Validation of the Korean version of the avoidance endurance behavior questionnaire in patients with chronic pain

How to objectively assess and observe maladaptive pain behaviors in clinical rehabilitation: a systematic search and review

Background

Cognitive-affective factors influence the perception of pain and disability. These factors can lead to pain behaviors (PB) that can persist and become maladaptive. These maladaptive PB will further increase the risk of chronicity or persistence of symptoms and disability. Thus, clinicians must be prepared to recognize maladaptive PB in a clinical context. To date, in the context of assessment in a rehabilitation setting, PB in clinical settings are poorly documented. The main objective of this study was to identify direct observation methods and critically appraise them in order to propose recommendations for practice. As a secondary objective, we explored and extracted the different observable PB that patients could exhibit and that clinicians could observe.

Methods

We conducted a comprehensive review on four databases with a generic search strategy in order to obtain the largest range of PB. For the first objective, a two-step critical appraisal used clinical criteria (from qualitative studies on barriers to implement routine measures) and psychometric criteria (from Brink and Louw critical appraisal tool) to determine which observation methods could be recommended for clinical practice. For the second objective, we extracted PB found in the literature to list potential PB that patients could exhibit, and clinicians could observe.

Results

From the 3362 retrieved studies, 47 met the inclusion criteria for the first objective. The clinical criteria allowed us to select three observation methods. After the psychometric step, two observation methods were retained and recommended for clinical practice: the Behavioral Avoidance Test-Back Pain (BAT-Back) and the Pain Behaviour Scale (PaBS). For the second objective, 107 studies met the inclusion criteria. The extraction of the PB allowed us to list a large range of PB and classify the data in 7 categories of PB.

Conclusion

Our results allowed us to recommend two observation methods for clinical practice. However, these methods have limitations and are validated only in chronic low back pain populations. With the extraction of PB presented in the literature, we contribute to better prepare clinicians to recognize PB in all patients who are experiencing pain.

Translation, reliability, and validity of the avoidance endurance questionnaire in Iranian subjects with chronic non-specific neck pain

Background:

To cross-cultural adaptation, test-retest reliability, construct validity of the Persian version of avoidance endurance questionnaire (AEQ) in Iranian subjects with chronic nonspecific neck pain (CNSNP).

Objective:

The AEQ differentiates endurance responses [ER; positive mood scale (PMS), thought suppression scale (TSS), pain persistence behavior scale (PPS), humor/distraction scale (HDS), and behavioral endurance scale (BES) from fear-avoidance responses (FARs; anxiety/depression scale (ADS), catastrophizing scale (CTS), helplessness/hopelessness scale (HHS), avoidance of social activities scale (ASAS), and avoidance of physical activities scale (APAS)].

Methods:

One hundred and thirty persons with CNSNP took part in this psychometric study. The translation process was done by Beaton guideline. Test–retest reliability and internal consistency were presented by intraclass coefficient (ICC) and Cronbach's alpha, respectively. The construct validity was measured by the correlation between AEQ subscales and the Short-form health survey (SF-12), visual analog scale (VAS), fear-avoidance beliefs questionnaire (FABQ), pain catastrophizing scale (PCS), Tampa scale for kinesiophobia (TSK), and neck disability index (NDI).

Results:

The Cronbach's alpha of all FAR and ER subscales was more than 0.7, and ICCs of all FAR subscales were more than 0.8 and ICCs of ER subscales were reported between 0.59 and 0.86. The correlation between FAR subscales and TKS, FABQ, FABQ.PA, FABQ.W, NDI, PCS, and VAS were the limit between -0.239 and 0.199, and the association between ER subscales and the abovementioned questionnaires was the limit between 0.179 and 0.644.

Conclusions:

The Persian version of AEQ showed acceptable reliability (test–retest, internal consistency) for FAR and ER, and also the construct validity was acceptable. The Persian version of AEQ had acceptable psychometric properties, thus it is a good instrument to identify fear avoidance and ERs of the pain.

Validation study of the Parent Attitudes About Childhood Vaccines (PACV) questionnaire: the Malay version

Vaccine hesitant parents are linked with re-emergence of vaccine preventable diseases, but evidence is scarce locally. The Parent Attitudes about Childhood Vaccines (PACV) questionnaire was validated and used in the USA to identify vaccine hesitant parents. This study aimed to adapt and translate the 15-item PACV questionnaire from English into the Malay language, and to examine its validity and reliability. The sample population was parents of children aged 0-24 months, recruited at an urban government health clinic between November 2016-June 2017. During content validation, two items from the "Behavior" subdomain were identified as items with formative scale and excluded from exploratory factor analysis (EFA) but retained as part of demography. A total of 151 parents completed the questionnaire with response rate of 93.3%. Test-retest reliability was tested in 25 respondents four weeks later and the intra-class correlation was between 0.53 and 1.00. EFA of the 13 items showed possibility of two to four factor domains, but three domains were most conceptually equivalent. Two of the domains were similar to the original and one factor was identified de novo. One item was deleted due to poor factor loading of < 0.3. Therefore, the validated final PACV-Malay consisted of 12 items framed within three-factor domains. The PACV-Malay was reliable with total Cronbach alpha of 0.77. In conclusion, the PACV-Malay is a valid and reliable tool which can be used to identify vaccine hesitant parents in Malaysia. Confirmatory factor analysis and predictive validity are recommended for future studies.