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The Pain Belief Screening Instrument (PBSI): Predictive validity for disability status in persistent musculoskeletal pain
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. (Caring Sciences)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. (Caring Sciences)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. (Caring Sciences)
2008 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 30, no 15, 1123-1130 p.Article in journal (Refereed) Published
Abstract [en]

Purpose. To evaluate the predictive validity of a screening instrument measuring disability, self-efficacy, fear of movement and catastrophizing, for disability status in patients with musculoskeletal pain in primary health care physical therapy. Development over time of pain-related disability, pain intensity, self-reported work capacity and overall daily function for subgroups of patients was also investigated. Method. Prospective and correlational study, where patients (n = 168) with a pain-duration of 4 weeks or more completed the questionnaires and their cases were followed for 8 months to assess the variables of interest. For predictive validity of the screening instrument discriminant analyses were conducted. The development over time for subgroups was analysed by comparing scores at the first and second measurement. Results. The PBSI correctly classified 72% of the subjects as High-disabled (n = 33) or Low-disabled (n = 110), as measured with the Pain Disability Index (Wilks' lambda = 0.848, p < 0.005). For pain intensity, self-reported changes in work capacity and overall daily function the discriminant analyses were not significant. The High-disability group had increased disability, unchanged pain intensity and decreased work capacity and daily function after 8 months. Conclusion. The predictive validity of the PBSI for disability was confirmed. In clinical use the PBSI could serve as a mean to obtain supplementary and clinically useful information.

Place, publisher, year, edition, pages
2008. Vol. 30, no 15, 1123-1130 p.
Keyword [en]
Physical therapy, measurement, pain, primary health care
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-97108DOI: 10.1080/09638280701523200ISI: 000259103800006PubMedID: 19230133OAI: oai:DiVA.org:uu-97108DiVA: diva2:171904
Available from: 2008-04-25 Created: 2008-04-25 Last updated: 2015-11-23Bibliographically approved
In thesis
1. Screening, Targeting, Tailoring, and Implementation in Primary Health Care: An integrated physical therapy and behavioural medicine approach to persons with persistent musculoskeletal pain
Open this publication in new window or tab >>Screening, Targeting, Tailoring, and Implementation in Primary Health Care: An integrated physical therapy and behavioural medicine approach to persons with persistent musculoskeletal pain
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis deals with a behavioural medicine approach to the management of patients with persistent musculoskeletal pain in primary health care physical therapy. The main aims of the thesis were; to develop, and evaluate the psychometric properties of, a screening instrument for risk of disability and; to evaluate the implementation and effects of a targeted and tailored treatment.

The studies comprise four samples of patients with musculoskeletal pain exceeding one month. All subjects were recruited when consulting physical therapists in Swedish primary health care settings. For development and evaluation of the Pain Belief Screening Instrument (PBSI) four samples were used; two samples (n1 = 215 and n2 = 93) in Study I, one sample (n = 168) in Study II, and one sample (n = 45) in Study III. For evaluation of implementation and effects of targeted and tailored treatment the 32 patients who completed treatment in Study III were used. In Study IV treatment documents of 18 patient cases from Study III were studied to evaluate treatment integrity.

The concurrent and predictive validity of the PBSI was good, and the instrument was therefore used to define subgroups with either a high or low risk for disability. A low treatment dosage of a tailored treatment for low risk patients was tried and found equally efficient as a longer treatment focusing physical exercise. Subjects who received a treatment tailored to individual patient characteristics perceived a better global outcome of treatment compared to subjects in the control group. However, no between-group differences in the disability measures were found. The evaluation of treatment integrity displayed low therapist adherence to the treatment rationale for the tailored treatment.

The studies demonstrate ways to systematically integrate a behavioural medicine approach and physical therapy. The results indicate efficiency in managing patients with persistent musculoskeletal pain in primary health care.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 67 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 338
Keyword
Caring sciences, physical therapy, behavioural medicine, screening, chronic pain, primary health care, Vårdvetenskap
Identifiers
urn:nbn:se:uu:diva-8665 (URN)978-91-554-7174-3 (ISBN)
Public defence
2008-05-16, Sal IX, Universitetshuset, Övre Slottsgatan 2, Uppsala, 13:00
Opponent
Supervisors
Available from: 2008-04-25 Created: 2008-04-25Bibliographically approved

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