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Díaz-Fernández Á, Ortega-Martínez AR, Cortés-Pérez I, Ibáñez-Vera AJ, Obrero-Gaitán E, Lomas-Vega R. Transcultural Adaptation and Psychometric Validation of the Spanish Version of the Pain Attitudes and Beliefs Scale for Physiotherapists. J Clin Med 2023; 12:6045. [PMID: 37762985 PMCID: PMC10531514 DOI: 10.3390/jcm12186045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Low back pain (LBP) is one of the main musculoskeletal pain conditions, and it affects 23-28% of the global population. Strong evidence supports the absence of a direct relationship between the intensity of pain and tissue damage, with psychosocial factors also playing a crucial role. In this context, the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) is a useful tool for evaluating physiotherapists' treatment orientations and beliefs regarding the management of low back pain (LBP). It helps identify practitioners who may benefit from additional education in modern pain neuroscience. However, there is not a Spanish validation of this scale for physiotherapists. Thus, the aims of this study were to translate and culturally adapt the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) into Spanish and to evaluate its psychometric properties. This validation study used three convenience samples of physiotherapists (PTs) (n = 22 for the pilot study, n = 529 for the validity study and n = 53 for assessing the instrument's responsiveness). The process of translating and adapting the PABS-PT into Spanish followed international guidelines and produced a satisfactory pre-final version of the questionnaire. Factor analysis confirmed the two-factor structure of the original version, with the biomedical (BM) factor explaining 39.4% of the variance and the biopsychosocial (BPS) factor explaining 13.8% of the variance. Cronbach's alpha values were excellent for the BM factor (0.86) and good for the BPS factor (0.77), indicating good internal consistency. Test-retest reliability was excellent for both factors, with intraclass correlation coefficients (ICCs) of 0.84 for BM and 0.82 for BPS. The standard error of measurement (SEM) was acceptable for both factors (3.9 points for BM and 2.4 points for BPS). Concurrent validity was moderate and in the expected direction and had significant correlations with the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and Revised Neurophysiology Pain Questionnaire (R-NPQ). Sensitivity to change was demonstrated by significant improvements in both factors after an educational intervention, with medium-to-large effect sizes. The PABS-PT also showed good discriminative ability, as it was able to distinguish between physiotherapists with and without pain education. Cut-off values for the BM and BPS factors were determined. In conclusion, the translated and adapted Spanish version of the PABS-PT demonstrated good psychometric properties and can be reliably used to assess the attitudes and beliefs of Spanish-speaking physiotherapists regarding LBP. The questionnaire is recommended for use in clinical and educational research in the Spanish language context.
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Affiliation(s)
- Ángeles Díaz-Fernández
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain (R.L.-V.)
| | - Ana Raquel Ortega-Martínez
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain (R.L.-V.)
- Department of Psychology, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain
| | - Irene Cortés-Pérez
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain (R.L.-V.)
| | | | - Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain (R.L.-V.)
| | - Rafael Lomas-Vega
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaen, Spain (R.L.-V.)
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Eland ND, Strand LI, Ostelo RW, Kvåle A, Magnussen LH. How do physiotherapists understand and interpret the "Pain Attitudes and Beliefs Scale"? A cognitive interview study. Physiother Theory Pract 2020; 38:513-527. [PMID: 32520655 DOI: 10.1080/09593985.2020.1774949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: The Pain Attitudes and Beliefs Scale (PABS) for physiotherapists aims to differentiate between clinicians' biomedical and biopsychosocial treatment orientations regarding nonspecific low back pain (LBP). Objective: To study the content validity of the Norwegian PABS by following international guidelines: exploring its relevance, comprehensibility and comprehensiveness. Methods: Cognitive interviews were performed using the Three-Step Test Interview, consisting of think-aloud techniques, retrospective probing and in-depth interviews. Eleven Norwegian physiotherapists with a diversity of professional backgrounds participated. Results: The participants encountered little difficulty in completing the PABS. All items were deemed relevant and important but five items had ambiguous formulations which can easily be handled. The biomedical subscale appeared to be a comprehensive representation of biomedical treatment orientation. The biopsychosocial subscale was found to lack items concerning cognitive behavioral aspects of LBP management, such as patient education, therapeutic alliance, shared decision making and graded exposure. Conclusions: This study provides empirical evidence that the Norwegian version of the PABS-PT is relevant and comprehensible, provided some minor adjustments. The biopsychosocial subscale, however, lacks comprehensiveness, as it is not able to capture important aspects of contemporary biopsychosocial best practice care. Measurement of biopsychosocial treatment orientation may therefore be incomplete.
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Affiliation(s)
- Nicolaas D Eland
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Liv Inger Strand
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Raymond W Ostelo
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije University, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands.,Department of Health Sciences, Faculty of Science, Vrije University, Amsterdam, The Netherlands
| | - Alice Kvåle
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Liv Heide Magnussen
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Eland ND, Kvåle A, Ostelo RWJG, de Vet HCW, Strand LI. Discriminative Validity of the Pain Attitudes and Beliefs Scale for Physical Therapists. Phys Ther 2019; 99:339-353. [PMID: 30690547 DOI: 10.1093/ptj/pzy139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 06/18/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Pain Attitudes and Beliefs Scale (PABS) for Physical Therapists aims to measure clinicians' biomedical and biopsychosocial treatment orientations regarding nonspecific low back pain. OBJECTIVE The objective of this study was to assess whether the PABS can differentiate between subgroups of physical therapists hypothesized to differ in treatment orientations. DESIGN This study was a cross-sectional survey. METHODS The PABS was completed by 662 Norwegian physical therapists with a diversity of professional backgrounds. Twenty-four a priori hypotheses on expected differences in PABS scores were formulated. Sufficient discriminative ability was defined as a minimum of 75% confirmed hypotheses. Hypotheses on differences in scores were tested for the biomedical and biopsychosocial subscales separately as well as for combinations of the 2 subscales, representing responders with high biomedical and low biopsychosocial PABS scores and vice versa. RESULTS Of the 24 hypotheses, only 15 (62.5%) were confirmed. Between-group differences concerning the separate subscales were small, varying from -0.63 to 1.70 scale points, representing values up to 6.0% of the total subscale ranges. Between-group differences were larger when combined subscales were used, varying from 1.80 to 6.70 points, representing values up to 25.1% of the total subscale ranges. Despite little spread in scores, 24% of respondents demonstrated extreme attitudes. LIMITATIONS The lack of convincing scientific evidence from previous research on differences in attitudes and beliefs between physical therapists was a limitation for the formulation of hypotheses. CONCLUSIONS Discriminative validity of separate subscales of the PABS was not supported. Combining the 2 subscales into global treatment attitudes enabled better discrimination. Little spread in biomedical and biopsychosocial orientations explains why more than one-third of the hypotheses were not confirmed. Either Norwegian physical therapists are basically similar in their treatment orientation or the PABS is not able to detect any differences between them.
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Affiliation(s)
- Nicolaas D Eland
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018 Bergen, Norway
| | - Alice Kvåle
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Raymond W J G Ostelo
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU Medical Centre; and Department of Health Sciences, Faculty of Earth and Life Sciences, EMGO+ Institute for Health and Care Research, VU University, Amsterdam, the Netherlands
| | - Henrica C W de Vet
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU Medical Centre
| | - Liv I Strand
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen
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Chiarotto A, Bishop A, Foster NE, Duncan K, Afolabi E, Ostelo RW, Paap MCS. Item response theory evaluation of the biomedical scale of the Pain Attitudes and Beliefs Scale. PLoS One 2018; 13:e0202539. [PMID: 30208092 PMCID: PMC6135359 DOI: 10.1371/journal.pone.0202539] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 08/06/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The assessment of health care professionals' attitudes and beliefs towards musculoskeletal pain is essential because they are key determinants of their clinical practice behaviour. The Pain Attitudes and Beliefs Scale (PABS) biomedical scale evaluates the degree of health professionals' biomedical orientation towards musculoskeletal pain and was never assessed using item response theory (IRT). This study aimed at assessing the psychometric performance of the 10-item biomedical scale of the PABS scale using IRT. METHODS Two cross-sectional samples (BeBack, n = 1016; DABS; n = 958) of health care professionals working in the UK were analysed. Mokken scale analysis (nonparametric IRT) and common factor analysis were used to assess dimensionality of the instrument. Parametric IRT was used to assess model fit, item parameters, and local reliability (measurement precision). RESULTS Results were largely similar in the two samples and the scale was found to be unidimensional. The graded response model showed adequate fit, covering a broad range of the measured construct in terms of item difficulty. Item 3 showed some misfit but only in the DABS sample. Some items (i.e. 7, 8 and 9) displayed remarkably higher discrimination parameters than others (4, 5 and 10). The scale showed satisfactory measurement precision (reliability > 0.70) between theta values -2 and +3. DISCUSSION The 10-item biomedical scale of the PABS displayed adequate psychometric performance in two large samples of health care professionals, and it is suggested to assess group-level professionals degree of biomedical orientation towards musculoskeletal pain.
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Affiliation(s)
- Alessandro Chiarotto
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Annette Bishop
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Nadine E. Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Kirsty Duncan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Ebenezer Afolabi
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Raymond W. Ostelo
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Muirne C. S. Paap
- Department of Special Needs, Education, and Youth Care, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
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The attitudes and beliefs of UK osteopaths towards the management of low back pain: A cross-sectional study. INT J OSTEOPATH MED 2018. [DOI: 10.1016/j.ijosm.2018.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Eland ND, Kvåle A, Ostelo RW, Strand LI. Rasch analysis resulted in an improved Norwegian version of the Pain Attitudes and Beliefs Scale(PABS). Scand J Pain 2016; 13:98-108. [DOI: 10.1016/j.sjpain.2016.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 06/20/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
Abstract
Background and aim
There is evidence that clinicians’ pain attitudes and beliefs are associated with the pain beliefs and illness perceptions of their patients and furthermore influence their recommendations for activity and work to patients with back pain. The Pain Attitudes and Beliefs Scale (PABS) is a questionnaire designed to differentiate between biomedical and biopsychosocial pain attitudes among health care providers regarding common low back pain. The original version had 36 items, and several shorter versions have been developed. Concern has been raised over the PABS’ internal construct validity because of low internal consistency and low explained variance. The aim of this study was to examine and improve the scale’s measurement properties and item performance.
Methods
A convenience sample of 667 Norwegian physiotherapists provided data for Rasch analysis. The biomedical and biopsychosocial subscales of the PABS were examined for unidimensionality, local response independency, invariance, response category function and targeting of persons and items. Reliability was measured with the person separation index (PSI). Items originally excluded by the developers of the scale because of skewness were re-introduced in a second analysis.
Results
Our analysis suggested that both subscales required removal of several psychometrically redundant and misfitting items to satisfy the requirements of the Rasch measurement model. Most biopsychosocial items needed revision of their scoring structure. Furthermore, we identified two items originally excluded because of skewness that improved the reliability of the subscales after reintroduction. The ultimate result was two strictly unidimensional subscales, each consisting of seven items, with invariant item ordering and free from any form of misfit. The unidimensionality implies that summation of items to valid total scores is justified. Transformation tables are provided to convert raw ordinal scores to unbiased interval-level scores. Both subscales were adequately targeted at the ability level of our physiotherapist population. Reliability of the biomedical subscale as measured with the PSI was 0.69. A low PSI of 0.64 for the biopsychosocial subscale indicated limitations with regard to its discriminative ability.
Conclusions
Rasch analysis produced an improved Norwegian version of the PABS which represents true (fundamental) measurement of clinicians’ biomedical and biopsychosocial treatment orientation. However, researchers should be aware of the low discriminative ability of the biopsychosocial subscale when analyzing differences and effect changes.
Implications
The study presents a revised PABS that provides interval-level measurement of clinicians’ pain beliefs. The revision allows for confident use of parametric statistical analysis. Further examination of discriminative validity is required.
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Affiliation(s)
- Nicolaas D. Eland
- Olsvik Institute for Manual Therapy , Postboks 522, 5884 Bergen , Norway
| | - Alice Kvåle
- Physiotherapy Research Group , Department of Global Public Health and Primary Care , University of Bergen , Kalfarveien 31, 5018 Bergen , Norway
- Occupational Therapy, Physiotherapy and Radiography , Department of Health and Social Sciences , Bergen University College , Inndalsveien 28, 5020 Bergen , Norway
| | - Raymond W.J.G. Ostelo
- Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research , VU Medical Centre , de Boelelaan 1081, 1081 HV Amsterdam , The Netherlands
- Department of Health Sciences , Faculty of Earth and Life Sciences, EMGO+ Institute for Health and Care Research , VU University , Amsterdam , The Netherlands
| | - Liv Inger Strand
- Physiotherapy Research Group , Department of Global Public Health and Primary Care , University of Bergen , Kalfarveien 31, 5018 Bergen , Norway
- Department of Physiotherapy , Haukeland University Hospital , Haukelandsveien 22, 5021 Bergen , Norway
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Eland ND, Kvåle A, Ostelo RW, Strand LI. The Pain Attitudes and Beliefs Scale for Physiotherapists: Dimensionality and Internal Consistency of the Norwegian Version. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2016; 22. [DOI: 10.1002/pri.1670] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 12/13/2015] [Accepted: 04/17/2016] [Indexed: 11/11/2022]
Affiliation(s)
| | - Alice Kvåle
- Physiotherapy Research Group, Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Department of Occupational Therapy, Physiotherapy and Radiography; Bergen University College; Bergen Norway
| | - Raymond W.J.G. Ostelo
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research; VU University Medical Centre Amsterdam; Amsterdam The Netherlands
- Department of Health Sciences, Faculty of Earth and Life Sciences, EMGO Institute for Health and Care Research; VU University; Amsterdam The Netherlands
| | - Liv Inger Strand
- Physiotherapy Research Group, Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Department of Physiotherapy; Haukeland University Hospital; Bergen Norway
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[Health care professionals' attitudes and beliefs towards older back pain patients. Analysis of the assessment methods and research gaps]. Schmerz 2015; 29:362-70. [PMID: 26232189 DOI: 10.1007/s00482-015-0025-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In recent years, the influence of doctors' and therapists' attitudes and beliefs for the treatment of chronic low back pain patients has been increasingly investigated. Attitudes and beliefs of health care providers have been identified as important contributors for an activity based, guideline-oriented therapeutic approach and different questionnaires were developed to evaluate this interaction. Recent reviews discuss the quality of those questionnaires as well as the impact of attitudes towards therapeutic choices and activity recommendations by health care professionals. This article summarizes these results and illuminates transferability of existing questionnaires to older patients with back pain. A literature review shows that most studies were conducted with physiotherapists and general practitioners. At present the most thoroughly investigated tool for its psychometric validity is the Pain Attitudes and Beliefs Scale (PABS). The PABS could be a suitable instrument for examinations regarding therapist attitudes towards older pain patients by using more age-neutral wording. Concluding from the literature, an additional methodological assessment tool could be the utilization of case vignettes. However, those case vignettes, which had been used in studies in England, should be translated and culturally adapted before its application in Germany. Overall, it must be assumed that attitudes and beliefs of clinicians are also important in the care of older patients in pain. With regards to activity recommendations, ageism and the special situation of older people should also be taken into account including possible risk of falling, multimorbidity, polypharmacy, and cognitive impairment. These topics should all be considered in adapted or newly developed questionnaires for the evaluation of attitudes and beliefs of health care providers regarding back pain in older persons.
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Pragmatic Implementation of a Stratified Primary Care Model for Low Back Pain Management in Outpatient Physical Therapy Settings: Two-Phase, Sequential Preliminary Study. Phys Ther 2015; 95:1120-34. [PMID: 25858972 PMCID: PMC4528015 DOI: 10.2522/ptj.20140418] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 04/02/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The effectiveness of risk stratification for low back pain (LBP) management has not been demonstrated in outpatient physical therapy settings. OBJECTIVE The purposes of this study were: (1) to assess implementation of a stratified care approach for LBP management by evaluating short-term treatment effects and (2) to determine feasibility of conducting a larger-scale study. DESIGN This was a 2-phase, preliminary study. METHODS In phase 1, clinicians were randomly assigned to receive standard (n=6) or stratified care (n=6) training. Stratified care training included 8 hours of content focusing on psychologically informed practice. Changes in LBP attitudes and beliefs were assessed using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS). In phase 2, clinicians receiving the stratified care training were instructed to incorporate those strategies in their practice and 4-week patient outcomes were collected using a numerical pain rating scale (NPRS), and the Oswestry Disability Index (ODI). Study feasibility was assessed to identify potential barriers for completion of a larger-scale study. RESULTS In phase 1, minimal changes were observed for PABS-PT and HC-PAIRS scores for standard care clinicians (Cohen d=0.00-0.28). Decreased biomedical (-4.5±2.5 points, d=1.08) and increased biopsychosocial (+5.5±2.0 points, d=2.86) treatment orientations were observed for stratified care clinicians, with these changes sustained 6 months later on the PABS-PT. In phase 2, patients receiving stratified care (n=67) had greater between-group improvements in NPRS (0.8 points; 95% confidence interval=0.1, 1.5; d=0.40) and ODI (8.9% points; 95% confidence interval=4.1, 13.6; d=0.76) scores compared with patients receiving standard physical therapy care (n=33). LIMITATIONS In phase 2, treatment was not randomly assigned, and therapist adherence to treatment recommendations was not monitored. This study was not adequately powered to conduct subgroup analyses. CONCLUSIONS In physical therapy settings, biomedical orientation can be modified, and risk-stratified care for LBP can be effectively implemented. Findings from this study can be used for planning of larger studies.
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Innes SI, Werth PD, Tuchin PJ, Graham PL. Attitudes and beliefs of Australian chiropractors' about managing back pain: a cross-sectional study. Chiropr Man Therap 2015; 23:17. [PMID: 26085924 PMCID: PMC4470072 DOI: 10.1186/s12998-015-0062-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 04/13/2015] [Indexed: 11/10/2022] Open
Abstract
Background Chiropractors are frequent providers of care for patients with lower back pain. Biopsychosocial approaches to managing patients are regarded as best practice and are gaining wider acceptance. Recent evidence suggests that practitioners’ attitudes and beliefs may also have an important effect on patients’ recovery from back pain. Past studies have pooled manual therapists from differing professions. Dissonant findings have been hypothesised as being a result of the chiropractic subpopulation within multi-practitioner participant pools who are hypothesised to focus on biomedical aspects of treatment and minimize biopsychosocial dimensions. The aim of this study is to determine whether a study population of only chiropractors would demonstrate similar attitudes and beliefs to other manual therapists’ biopsychosocial or biomedical approach to the management of their patients. Methods A survey of chiropractors in Victoria Australia in September 2010 was undertaken utilising the Pain Attitude and Belief Scale (PABS.PT), a tool which has been developed to determine the orientation (biopsychosocial or biomedical approach) of practitioners to the management of people with low back pain. The survey also obtained demographic data from respondents to determine whether variables such as education, gender or practice related factors influenced their orientation. Results The overall response rate was 29% (n = 218). The majority of the sample was male (68%), with a mean age of 44 years. The 6 point Likert scale scores were 34.5 (6.3) for the biomedical factor scale and 31.4 (4.1) for the biopsychosocial scale. Internal consistency of the psychosocial subscale was poor. None of the demographic variables were found to influence the biomedical or psychosocial scales. Conclusions Chiropractors in the state of Victoria were found to have similar biomedical and psychosocial orientations in their attitudes and beliefs when compared to other manual therapists’ levels of previous studies from differing cultural and educational backgrounds. This study was unable to replicate any of the relationships from past studies with any of the demographic variables. The psychosocial scale internal consistency may be a significant factor in this non-finding. Future research should address the identification of more robust items of the biopsychosocial attitudes of Victorian chiropractors toward treating lower back pain.
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Affiliation(s)
- Stanley I Innes
- Discipline of Chiropractic, Health Professions, Murdoch University, Murdoch, WA 6150 Australia
| | - Peter D Werth
- Private Practice, Australian Injury Management Consulting, 117 Hall Road, Carrum Downs, VIC 3201 Australia
| | - Peter J Tuchin
- Department of Chiropractic, Faculty of Science, Macquarie University, Sydney, NSW 2109 Australia
| | - Petra L Graham
- Department of Statistics, Faculty of Science, Macquarie University, Sydney, NSW 2109 Australia
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The psychometric properties of the PABS-PT in neck pain patients: a validation study. ACTA ACUST UNITED AC 2014; 19:208-14. [PMID: 24560002 DOI: 10.1016/j.math.2013.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 11/22/2013] [Accepted: 12/16/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aims to assess the reliability and validity of the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) in neck pain patients. Three research goals were formulated. (1): to reexamine the factor structure of the PABS-PT, (2) to assess the test-retest reliability of the PABS-PT and (3) to determine the construct validity of the biomedical factor of the PABS-PT. METHODS Manual therapists (n = 272) included in this study participated in an educational upgrade program for a professional masters' degree in the Netherlands and completed the Health Care Providers' Pain and Impairment Relationship Scale and the PABS-PT. Principal Axis Factor analysis was performed and correlation coefficients were calculated. In addition, Bland and Altman plots and the smallest real difference were determined. RESULTS We performed factor analysis on 182 questionnaires and test-rest calculations on 73 questionnaires. The principal factor analysis confirmed the existing interpretable 2-factor model of a 'biomedical treatment orientation' and a 'behavioral treatment orientation'. Test-retest reliability was 'moderate' to 'good' and construct validity for the biomedical factor was 'moderate' to 'substantial'. CONCLUSION The PABS-PT shows a consistent factor structure and good test-retest reliability and construct validity. More research is needed to gain further insight in the interplay between implicit and explicit attitudes and the dynamics of the PABS-PT score across different body parts.
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Pincus T, McCracken LM. Psychological factors and treatment opportunities in low back pain. Best Pract Res Clin Rheumatol 2013; 27:625-35. [PMID: 24315144 DOI: 10.1016/j.berh.2013.09.010] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A large body of evidence suggests that psychological factors, including emotions, beliefs and avoidant behaviours, are linked to poor outcomes in low back pain. At the same time, the evidence from trials of psychological interventions suggests that they improve outcomes mostly in the short term and against passive controls only. These suboptimal results may be due to low competency or fidelity in delivery, or inadequate matching of treatment methods with specific patient problems. Most importantly, there is insufficient theoretical guidance and integration in the design, selection and delivery of methods that precisely target known process of pathology. We identify several new directions for research and opportunities to improve the impact of psychological interventions and to change clinical practice. These include better ways to conceptualise and deliver reassurance at early stages of back pain, utilising models such as the psychological flexibility model to guide treatment development, and essentially extend the fear-avoidance model.
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Affiliation(s)
- Tamar Pincus
- Department of Psychology, Royal Holloway University of London, Egham, Surrey TW20 0EX, UK.
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Thinking beyond muscles and joints: Therapists' and patients' attitudes and beliefs regarding chronic musculoskeletal pain are key to applying effective treatment. ACTA ACUST UNITED AC 2013; 18:96-102. [DOI: 10.1016/j.math.2012.11.001] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 10/22/2012] [Accepted: 11/03/2012] [Indexed: 11/22/2022]
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Mutsaers JH, Peters R, Pool-Goudzwaard A, Koes B, Verhagen A. Psychometric properties of the Pain Attitudes and Beliefs Scale for Physiotherapists: A systematic review. ACTA ACUST UNITED AC 2012; 17:213-8. [DOI: 10.1016/j.math.2011.12.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 11/28/2011] [Accepted: 12/19/2011] [Indexed: 10/14/2022]
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Embedding psychosocial perspectives within clinical management of low back pain: integration of psychosocially informed management principles into physical therapist practice--challenges and opportunities. Phys Ther 2011; 91:790-803. [PMID: 21451095 DOI: 10.2522/ptj.20100326] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As the biopsychosocial model of health has become increasingly understood, it has become clear that there are complex, interdependent relationships between the physical and biomedical features of low back pain and the psychological and social factors that present concomitantly. Epidemiological studies have not only highlighted that psychological and social factors are associated with back pain and disability but also have shed light on the way in which these factors serve as prognostic indicators, or obstacles to recovery, predicting which patients will have a poor prognosis. Integrating the assessment of these obstacles to recovery into physical therapist practice and using this information to guide clinical decision making have the potential to improve the quality of care offered by physical therapists by improving the targeting of treatments to individuals and enhancing the therapist-patient relationship and adherence to management advice and treatment programs. In turn, such approaches may improve both patients' clinical outcomes and the efficiency and effectiveness of service provision, helping direct interventions to those who need them. This article summarizes the key challenges to embedding psychosocial perspectives within physical therapist practice for patients with low back pain and the opportunities that could be realized by doing so, and it highlights new developments in research, clinical practice, and education that are shaping future directions in this field.
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