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Objective: This study validated a measure entitled the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) for assessing the attitudes . physiotherapy students completed the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), of these completing. of a chiropractic teaching institution using the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and evaluate their.
Turner JA, Clancy S. Strategies for coping with chronic low back pain: The importance of fear, beliefs, catastrophizing and kinesiophobia in chronic low back pain rehabilitation. Ann Phys Rehabil Med. Fear-avoidance beliefs about back pain in patients with acute LBP. The correlation between pain, catastrophizing, and disability in subacute and chronic low back pain: Spine Phila Pa Negative beliefs about low back pain are associated with high pain intensity and high level disability in community-based women.
How does the self-reported clinical management of patients with low back pain relate to the attitudes and beliefs of health care practitioners? A survey of UK general practitioners and physiotherapists. Effect of a simple information booklet on pain persistence after an acute episode of low back pain: Buchbinder R, Jolley D.
Health care providers' attitudes and beliefs about functional impairments and chronic back pain.
Effects of a media campaign on back beliefs is sustained 3 years after its cessation. Do attitudes and beliefs influence work loss due to low back trouble? Cost-effectiveness of guideline- endorsed treatments for low back pain: Diagnosis and treatment of low back pain: In Brazil, such topic was studied just once, in which the HC-PAIRS was translated and cross-culturally adapted into Brazilian-Portuguese and was used to investigate the attitudes and beliefs of physical therapy students about chronic low back pain However, the clinimetric properties of the adapted scale were not still performed.
PT was not still developed. Therefore, the objectives of the present study were to translate and cross-culturally adapt the Brazilian-Portuguese version of PABS. Methods This study was performed in two stages. The first stage consisted on the translation and cross-cultural adaptation of the PABS. PT in physical therapists who routinely worked with patients with low back pain in their clinical practice.
The following hypotheses were tested: PT scales would demonstrate an acceptable level of internal consistency; 2. PT would demonstrate an acceptable reproducibility in a test-retest design with seven-day interval; 4.
PT would demonstrate low levels of ceiling and floor effects. Translation and cross-cultural adaptation The translation and cross-cultural adaptation procedures followed the Guidelines for the process of cross-cultural adaptation of self report measures21, as described below: PT scale was translated into the Brazilian-Portuguese by two independent bilingual translators who were unaware of the instrument; 2.
Health care providers' attitudes and beliefs about functional impairments and chronic back pain.
Synthesis of the translations: PT into Brazilian-Portuguese; 3. PT was then back translated into English by two independent bilingual translators, who did not have previous knowledge of the original version of the questionnaire; 4. An expert committee composed by the four translators and the authors of this study revised all the previous procedures, compared all translations and corrected possible discrepancies so that the final version of PABS.
PT could be tested in Brazil. Pre-tests were not performed to check the understanding of items of the instruments as suggested by the guidelines The participants of the study were asked about the comprehensibility of the items of these instruments and they reported no major problems when answering the instruments.
PT scales were tested in a sample of physical therapists who routinely treat patients with low back pain in their clinical practice. To participate in the study, the physical therapists should be registered in any Brazilian registration board, have experience in the treatment of patients with low back pain this information was obtained through the question: How many patients with low back pain on average do you treat per week?
The sample size of physical therapists was defined following the recommendations of the Quality criteria for measurement properties of health status questionnaires22 which suggest that, at least, 50 participants would be necessary for the reproducibility, validity and ceiling and floor effects analyses, and at least participants would be needed for the internal consistency analysis.
The following clinimetric properties were tested: The internal consistency of the instruments was tested through the Cronbach's alpha statistics Cronbach's alpha values ranging from 0. Reproducibility is an umbrella term that covers two properties: In other words, the reliability is the relative measurement error22, ICCs lower than 0. The statistical procedure of agreement is able to determine how close two scores measured in different time points are from each other.
Agreement is always expresses in the same measurement units of the instrument through the Standard Error of the Measurement SEM. The construct validity is evaluated by testing a priori hypotheses. The statistical test used in our study was the Pearson Correlation Coefficient r Ceiling and floor effects: One of the consequences of the ceiling and floor effects is the inability to distinguish patients who answered very low or very high scores, which influences the reliability of the instrument.
The ceiling and floor effects were calculated through frequency analyses starting from summing the number of participants who answered the questionnaires with maximum ceiling and minimum floor scores and through the subsequent conversion of these values into percentages.
PT scales twice through interviews, being the first interview at baseline day 0 and the second one seven days later day 7. The seven-day interval was chosen to avoid the recall from the first interview, but also to ensure that there was not enough time that the beliefs with regards to low back pain could be changed for example due to continuous education courses.
The baseline interview and the one seven days later were previously scheduled with the participants, and there were no drop outs between the first and the second interview. Demographic data, such as age, gender, workplace and professional experience were also collected at baseline. Results A total of physical therapists of both genders, being most young adults, with professional experience lower than 5 years, following different treatment approaches for low back pain and attending in different types of clinical environment participated in the study Table 1.
The final version of the PABS.
- Questionnaires to Examine Back Pain Beliefs Held by Health Care Professionals
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PT scale translated and cross- culturally adapted into Brazilian-Portuguese is described in appendix 1. Tables 2 and 3 present the results for the internal consistency, reproducibility and construct validity of the instruments as well as their respective subscales.
The internal consistency estimates ranged from 0. These results reflect appropriate estimates of internal consistency and reproducibility. The correlation matrix with the results of the construct validity analysis shows correlation estimates that ranged from weak to moderate in most of the cases, except for the correlation between the subscale PABS. Moreover the participants were physical therapists with different levels of academic degrees and professional experience, who worked in different clinical environments.
These factors together are relevant with regards to the external validity of the study. An acceptable Cronbach's alpha value was observed 0. Two studies presented similar estimates. The first study15 analyzed attitudes and beliefs of health care providers in relation to patients with chronic low back pain. This study recruited American health care providers i. The second study7 recruited a sample of Dutch therapists i. PT scale is interpreted according to a two-dimensional model.
In this study, the analyses of the internal consistency of the PABS. PTBiomedical factor subscale 0. PTBiopsychosocial factor subscale 0.
These results are also similar to the results of clinimetric studies performed previously. PTBiomedical factor subscale and 0. The same pattern of results was observed in Ostelo's et al. PTBiomedical factor subscale and of 0.
In all studies which the internal consistency of PABS. Studies are necessary in order to revise and retest the items of this subscale. Reproducibility refers to the ability of a measurement instrument to obtain similar answers under stable conditions24 and it is evaluated through the relative reliability and absolute agreement error of the instrument. In the present study, reliability estimates ranged from moderate to substantial.
Similarly the study of Rainville et al. With regards to the PABS. PT scale, we observed an ICC of 0. The agreement values observed in this study were 4. PTBiomedical factor and 3. The percentage of the SEM in relation to the total score of the questionnaires ranged from 4. PTBiopsychosocial factor subscalerepresenting a good agreement.
We are unaware of previous studies that measured the agreement of these instruments. Construct validity is tested when the score of a certain measurement instrument is correlated with the score of another instrument that measures the same construct or a similar construct. The correlation matrix in Table 3 demonstrates correlations that range from weak to moderate in all cases, except for the correlations between the PABS.
It is important to highlight that the PABS. Therefore, moderate correlation coefficients can be considerate acceptable given that our results support our a priori hypothesis that these scales would be positively correlated.