therapists were trained in the approach and were silently observed administering the Functional Capacity Evaluations by at least 1 other trained therapists or the first investigator or both. An expert review using 5 expert occupational therapists was also conducted.

RESULTS

Study 1, the pilot with healthy individuals, indicated that the GAPP FCE was a feasible approach with good utility. Study 2, a pilot using 2 trained therapists assessing 5 back pain clients, supported the clinical feasibility of the approach. The expert review in Study 3 found support for GAPP FCE. Study 4, a trial of the approach with 14 rehabilitation clients, found support for the interrater reliability of recommendations for return to work based on performance in the GAPP FCE.

DISCUSSION

The evidence thus far available supports the GAPP FCE as an approach that provides a sound method for evaluating the performance of the physical demands of work with clients with chronic back pain. The tool has been shown to have good face and content validity, to meet acceptable test standards, and to have reasonable interrater reliability. Further research is occurring to look at a larger interrater reliability study, to further examine content validity, and to examine predictive validity.

Assessment of functional capacity of the musculoskeletal system in the context of work, daily living, and sport: a systematic review

The aim of this systematic review was to survey methods to assess the functional capacity of the musculoskeletal system within the context of work, daily activities, and sport. The following key words and synonyms were used: functional physical assessment, healthy/disabled subjects, and instruments. After applying the inclusion criteria on 697 potential studies and a methodological quality appraisal, 34 studies were included. A level of reliability > 0.80 and of > 0.60 resp 0.75 and 0.90, dependent of type of validity, was considered high. Four questionnaires (the Oswestry Disability Index, the Pain Disability Index, the Roland-Morris Disability Questionnaire, and the Upper Extremity Functional Scale) have high levels on both validity and reliability. None of the functional tests had a high level of both reliability and validity. A combination of a questionnaire and a functional test would seem to be the best instrument to assess functional capacity of the musculoskeletal system, but need further examined.

Three-year follow-up of lumbar artery occlusion with magnetic resonance angiography in patients with sciatica: associations between occlusion and patient-reported symptoms

STUDY DESIGN

Comparison of occlusion of lumbar arteries in magnetic resonance angiography (MRA) with patient-reported sciatica symptoms during a 3-year follow-up.

OBJECTIVES

To evaluate whether occlusion of lumbar arteries is associated with subjective pain symptoms and physical ability among sciatica patients.

SUMMARY OF BACKGROUND DATA

Cadaveric studies indicate that atherosclerotic manifestations of the abdominal aorta are associated with low back pain (LBP). Impaired blood flow may disturb diffusion of nutrients into the disc, causing degeneration and possibly back pain.

METHODS

Two-dimensional time-of-flight MRA was used to evaluate lumbar arteries at baseline and 3 years. The arteries on both sides (L1-L4) were evaluated visually and scored as normal, narrowed, or occluded. Incidence of new stenosis was estimated. The associations of stenosis with self-reported previous medical consultations, pain duration through the first year, and number of pain episodes through the last 2 years of follow-up were calculated. Additionally, leg and back pain (10-cm VAS), disability (Oswestry), and self-reported physical ability (self-efficacy) were inquired at 1, 2, and 3 years. In the statistical analysis, bivariate correlation, and the chi or Fisher's test were used.

RESULTS

MRA was obtained at baseline for 147 patients and at 3 years for 134 patients. Baseline stenosis associated with intensity of back pain at 1 year, leg pain at 2 years, and self-efficacy at every follow-up assessment, but not with disability, previous LBP history, or future pain episodes. The associations of stenosis at 3 years were similar but weaker. Newly formed stenosis was associated with the preceding year's medical consultations due to LBP and prolonged LBP during the first follow-up year.

CONCLUSIONS

Arterial stenosis is associated strongly and consistently with patient-estimated physical ability,but only slightly with subjective pain symptoms. Interestingly, new stenosis is preceded by pain symptoms. The evaluation of lumbar blood flow may thus be useful in clinical practice.

Conversion disorder after implant of a spinal cord stimulator in a patient with a complex regional pain syndrome

IMPLICATIONS

This case history describes the treatment of a patient suffering with persistent pain. He was treated surgically with implantation of a spinal cord stimulator. After surgery, a partial paralysis that could not be explained medically and that was probably related to emotional factors occurred, and cognitive behavioral treatment was begun. This paper discusses the importance of considering social and psychological factors when medical treatment options are considered.

Pain self-efficacy beliefs and pain behaviour. A prospective study

This study examined the relationship between pain self-efficacy beliefs and a range of pain behaviours, as measured by the pain behaviour questionnaire (PBQ), using a prospective design. A heterogeneous sample of 145 chronic pain patients completed sets of questionnaires on four occasions over a nine-month period. Multiple hierarchical regression analyses revealed that the subjects' confidence in their ability to perform a range of tasks despite pain (assessed at baseline), was predictive of total pain behaviour and avoidance behaviour over the nine-month study period. This finding was particularly significant because the analyses controlled for the possible effects of pain severity (at each measurement occasion), pain chronicity, age, gender, physical disability, depression, neuroticism and catastrophising. These findings suggest that pain self-efficacy beliefs are an important determinant of pain behaviours and disability associated with pain, over and above the effects of pain, distress and personality variables. In particular, higher pain self-efficacy beliefs are predictive of reduced avoidance behaviours over an extended period.

Assessing the significant others of chronic pain patients: the psychometric properties of significant other questionnaires

Contemporary reviews of psychological models of chronic pain have favoured behavioural and cognitive-behavioural formulations. These have often assumed that pain behaviours are maintained by environmental reinforcers. One of the most commonly hypothesized sources of reinforcement has been patients' significant others. Further, it has often been recognized that significant others may also be affected by pain behaviours and that they may experience changes in their lifesyles and in their mood as a consequence of living with someone who has pain. Somewhat surprisingly, relatively little clinical research has been published investigating significant others and their relationships with pain patients. Among other things, one of the limiting factors has been the lack of measurement tools available for assessing the relevant variables thought to be important with regards to significant others (such as their responses to, and perceptions of, chronic pain). This study attempted to remedy this situation by developing and testing the psychometric properties of a number of questionnaires specifically designed for significant others of chronic pain patients. The questionnaires have been selected to assess both significant others' (behavioural and cognitive) responses to pain as well as the extent to which pain impacts on their lives. Although not all of the questionnaires were found to possess equally strong psychometric properties, the availability of several solid measures opens the way for more empirical analyses of significant others and their interactions with chronic pain patients.

Do psychological factors predict changes in musculoskeletal pain? A prospective, two-year follow-up study of a working population

Our aim was to determine the predictive value of some psychometric instruments for the development and persistence of musculoskeletal pain. In 452 subjects, pain in the shoulder, neck, and low back during the preceding year was assessed at baseline, one year, and two years' follow-up. Psychological distress, depression, self-efficacy beliefs, subjective work prognosis, disability, and work characteristics were assessed at baseline. The best predictor of future pain was disability. The psychometric measures did not predict changes in pain. The explanatory power of the variables in the multivariate analyses was low. Perceived disability in persons with musculoskeletal symptoms should be acknowledged early. The traditional research paradigm focusing on a few hypothetically relevant variables does not take into account the reflective, dynamic, reciprocal nature of human behavior during the process of recovery from or development of a pain problem.