Rasch analysis of the Italian version of fear avoidance beliefs questionnaire (FABQ-I)

Challenges in applying minimal clinically important difference: a critical review

Healthcare clinicians strive to make meaningful changes in patient function and participation. A minimal clinically important difference (MCID) is an estimate of the magnitude of change needed to be meaningful to a patient. Clinicians and investigators may assume that a cited MCID is a valid and generalizable estimate of effect. There are, however, at least two concerns about this assumption. First, multiple methods exist for calculating an MCID that can yield divergent values and raise doubt as to which one to apply. Second, MCID values may be erroneously generalized to patients with dissimilar health conditions. With this in mind, we reviewed the methods used to calculate MCID and citations of reported MCID values for outcome measures commonly used in neurologic, orthopedic, and geriatric populations. Our goal was to assess whether the calculation methods were acknowledged in the cited work and whether the enrolled patients were similar to the sample from which the MCID estimate was derived. We found a concerning variation in the methods employed to estimate MCID. We also found a lack of transparency in identifying calculation methods and applicable health conditions in the cited work. Thus, clinicians and researchers must pay close attention and exercise caution in assuming changes in patient status that exceed a specific MCID reflect meaningful improvements in health status. A common standard for the calculation and reporting of an MCID is needed to address threats to the validity of conclusions drawn from the interpretation of an MCID.

Sensory Modulation Abilities in Healthy Preterm-Born Children: An Observational Study Using the Sensory Processing and Self-Regulation Checklist (SPSRC)

This study aimed to investigate prematurity as a risk factor for sensory processing disorders, using the Italian Version of Sensory Processing and Self-Regulation Checklist (SPSRC-IT), based on a sample of healthy Italian children born preterm in comparison with a sample of typical full-term children. Two groups of caregivers of Italian healthy preschooler children were recruited. The first group comprised 37 caregivers of full-term children (FT), while the second group consisted of 37 caregivers of preterm children (PT) (gestational age < 37 weeks). Significant differences between the groups in several subsections and factors of the SPSRC-IT were found, specifically in the Physiological Conditions section, in the Gustatory and Olfactory Sense section, in the Vestibular Sense section, and in the Proprioceptive Sense section, with lower scores in the PT group. Moreover, children born at a lower gestational age or with lower weights had a higher risk of dysfunctions in processing gustatory and olfactory, vestibular, and proprioceptive stimuli. In conclusion, the SPSRC-IT suggested a potential link between prematurity and challenges in the development of sensory processing and self-regulation skills, especially in children with a very low birth weight and very low gestational age.

Meniscal Allograft Transplants in Skeletally Immature Patients: A Systematic Review of Indications and Outcomes

Meniscal lesions in skeletally immature patients can lead to joint degradation and knee instability. Meniscal allograft transplant (MAT) surgery is a solution to maintain knee stability. There is a lack of consensus on MAT surgery outcomes in pediatric patients. A systematic review was conducted according to the PRISMA guidelines. PubMed, Scopus and EMBASE databases were searched from 1965 to June 2022. Studies were evaluated using the Newcastle-Ottawa Scale (NOS). Three studies were selected, and 58 patients were included (mean age 15.9 years) in total. The lateral meniscus was involved in 82.8% of all MAT surgeries. Post-meniscectomy syndrome and discoid meniscus were the main indications for MAT surgery. All studies reported improved subjective clinical scores and levels of sport after the surgery. The complication rate was 27.5%. Partial meniscectomy, meniscus knot removal, chondral defect treatment and lysis of adhesions were the most frequent procedures performed during reoperation. MAT surgery can improve clinical outcomes in pediatric patients with strictly selected indications. MAT surgery is safe when there are no limb asymmetries or malalignments, but it remains a challenging procedure with a high complication rate. Long-term follow-up is needed for definitive statements on the use of MAT in skeletally immature patients.

Acute Ankle Sprain Management: An Umbrella Review of Systematic Reviews

Even though ankle sprains are among the most frequent musculoskeletal injuries seen in emergency departments, management of these injuries continues to lack standardization. Our objective was to carry out an umbrella review of systematic reviews to collect the most effective evidence-based treatments and to point out the state-of-the-art management for this injury. PubMed, Scopus, Web of Science, and the Cochrane library were searched from January 2000 to September 2020. After removing duplicates and applying the eligibility criteria, based on titles and abstracts, 32 studies were screened. At the end of the process, 24 articles were included in this umbrella review with a mean score of 7.7/11 on the AMSTAR quality assessment tool. We found evidence supporting the effectiveness of non-surgical treatment in managing acute ankle sprain; moreover, functional treatment seems to be preferable to immobilization. We also found evidence supporting the use of paracetamol or opioids as effective alternatives to non-steroidal anti-inflammatory drugs to reduce pain. Furthermore, we found evidence supporting the effectiveness of manipulative and supervised exercise therapy to prevent re-injury and restore ankle dorsiflexion.

Fear of Movement/(Re)Injury: An Update to Descriptive Review of the Related Measures

The prevalence of fear of movement (kinesiophobia) in persistent pain ranges from 50 to 70%, and it may hinder the subsequent rehabilitation interventions. Therefore, the evaluation of fear of movement/(re)injury plays a crucial role in making clinical treatment decisions conducive to the promotion of rehabilitation and prognosis. In the decision-making process of pain treatment, the assessment of fear of movement/(re)injury is mainly completed by scale/questionnaire. Scale/questionnaire is the most widely used instrument for measuring fear of movement/(re)injury in the decision-making process of pain treatment. At present, the most commonly used scale/questionnaire are the Tampa Scale for Kinesiophobia (TSK), the Fear-Avoidance Beliefs Questionnaire (FABQ), the Kinesiophobia Causes Scale (KCS), the Athlete Fear-Avoidance Questionnaire (AFAQ), and the Fear-Avoidance Components Scale (FACS). In order to provide necessary tools and references for related research and rehabilitation treatment, this descriptive review is designed as an introduction to the background and content, score system, available language versions, variants of the original questionnaire, and psychometric properties of these scales/questionnaries.

A further Rasch analysis of the Fear-Avoidance Beliefs Questionnaire in adults with chronic low back pain suggests the revision of its rating scale

BACKGROUND

Low-back pain (LBP) is a common health problem and one of the leading causes of activity limitation and work absence. LBP determines high societal burdens, as it is the most common cause of medically certified sick leave and early retirement, with economic impacts similar to other high-cost conditions such as cancer, cardiovascular and autoimmune diseases.

AIM

The aim of this study was to examine the psychometric properties of the Fear-Avoidance Beliefs Questionnaire (FABQ) and its two subscales, in subjects with chronic low back pain (LBP).

DESIGN

Methodological research based on a cross-sectional observational study.

SETTING

Outpatients consecutively admitted to our Rehabilitation Unit were enrolled between January and August 2015, before the beginning of an 8-week program of multidisciplinary rehabilitation.

POPULATION

A convenience sample of 155 Italian subjects with chronic LBP (57% men; mean age: 43±11 years; mean pain duration: 23±32 months) completed the FABQ.

METHODS

Rasch analysis was used to investigate dimensionality of the entire scale and key psychometric properties of its two subscales.

RESULTS

The FABQ-Physical Activity (FABQ-PA) and FABQ-Work (FABQ-W) subscales showed two distinct unidimensional structures. Their 7-option rating categories were malfunctioning, but after collapsing problematic categories and omitting the central one ("unsure") the new 4 categories (completely disagree; disagree; agree; completely agree) functioned as intended. After that and accommodation of local response dependency between two items in a testlet solution, each of the two subscales presented acceptable fit to the Rasch model (just one FABQ-W items was slightly underfitting). Person separation reliability was acceptable, but not high (0.69 for FABQ-PA, and 0.79 for FABQ-W).

CONCLUSIONS

FABQ-PA and FABQ-W have adequate unidimensionality. A simplification of the response options of both subscales is strongly recommended to improve the technical quality of the scale. The reliability indexes suggest FABQ-PA and FABQ-W can be used for group judgements about level of fear-avoidance beliefs, but not for clinical decision-making in individuals. The selection of their items is acceptable, although if future studies corroborate our results - there is room for some refinements to improve the general measurement quality.

CLINICAL REHABILITATION IMPACT

Fear-avoidance beliefs are associated with reduction of physical activity, and development of disability and deconditioning. This study examined the measurement properties of the two FABQ subscales, showing their essential unidimensionality, recommending the simplification of the rating categories, and discussing strengths and weaknesses of item selection. Our results extend the evidence for FABQ as a satisfactory (but improvable) measure of fear-avoidance beliefs in chronic LBP.

The Fear Avoidance Beliefs Questionnaire (FABQ) Does it Really Measure Fear Beliefs?

STUDY DESIGN

A cohort study with 12 months of follow-up.

OBJECTIVE

To assess (1) the unidimensionality of the Fear-Avoidance Beliefs Questionnaire (FABQ) and (2) whether single questions in the FABQ predict future sickness absence as well as the whole scale.

SUMMARY OF BACKGROUND DATA

The fear-avoidance model is a leading model in describing the link between musculoskeletal pain and chronic disability. However, reported measurement properties have been inconsistent regarding the FABQ.

METHODS

Individuals (n = 722) sick listed due to musculoskeletal, unspecified or common mental health disorders undergoing rehabilitation was included. A Rasch analysis was applied to evaluate the measurement properties of FABQ and its two subscales (physical activity and work). Linear regression was used to assess how well single items predicted future sickness absence.

RESULTS

The Rasch analysis did not support the FABQ or its two subscales representing a unidimensional construct. The 7-point scoring of the items was far too fine meshed and in the present population the data only supported a yes or no or a 3-point response option. The items were invariant to age, whereas two of the items revealed sex differences. The item "I do not think that I will be back to my normal work within 3 months" was the best predictor of future sickness absence. Adding the item "I should not do my regular work with my present pain" improved the prediction model slightly.

CONCLUSION

The FABQ is not a good measure of fear-avoidance beliefs about work or physical activity, and the predictive property of the FABQ questionnaire is most likely related to expectations rather than fear. Based on these results we do not recommend using the FABQ to measure fear-avoidance beliefs.

LEVEL OF EVIDENCE

1.

Interstitial Lung Disease in Rheumatoid Arthritis Remains a Challenge for Clinicians

Interstitial lung disease (ILD) is a serious complication of rheumatoid arthritis (RA) contributing to significantly increased morbidity and mortality. Other respiratory complications, such as chronic obstructive pulmonary disease and bronchiectasis, are frequent in RA. Infections and drug toxicity are important differential diagnoses and should be considered in the diagnostic work-up of patients with RA presenting with respiratory symptoms. This review provides an overview of the epidemiology and pathogenesis of RA-ILD, the radiological and histopathological characteristics of the disease as well as the current and future treatment options. Currently, there is no available evidence-based therapy for RA-ILD, and immunosuppressants are the mainstay of therapy. Ongoing studies are exploring the role of antifibrotic therapy in patients with progressive fibrotic ILD, which may lead to a new treatment approach for subgroups of patients with RA-ILD.

Psychometric Properties of the Hindi Version of the Fear-Avoidance Beliefs Questionnaire in Patients With Chronic Non-Specific Low Back Pain

STUDY DESIGN

Prospective cohort study.

OBJECTIVE

To translate, adapt, and establish psychometric properties of the Fear-Avoidance Beliefs Questionnaire (FABQ) for Hindi-speaking patients with chronic non-specific low back pain.

SUMMARY OF BACKGROUND DATA

The FABQ is a patient-reported measure to assess beliefs regarding how physical activity and work are influenced based on fear related to low back pain.

METHODS

Standardized translation guidelines were implemented to confirm Hindi-version of the FABQ (FABQ-H). A cross-sectional study design was utilized. Construct validity analysis included factor analysis of the FABQ and use of Pearson correlation coefficients to report convergent and divergent validity. Reliability assessment included calculation of intraclass correlation coefficient (ICC) and Cronbach α for internal consistency. Outcome measures consisted of Numeric Rating Scale (NRS), Roland Morris Disability Questionnaire (RMDQ) Hindi, and Tampa Scale of Kinesiophobia (TSK).

RESULTS

In total, 100 patients with chronic non-specific low back pain were recruited, with a mean age of 36.89 (±7.78). Factor analysis revealed a three-factor structure of the FABQ, which consisted of subscales FABQ Physical activity, FABQ Work, and FABQ Work prognosis. Convergent validity analysis demonstrated a moderate correlation between FABQ-H and TSK (r = 0.413). Divergent validity analysis displayed a moderate correlation between FABQ-H and NRS (r = 0.362) and RMDQ Hindi (r = 0.399). ICC value for the FABQ-H was observed as 0.938 indicating high significance for test-retest reliability. Cronbach α for the FABQ-H was recorded as 0.806 demonstrating high internal consistency.

CONCLUSION

A successful translation and adaptation of the Hindi version of FABQ is reported in this study. The three-factored FABQ-H exhibited satisfactory construct validity, test-retest reliability, and internal consistency. Based on findings of this study, the FABQ-H can be implemented in Hindi-speaking patients with chronic non-specific low back pain (LBP).

LEVEL OF EVIDENCE

3.

Translation, cultural adaptation, and psychometric testing of the Yoruba version of Fear-Avoidance Beliefs Questionnaire in patients with low-back pain

PURPOSE

To translate, culturally adapt, and validate the Fear-Avoidance Beliefs Questionnaire into Yoruba language.

MATERIALS AND METHODS

Translation and cultural adaptation of the Yoruba version of the Fear-Avoidance Beliefs Questionnaire was carried out following the Guillemin criteria. One hundred and thirty-one individuals with chronic low-back pain participated in the psychometric evaluation of the Yoruba language translation. Cronbach's alpha (α), principal component analysis, intra-class correlation, Bland-Altman analysis, Spearman rank correlation coefficient, and minimal detectable difference were used for the analysis. Alpha level was set at p < 0.05.

RESULTS AND CONCLUSION

The mean age of the respondents was 53.6 ± 11.6 years. The internal consistency of the Yoruba language version of the Fear Avoidance Beliefs Questionnaire yielded a Cronbach's alpha of 0.9. Principal component analysis yielded a three-factor structure including the "work", "beliefs related to work", and "physical activity" which accounted for 61.6% of variance in the Yoruba translation. Test-retest reliability of the Yoruba translation yielded an Intra class correlation coefficient 0.97 (0.95-0.98). The Yoruba Fear Avoidance Beliefs Questionnaire was poorly correlated with the Visual Analog Scale (r = 0.01) and Roland-Morris Disability Questionnaire (r = 0.3). The minimal detectable difference of the Yoruba translation was 7.0. The Yoruba Fear Avoidance Beliefs Questionnaire demonstrated excellent psychometric properties similar to existing versions and is appropriate for clinical use among Yoruba-speaking patients.IMPLICATIONS FOR REHABILITATIONThe Fear-Avoidance Beliefs Questionnaire is a culturally sensitive psychosocial outcome measure, necessitating its existence, and adaptation into different languages.The instrument was translated and culturally adapted into the Yoruba language following the Guillemin criteria.The Yoruba translation demonstrated excellent internal consistency, test-retest reliability and weak correlations with the Visual analog scale and Roland-Morris Disability Scale.The Yoruba version of the Fear-Avoidance Beliefs Questionnaire can be used to assess fear-avoidance beliefs among Yoruba speaking patients with low-back pain.

[Clinical-demographic factors associated with fear-avoidance in subjects with non-specific chronic low back pain in Primary Care: secondary analysis of intervention study]

Objetivo

Describir algunas características sociodemográficas y clínicas de los sujetos con lumbalgia crónica inespecífica (LCI) atendidos habitualmente en atención primaria (AP), así como investigar su asociación con el miedo-evitación (ME).

Diseño

Descriptivo transversal. Análisis secundario de estudio de intervención.

Emplazamiento

Zonas Básicas de Salud del Distrito Sanitario de AP Costa del Sol (Málaga).

Participantes

Un total de 147 sujetos con LCI extraídos de la base de datos de un estudio de intervención previo en fisioterapia de AP. Características: edad, 18-65 años; comprensión del idioma español; ausencia de deterioro cognitivo, ausencia de fibromialgia, ausencia de cirugía dorsolumbar, y tolerancia al ejercicio físico.

Mediciones principales

La variable principal fue el ME (FABQ y subescalas FABQ-PA y FABQ-W); las variables clínicas incluyeron: dolor (NRPS-11), discapacidad (RMQ), tiempo de evolución, tratamientos previos y diagnósticos de imagen; las variables sociodemográficas incluyeron: sexo, edad, nivel educativo y situación laboral.

Resultados

El 51,7% de los sujetos presentaron elevado ME con la escala FABQ-PA. Incapacidad temporal (IT) [β = 24,45 (p = 0,009^*); β = 13,03 (p = 0,016^*); β = 14,04 (p = 0,011^*) para FABQ, FABQ-PA y FABQ-W, respectivamente]; estudios primarios [β = 15,09 (p = 0,01^*); β = 9,73 (p = 0,01^*) para FABQ y FABQ-PA], y discapacidad [β = 1,45 (p < 0,001); β = 0,61 (p < 0,001); β = 0,68 (p < 0,001) para FABQ, FABQ-PA y FABQ-W, respectivamente] aparecieron asociados al ME cuando fueron modelados por regresión multivariante.

Conclusiones

Algunos rasgos sociodemográficos y clínicos de la población con LCI son presentados. Las pruebas de imagen (81,63%) y los tratamientos previos pasivos (55,78%) podrían reflejar problemas de adherencia a las recomendaciones de las GPC. IT, estudios primarios y discapacidad se asociaron al ME. Los hallazgos deben ser interpretados a la luz de las posibles limitaciones. Algunas sugerencias para la práctica clínica son aportadas.

Using existing questionnaires in latent class analysis: should we use summary scores or single items as input? A methodological study using a cohort of patients with low back pain

Background

Latent class analysis (LCA) is increasingly being used in health research, but optimal approaches to handling complex clinical data are unclear. One issue is that commonly used questionnaires are multidimensional, but expressed as summary scores. Using the example of low back pain (LBP), the aim of this study was to explore and descriptively compare the application of LCA when using questionnaire summary scores and when using single items to subgrouping of patients based on multidimensional data.

Materials and methods

Baseline data from 928 LBP patients in an observational study were classified into four health domains (psychology, pain, activity, and participation) using the World Health Organization’s International Classification of Functioning, Disability, and Health framework. LCA was performed within each health domain using the strategies of summary-score and single-item analyses. The resulting subgroups were descriptively compared using statistical measures and clinical interpretability.

Results

For each health domain, the preferred model solution ranged from five to seven subgroups for the summary-score strategy and seven to eight subgroups for the single-item strategy. There was considerable overlap between the results of the two strategies, indicating that they were reflecting the same underlying data structure. However, in three of the four health domains, the single-item strategy resulted in a more nuanced description, in terms of more subgroups and more distinct clinical characteristics.

Conclusion

In these data, application of both the summary-score strategy and the single-item strategy in the LCA subgrouping resulted in clinically interpretable subgroups, but the single-item strategy generally revealed more distinguishing characteristics. These results 1) warrant further analyses in other data sets to determine the consistency of this finding, and 2) warrant investigation in longitudinal data to test whether the finer detail provided by the single-item strategy results in improved prediction of outcomes and treatment response.