Alemam D.1,2, Leaver A.1, Moloney N.3, Alsobayel H.2, Alashaikh G.4, Mackey M.1
1The University of Sydney, Faculty of Health Sciences, Sydney, Australia, 2King Saud University, Health Rehabilitation Sciences, Riyadh, Saudi Arabia, 3Macquaire University, Faculty of Medicine and Health Sciences, Sydney, Australia, 4Prince Sultan Military Medical City, Physiotherapy Department, Riyadh, Saudi Arabia
Background: Chronic low back pain (LBP) is disabling and commonly associated with observable pain-related behaviours. However, valid and reliable methods to systematically assess related pain behaviours are lacking. The Pain Behaviour Scale (PaBS) was designed to uniquely measure both the presence and severity of LBP related-pain behaviours.
Purpose: The primary aim of the study was to examine the reliability and construct validity of the PaBS during standard physical performance tests (PP). A second aim was to examine the test-retest reliability of the PP measures.
Methods: Twenty-two participants with chronic LBP were observed during performance of five PP by two raters. Pain behaviour was assessed using PaBS. Visual Analogue Scale and Modified Oswestry Disability Index were used to measure pain and disability respectively. Inter- and intra-rater reliability of the PaBS were analyzed by inter-class correlation coefficients. Rater agreement was analyzed by weighted Cohens kappa and percent agreement. Construct validity of the PaBS was analyzed by examining the correlations between PaBS, self-reported measures and PP using Pearsons product moment correlations.
Results: The PaBS demonstrated excellent inter-rater (1.0) and intra-rater (0.9) reliability. The PP demonstrated good test-retest (0.6-1.0) reliability. Perfect agreement in the reporting of pain behaviours was found. Strong correlations between pain behaviour and pain intensity (r=0.6) and disability (r= 0.6) were found indicating good construct validity of PaBS. Moderate correlations were found between pain behaviours and PP in: sit to stand (r= 0.5), trunk flexion (r=0.4) timed-up-and-go (r=0.4) and fifty-foot walk (r=0.4).
Conclusion(s): The PaBS is a valid and reliable tool for measuring the presence and severity of pain behaviour and the PP are reliable tests to distinguish people with LBP. Longitudinal studies to examine how pain behaviours change over time and whether they can predict pain and disability would support the usefulness of the scale. Further, evaluation of the scales utility as a way of sub-grouping patients and targeting treatment is also warranted.
Implications: The PaBS is important because it assesses pain behaviours during the performance of functional tests commonly used in the assessment of people with LBP. The tool is easy to use and clinicians should be able to easily and accurately document pain behaviours with some training. This tool would also support a multi-dimensional assessment of chronic pain.
Funding acknowledgements: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Topic: Musculoskeletal: spine
Ethics approval: Ethical approval for this study was obtained from Human Research Ethics Committee of the University of Sydney, Australia (2015/771).
All authors, affiliations and abstracts have been published as submitted.
