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Budzisz A, Jung A, Adamczyk WM, Szikszay TM, Carvalho GF, Bąbel P, Luedtke K. Body Image Measured via the Fremantle Awareness Questionnaire in Individuals With and Without Pain: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2024; 25:104530. [PMID: 38599266 DOI: 10.1016/j.jpain.2024.104530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
Research suggests that pain negatively affects body image, and body image may also influence reported pain levels. This review aims to summarize the literature on differences in body image distortion between individuals with pain compared to pain-free individuals. The review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 statement and an a priori preregistered protocol. The literature was searched using 5 electronic databases. Studies assessing body image with the Fremantle Awareness Questionnaire (FAQ) in individuals with and without pain were eligible for inclusion. Screening and selection of eligible studies were performed by independent reviewers. Methodological quality was assessed with the Joanna Briggs Institute critical appraisal tool. Meta-analyses, meta-correlations, and metamean analyses were performed using random-effect models. The primary outcome was the FAQ score; secondary outcomes were reported pain variables. Data from individuals with pain (n = 2277) and without pain (n = 615) were summarized. Significant body image distortions were found in individuals with pain compared to individuals without pain. Compared to pain-free individuals, the pain group rated significantly higher in the FAQ when experiencing back pain (standardized mean differences=1.33, 95% confidence interval=.88-1.77) or other body parts (standardized mean differences=1.25, 95% confidence interval=.51-1.99). The results of meta-correlation analyses confirmed the positive relationship between body image distortion and pain intensity (r = .31), pain at rest (r = .31), or pain during movement (r = .36), but not for pain duration. A difference in mean FAQ results was observed between individuals with pain in different areas (knee and back). PERSPECTIVE: This review confirms differences in body image distortion between pain and pain-free individuals. Pain intensity was correlated with altered body perception, but not pain duration. A moderate correlation was observed between body image distortion and reported pain variables. Body image was more impaired by knee pain than back pain. REGISTERED PROTOCOL AT PROSPERO: CRD42022309937; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022309937.
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Affiliation(s)
- Aleksandra Budzisz
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland; Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland.
| | - Andres Jung
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Waclaw M Adamczyk
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Tibor M Szikszay
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Luebeck, Germany
| | - Gabriela F Carvalho
- Department of Physiotherapy, Faculty of Health, Safety and Society, Furtwangen University, Furtwangen, Germany
| | - Przemysław Bąbel
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Luebeck, Germany
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García-Dopico N, Terrasa JL, González-Roldán AM, Velasco-Roldán O, Sitges C. Unraveling the Left-Right Judgment Task in Chronic Low Back Pain: Insights Through Behavioral, Electrophysiological, Motor Imagery, and Bodily Disruption Perspectives. THE JOURNAL OF PAIN 2024; 25:104484. [PMID: 38307439 DOI: 10.1016/j.jpain.2024.01.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/04/2024]
Abstract
Bodily disruptions have been consistently demonstrated in individuals with chronic low back pain. The performance on the left-right judgment task has been purposed as an indirect measure of the cortical proprioceptive representation of the body. It has been suggested to be dependent on implicit motor imagery, although the available evidence is conflicting. Hence, the aim of this case-control observational study was to examine the performance (accuracy and reaction times) and event-related potentials while performing the left-right judgment task for back and hand images in individuals with chronic low back pain versus healthy controls, along with its relationship with self-reported measurements and quantitative sensory testing. While self-reported data suggested bodily disruptions in the chronic low back pain sample, this was not supported by quantitative sensory testing. Although both groups displayed the same performance, our results suggested an increased attentional load on participants with chronic low back pain to achieve equal performance, measured by a higher N1 peak amplitude in occipital electrodes, especially when the effect of contextual images arises. The absence of differences in the reaction times for the left-right judgment task between both groups, along with inconsistencies in self-reported and quantitative sensory testing data, could question the involvement of implicit motor imagery in solving the task. In conclusion, our results suggest disrupted attentional processing in participants with chronic low back pain to solve the left-right judgment task. PERSPECTIVE: Although there are no differences in the performance of the left-right judgment task (hits, reaction times) between chronic low back pain patients and controls, the analysis of event-related potentials revealed that patients require a higher cognitive load, measured by N1 peak amplitude.
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Affiliation(s)
- Nuria García-Dopico
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain; Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Juan L Terrasa
- Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Ana M González-Roldán
- Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Olga Velasco-Roldán
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain; Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Carolina Sitges
- Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
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Monticone M, Maurandi C, Porcu E, Arippa F, Wand BM, Corona G. The Fremantle Back Awareness Questionnaire: cross-cultural adaptation, reliability, and validity of the Italian version in people with chronic low back pain. BMC Musculoskelet Disord 2024; 25:279. [PMID: 38605331 PMCID: PMC11007946 DOI: 10.1186/s12891-024-07420-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/05/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND AND AIM There is evidence to suggest that assessing back-specific altered self-perception may be useful when seeking to understand and manage low back pain (LBP). The Fremantle Back Awareness Questionnaire (FreBAQ) is a patient-reported measure of back-specific body perception that has never been adapted and psychometrically analysed in Italian. Hence, the objectives of this research were to cross-culturally adapt and validate the Italian version of this outcome measure (namely, the FreBAQ-I), to make it available for use with Italians suffering from chronic LBP. METHODS The FreBAQ-I was developed by forward and backward translation, review by a committee skilled in patient-reported measures and test of the pre-final version to assess its clarity, acceptability, and relevance. The statistical analyses examined: structural validity based on Rasch analysis; hypotheses testing by investigating correlations of the FreBAQ-I with the Roland Morris Disability Questionnaire (RMDQ), a pain intensity numerical rating scale (PI-NRS), the Pain Catastrophising Scale (PCS), and the Tampa Scale of Kinesiophobia (TSK) (Pearson's correlations); reliability by internal consistency (Cronbach's alpha) and test-retest repeatability (intraclass correlation coefficient, ICC (2,1)); and measurement error by determining the minimum detectable change (MDC). After the development of a consensus-based translation of the FreBAQ-I, the new outcome measure was delivered to 100 people with chronic LBP. RESULTS Rasch analysis confirmed the substantial unidimensionality and the structural validity of the FreBAQ-I. Hypothesis testing was considered good as at least 75% of the hypotheses were confirmed; correlations: RMDQ (r = 0.35), PI-NRS (r = 0.25), PCS (r = 0.41) and TSK (r = 0.38). Internal consistency was acceptable (alpha = 0.82) and test-retest repeatability was excellent (ICC (2,1) = 0.88, 95% CI: 0.83, 0.92). The MDC95 corresponded to 6.7 scale points. CONCLUSION The FreBAQ-I was found to be a unidimensional, valid, and reliable outcome measure in Italians with chronic LBP. Its application is advised for clinical and research use within the Italian speaking community.
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Affiliation(s)
- Marco Monticone
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Elisa Porcu
- Rehabilitation Medicine and Neurorehabilitation, P.O. San Martino, Oristano, Italy
| | - Federico Arippa
- Department of Mechanical, Chemical, and Materials Engineering, University of Cagliari, Cagliari, Italy.
| | - Benedict M Wand
- The Faculty of Medicine, Nursing & Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, WA, Australia
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García-Dopico N, de la Torre-Luque A, Sitges C, Velasco-Roldán O. Proprioceptive acuity is core for back awareness in chronic low back pain: Further analysis of the content validity of the Spanish version of the Fremantle Back Awareness Questionnaire. Front Hum Neurosci 2022; 16:1070402. [PMID: 36875741 PMCID: PMC9983349 DOI: 10.3389/fnhum.2022.1070402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/28/2022] [Indexed: 02/19/2023] Open
Abstract
Treatments aimed at increasing self-perception may improve chronic low back pain (CLBP) symptomatology and present novel management approaches. Consequently, it is important to have valid, complete, and reliable tools for its assessment, and to understand which variables influence altered back awareness. We aimed to evaluate the face/content validity of the Spanish version of the Fremantle Back Awareness Questionnaire (FreBAQ-S) among people with and without CLBP, and to explore additional variables suggested to be involved in back awareness. A total of 264 individuals with CLBP and 128 healthy controls (HC) answered an online survey, including the FreBAQ-S, and questions regarding the completeness, comprehensibility, time-to-complete adequacy, and time spent completing it. If participants declared a lack of completeness, they had to report which aspects would be incorporated into the questionnaire to explore additional back-awareness-related variables. A statistically significant difference in completeness emerged between groups (p < 0.01). The questionnaire was comprehensible for more than 85% of participants, regardless of the group (p = 0.45). CLBP participants spent significantly more time in completing the questionnaire than controls (p < 0.01), but no differences were found between groups regarding the time-to-complete adequacy (p = 0.49). Regarding the back-awareness-related variables, 77 suggestions from CLBP group and seven from the HC were received. Most of them were related to proprioceptive acuity such as posture, weight, or movement patterns, among others. The FreBAQ-S demonstrated adequate face/content validity, completeness, comprehensibility, and adequate time of response. The feedback provided will help improve currently available assessment tools.
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Affiliation(s)
- Nuria García-Dopico
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain.,Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Alejandro de la Torre-Luque
- Department of Legal Medicine, Psychiatry and Pathology, CIBERSAM ISCIII, Complutense University of Madrid (UCM), Madrid, Spain
| | - Carolina Sitges
- Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Olga Velasco-Roldán
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain.,Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
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