COGNITIVE BEHAVIOR QUESTIONNAIRE IN NONSPECIFIC CHRONIC LOW BACK PAIN - DEVELOPMENT AND VALIDATION

S. Saini¹, P. Golwala², D. Tiwari³, T. Palekar¹

¹Dr D Y Patil Vidyapeeth, Physiotherapy, Pune, India, ²Sumandeep University, Orthopaedics, Vadodara, India, ³Simmons University, Physiotherapy, Boston, United States

Background: Low Back Pain (LBP) affects 60–80% of adults at some stage in life. According to Andersson the annual global incidence of LBP in adults is 15%, with a 30% point prevalence. Data has shown that only 8–15 percent of patients with LBP have a patho-anatomical diagnosis, leaving the rest with non-specific LBP. A small but considerable part of this population develops Nonspecific chronic low back pain (NSCLBP), which consumes a significant amount of healthcare costs.The evidence suggested that NSCLBP is a multifaceted condition in which impairment levels are more strongly connected with cognitive and behavioural components of pain than sensory and biological ones. A number of RCTs have investigated that cognitive behavioural interventions can successfully treat NSCLBP. However, systematic reviews of these interventions have failed to show that they are more effective in managing NSCLBP than other conservative interventions. The absence of patient-centred and targeted management without a proper assessment tool could be an explanation for this failure.

Purpose: The purpose of this study was to develop and validate the Cognitive Behavior Questionnaire (CABQ) for Nonspecific chronic low back pain.

Methods: The modified Delphi method was used for gathering the responses from the thirteen experts (selected using the purposive sampling method) from multiple disciplines (Physiotherapists, Orthopaedics, General Medicine and Clinical Psychologists) having a minimum 5-year experience in the management of CLBP. The questionnaire was created using a comprehensive literature review. The Questionnaire comprised 35 items based on psychological distress (18 Items), pain catastrophizing (7 items) and Fear avoidance belief (10 items). The experts assessed each of the proposed items and expressed their agreement using a five-point Likert scale:
1 = Strongly disagree;
2 = Disagree;
3 = Neither agree nor disagree;
4 = Agree;
5 = Strongly agree.
Data for both rounds were analyzed using the Content Validity Index (CVI) and Content Validity ratio (CVR). Following each round, a report outlining the item analysis, results collected, and items validated, removed, or retained was sent to each expert.

Results: Based on previous studies, the minimum CVR value of 0.54 for panel size (N) 13 was considered a cutoff value for item retention and for the questionnaire CVR value of 0.70 was an indicator of good content validity. Based on the expert's recommendations and scoring, the number of items in the second round of the modified Delphi process was reduced from 35 to 16, and items with a CVI score of less than 0.70 were deleted. Overall, the CVI for the questionnaire was 0.88 indicating excellent content validity.

Conclusions: We have developed a tool for assessing cognitive behavior in patients with nonspecific chronic low back pain. This will provide a valid measure to examine the affected level of cognition in non-specific chronic low back pain patients in terms of psychological distress, catastrophizing, and fear avoidance belief.

Implications: This novel measure will help clinicians to make informed clinical decisions to manage a patient with nonspecific CLBP once validity and responsiveness are established.

Funding acknowledgements: This study is not funded by any agency.

Keywords:
Cognition
Assessment Tool
Validation

Topics:
Musculoskeletal: spine
Pain & pain management
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: Sumandeep Vidyapeeth, Vadodara, Gujarat, India

Committee: Sumandeep Vidyapeeth Institutional Ethics Committee(SVIEC)

Ethics number: SVIEC/ON/Phys/PhD/20027