The Experience of Pregnancy-Related Lumbopelvic Pain: A Qualitative Evidence Synthesis.

Background. Pregnancy-related lumbopelvic pain is common and can impact quality of life. Purpose. To synthesize existing qualitative research on people's experiences of pregnancy-related lumbopelvic pain in pregnancy and during the postpartum period. Method. A keyword search of four electronic databases between 2000 and 2022 was completed. Included studies were appraised and synthesized using a meta-ethnographic approach. Findings. Twenty-three studies were included. Analysis identified four core themes: (1) uncertainties about pregnancy-related lumbopelvic pain, (2) struggles to attain achieve treatment and pain management, (3) profound activity consequences, and (4) emotional wellbeing, relationship, and identity impacts of pregnancy-related lumbopelvic pain. Implications. The occupational therapy role with this population has not to our knowledge yet been described. Given the centrality of occupational disruption to the experience of this population we argue that developing and evaluating occupational therapy interventions to address functional, work, parenting and wellbeing outcomes for this population is warranted and should be prioritized.

Acceptability of a Pain History Assessment and Education Chatbot (Dolores) Across Age Groups in Populations With Chronic Pain: Development and Pilot Testing.

BACKGROUND: The delivery of education on pain neuroscience and the evidence for different treatment approaches has become a key component of contemporary persistent pain management. Chatbots, or more formally conversation agents, are increasingly being used in health care settings due to their versatility in providing interactive and individualized approaches to both capture and deliver information. Research focused on the acceptability of diverse chatbot formats can assist in developing a better understanding of the educational needs of target populations. OBJECTIVE: This study aims to detail the development and initial pilot testing of a multimodality pain education chatbot (Dolores) that can be used across different age groups and investigate whether acceptability and feedback were comparable across age groups following pilot testing. METHODS: Following an initial design phase involving software engineers (n=2) and expert clinicians (n=6), a total of 60 individuals with chronic pain who attended an outpatient clinic at 1 of 2 pain centers in Australia were recruited for pilot testing. The 60 individuals consisted of 20 (33%) adolescents (aged 10-18 years), 20 (33%) young adults (aged 19-35 years), and 20 (33%) adults (aged >35 years) with persistent pain. Participants spent 20 to 30 minutes completing interactive chatbot activities that enabled the Dolores app to gather a pain history and provide education about pain and pain treatments. After the chatbot activities, participants completed a custom-made feedback questionnaire measuring the acceptability constructs pertaining to health education chatbots. To determine the effect of age group on the acceptability ratings and feedback provided, a series of binomial logistic regression models and cumulative odds ordinal logistic regression models with proportional odds were generated. RESULTS: Overall, acceptability was high for the following constructs: engagement, perceived value, usability, accuracy, responsiveness, adoption intention, esthetics, and overall quality. The effect of age group on all acceptability ratings was small and not statistically significant. An analysis of open-ended question responses revealed that major frustrations with the app were related to Dolores' speech, which was explored further through a comparative analysis. With respect to providing negative feedback about Dolores' speech, a logistic regression model showed that the effect of age group was statistically significant (χ22=11.7; P=.003) and explained 27.1% of the variance (Nagelkerke R2). Adults and young adults were less likely to comment on Dolores' speech compared with adolescent participants (odds ratio 0.20, 95% CI 0.05-0.84 and odds ratio 0.05, 95% CI 0.01-0.43, respectively). Comments were related to both speech rate (too slow) and quality (unpleasant and robotic). CONCLUSIONS: This study provides support for the acceptability of pain history and education chatbots across different age groups. Chatbot acceptability for adolescent cohorts may be improved by enabling the self-selection of speech characteristics such as rate and personable tone.

A Comparison of Leximancer Semi-automated Content Analysis to Manual Content Analysis: A Healthcare Exemplar Using Emotive Transcripts of COVID-19 Hospital Staff Interactive Webcasts.

Effective consumer centred healthcare incorporates consumer and clinician perspectives into decision making, in addition to traditional quantitative measures. This information is usually captured in qualitative data that requires manual analysis. Healthcare systems often lack resources to systematically incorporate qualitative feedback into decision making. Semi-automated content analysis tools, such as Leximancer, provide an efficient and objective alternative to time consuming manual content analysis (MCA). Literature on the validity of Leximancer in healthcare is sparse. This study seeks to validate Leximancer against MCA on a broad emotive conversational dataset gathered in a healthcare setting. At the outset of the COVID-19 pandemic, a large Australian hospital and health service conducted interactive webcasts with staff to provide updates and answer questions. A manual thematic analysis and a Leximancer content analysis were conducted independently on 20 webcast transcripts. The findings were compared, along with the time required to the complete each analysis. The Leximancer analysis identified nine concepts, while the manual analysis identified 12 concepts. The Leximancer concepts mapped to five of the concepts identified in the manual analysis, which accounted for 74% of mentions tagged in the text through the manual analysis. Leximancer missed concepts which required an emotional or contextual interpretation. The Leximancer analysis took 21 hours (excluding time to learn the program), compared to 73 hours for the manual analysis. Semi-automated content analysis provides an efficient alternative to manual qualitative data analysis, shifting it from a small-scale research activity to a more routine operational activity, albeit with some limitations. This is critical to be able to utilise at scale the rich narratives from consumers and clinicians in healthcare decision making.

Student-resourced service delivery of occupational therapy rehabilitation groups: patient, clinician and student perspectives about the ingredients for success.

BACKGROUND: A number of innovative models of student practice placements are emerging due to pressures on universities to provide quality practice placements and on health services to deliver rehabilitation efficiently, safely and cost-effectively. The student-resourced service delivery (SRSD) group program is one such model in occupational therapy. There is a paucity of research evidence to guide services in planning, implementing and evaluating the SRSD model. OBJECTIVE: The study aimed to explore and identify the factors that key stakeholders perceived as contributing to the successful development and implementation of the occupational therapy student-resourced service delivery group programs. METHODS: Participants in this multi-site study were rehabilitation inpatients, clinicians, Clinical Education Liaison Managers and students completing practice placement in the student-resourced service delivery group program. Data were collected using face-to-face semi-structured interviews and focus groups. RESULTS: A total of 83 participants consented to the study. Four themes emerged from the data. Planning needs to be an iterative process that commences before and continues during the program. Support processes need to be established for students and clinicians during and across placements. The creation of an engaging, client-relevant and graded group dynamic is critical for success. Establishing a culture whereby groups are valued by the clients, therapy and multidisciplinary teams is important. CONCLUSIONS: The above-mentioned factors were perceived as contributing to successful operationalisation of a student-resourced service delivery group program, and may be helpful when developing student-resourced service delivery professional practice placements in other settings.IMPLICATIONS FOR REHABILITATIONStudent-resourced service delivery of groups are one way to achieve additional professional practice placements for students and delivery of therapy services for patients.Ongoing investment for planning and preparation, provision of continual support for students, a culture of valuing groups and students, and creating a group dynamic that engages group participants were perceived by stakeholders as key ingredients for successful implementation of the student-resourced service delivery group model.Clinicians and educators are encouraged to use the perceived success factors identified in this study as a resource for future student-resourced service delivery program development.

Can Sensory- and Attachment-Informed Approaches Modify the Perception of Pain? An Experimental Study.

Accumulating evidence linking pain with both attachment and sensory processing variables introduces the possibility that attachment- and sensory-informed strategies may modify pain experiences. The aim of this study was to investigate this proposition using an experimentally induced pain procedure. Pain perceptions of individuals using either a sensory-informed (weighted modality) or an attachment-informed (secure base priming) coping strategy were compared with those of individuals using no designated coping strategy. An independent measures experimental study design was used with a convenience sample of 272 pain-free adults. Experimental participants (n = 156) were randomly allocated to either an attachment (n = 75) or a sensory (n = 81) intervention group. Data from these participants were compared to those of 116 participants involved in an earlier cold pressor study in which no coping strategy was used. All participants completed the same sensory, attachment, and distress questionnaires and participated in the same cold pressor pain test. ANCOVAs revealed that participants in the sensory- and attachment-informed intervention groups reported significantly higher pain thresholds than the control group. Participants allocated to the sensory group also reported higher pain intensity scores than the control group. There were no significant differences in pain tolerance between the three groups after controlling for covariates. While further research is required, findings encourage further consideration of sensory- and attachment-informed strategies for people anticipating a painful experience.

Prenatal Predictors of Maternal-infant Attachment.

BACKGROUND.: Increasingly, occupational therapists are working with women in the perinatal period, including supporting the developing mother-child relationship. PURPOSE.: To examine prenatal predictors of maternal-infant attachment (maternal-fetal attachment, sensory patterns, adult attachment, perinatal loss, and mental health) that may provide possible avenues for assessment and intervention by occupational therapists. METHOD.: Women (N = 60) were assessed during pregnancy and within one year postpartum in a cohort study. Independent t-tests, correlations, and multivariate regression models were conducted. FINDINGS.: Low threshold maternal sensory patterns, more insecure adult attachment, and poorer quality of maternal-fetal attachment were each correlated with less optimal maternal-infant attachment. Quality of prenatal attachment was the best predictor of overall postnatal attachment in multivariate regression models. IMPLICATIONS.: Occupational therapists working in a range of clinical settings (e.g., mental health, substance use, and perinatal care) may work with women during pregnancy to promote their relationship with their developing baby in utero and after birth.

Pediatric Persistent Pain: Associations Among Sensory Modulation, Attachment, Functional Disability, and Quality of Life.

IMPORTANCE: Although attachment is associated with sensory modulation among children and adolescents and insecure attachment is associated with pain severity among adolescents, relationships among sensory modulation, attachment, and function have not previously been demonstrated in a clinical sample of children and adolescents with complex persistent pain. OBJECTIVE: To investigate relationships among sensory modulation, attachment, function, and quality of life (QOL) in a pediatric population with persistent pain. DESIGN: Cross-sectional quantitative design. From October 2015 to July 2017, all children, adolescents, and parents attending a clinic for assessment completed questionnaires and were provided information and consent forms. Those who consented completed sensory modulation and attachment questionnaires. SETTING: Tertiary pain management clinic. PARTICIPANTS: Children (ages 8-12 yr) and adolescents (ages 13-18 yr) with persistent pain (pain of >3 mo duration or a specific pain disorder) and the capacity to answer questionnaires independently. MEASURES: Standardized sensory modulation, attachment, pain intensity, functional disability, and QOL questionnaires. Hypotheses were generated before data collection. RESULTS: Of 152 children and adolescents, 114 children (30 girls, 9 boys) and adolescents (68 girls, 7 boys) met study criteria and consented to participate. Hierarchical multiple regression analyses revealed that sensory sensitivity predicted disability for children and adolescents, and attachment anxiety mediated the relationship between low registration and poorer school-related QOL. CONCLUSION AND RELEVANCE: Behaviors related to insecure attachment patterns provide a mediating pathway from sensory modulation to functional disability; addressing such behaviors clinically may facilitate engagement in daily activities for children and adolescents with persistent pain. WHAT THIS ARTICLE ADDS: Results support the need to consider the interactions between sensory modulation and attachment when addressing functional abilities with occupational therapy treatment.

The experience of wearing compression garments after burn injury: "On the inside it is still me".

BACKGROUND: Compression garments are widely used for the management of hypertrophic scars, however, the patient experience of wearing compression garments remains minimally explored. OBJECTIVE: To gain an understanding of the patient experience of wearing compression garments post burn injury, including why patients remove their garments. METHOD: Interpretive description was the methodological approach used in this study. Semi-structured interviews and a focus group were used to gain in-depth insights into the lived experience of wearing compression garments. Thematic analysis revealed key themes across the data and member checking confirmed data interpretation. RESULTS: Three main themes related to wearing compression garments were identified: what it feels like to wear compression garments, what it is like to be a patient within a burns service and the impact of garments on patients' lives and recovery. CONCLUSIONS: The results highlighted a variety of influences that affected the individual experience of garment wear, highlighting the need for a patient centred approach by burn service providers.

How to improve compression garment wear after burns: Patient and therapist perspectives.

BACKGROUND: Compression garments are a widely used intervention for the management of hypertrophic scar and recent research demonstrates the varied experiences of patients wearing compression garments. However, the patient and therapist perspective on how to improve the experience of wearing compression garments remains unexplored. OBJECTIVE: To gain an understanding of the patient and therapist perspective of potential improvements to the provision of compression garments after burns. METHOD: A qualitative research design with an interpretive description approach was utilised in this study. Data was collected from patients through semi-structured interviews and a focus group and therapists by a focus group. Thematic analysis was completed to reveal the key themes across the data. RESULTS: Two main themes were identified: "what patients want" and "access to professional development". The first theme "what patients want" described three suggested improvements including education, peer support, and increased participation in garment prescription. CONCLUSIONS: The reported patient and therapist perspectives highlight the need for further research into service improvement to enhance the patient experience of wearing compression garments after burns.

Sensory sensitivity and its relationship with adult attachment and parenting styles.

Parenting styles vary in levels of both warmth and control, with evidence that type of parenting behavior is linked with social-emotional and other developmental outcomes for children. There are well-established associations between adult attachment and parenting styles. Given emerging evidence that people with different attachment patterns vary in how they receive and modulate sensory information, there are potential implications for parenting which have rarely received research attention. This cross-sectional study investigates the links between parenting style and parental sensory sensitivity, and the possible mediating role of parental sensory sensitivity in the relationship between adult attachment and parenting styles. A convenience sample of 155 parents of children aged 4-12 years old completed an online survey measuring: adult attachment (Experiences in Close Relationships-Modified 16-item Scale), sensory sensitivity (Highly Sensitive Persons Scale-Shortened Version), and parenting styles (Parenting Styles and Dimensions Questionnaire). Correlation, regression and mediation analyses were conducted. Analyses revealed that parents who reported more attachment insecurity also reported higher levels of parental sensory sensitivity, and more authoritarian and/or permissive (non-optimal) parenting styles. Parental sensory sensitivity was found to fully mediate the relationship between attachment avoidance and permissive parenting, and to partially mediate the relationship between attachment anxiety and both authoritarian and permissive parenting. This study represents the first quantitative evidence for associations between parental sensory sensitivity and parenting styles, and the mediating effect of parental sensory sensitivity on the known relationship between attachment insecurity and parenting. Awareness of a parent's level of sensory sensitivity, in addition to his/her attachment style, may assist in developing effective strategies to meet both the parent's and child's needs and support the parent-child relationship.

Sensory Modulation: An Important Piece of the Disability Puzzle for Adolescents With Persistent Pain.

OBJECTIVES: Sensory modulation patterns contribute to altered pain perception and disengagement in activities; atypical sensory modulation patterns have been associated with higher pain sensitivity, catastrophizing, and reduced function. Objectives of this study were to ascertain whether: adolescents with persistent pain had atypical sensory modulation patterns, atypical sensory modulation was associated with reduced functioning and higher pain, and pain catastrophizing mediated the relationship between sensory modulation and functional disability. METHODS: Adolescents (N=70, females=63, males=7) attending tertiary level interdisciplinary team assessment for persistent pain completed sensory modulation (Adolescent/Adult Sensory Profile), pain catastrophizing (Bath Adolescent Pain Questionnaire), pain intensity, functional disability (Functional Disability Index), and quality of life (QOL) (Pediatric QOL Scales) questionnaires. RESULTS: Adolescents with persistent pain had atypical patterns of sensory modulation compared with normative data. Sensory modulation patterns were not associated with pain intensity; however, higher sensitivity was associated with greater disability (r=0.36, P<0.01), and lower registration of sensation was associated with poorer emotional (r=0.31, P<0.01), social (r=0.35, P<0.01), and school-related (r=0.49, P<0.001) QOL. Sensory modulation, pain intensity, and catastrophizing contributed independently to disability; catastrophizing mediated sensory sensitivity and both functional disability and emotional QOL. DISCUSSION: This study is the first to show that atypical sensory modulation patterns are associated with poorer function for adolescents with persistent pain, suggesting that individualized sensory-informed interventions can potentially facilitate participation in daily activities and improve QOL.

Approach to activity engagement and differences in activity participation in chronic pain: A five-day observational study.

BACKGROUND/AIM: Activity pacing is one of the most widely endorsed interventions used by occupational therapists to assist clients to manage chronic pain conditions. It targets two behaviours that are thought to be maladaptive: activity avoidance and overactivity (activity engagement that severely aggravates pain). However, in more recent years, the potential for activity pacing to negatively impact activity participation has been recognised which deters habitually overactive individuals from adopting the self-management strategy. The main aim of this study was to evaluate if variances in activity participation can be explained by how individuals approach activity engagement when in pain. METHODS: Sixty-eight adults with chronic pain completed a demographic questionnaire, the Pain and Activity Relations Questionnaire (PARQ), and recorded their participation in activities for five days using a paper diary. Two of the authors independently coded the recorded activities into one of three time-use categories: rest, productivity or leisure/social. A MANCOVA model was produced to examine differences in time use across four 'approach to activity engagement' categories which were determined by scores on the PARQ. RESULTS: A significant multivariate effect was found. Univariate comparisons revealed that 'overactives' (high overactivity, low avoidance) and 'pacers' (low overactivity, low avoidance) spent a similar amount of time resting over the five-day period. 'Overactives' spent the most amount of time on productive tasks and the least amount of time on social/leisure activities out of the four subgroups. CONCLUSION: Results suggest that activity pacing does not negatively impact on activity participation in chronic pain populations. 'Pacers' spent a similar amount of time resting, and had a slightly better balance between productive tasks and leisure/social activities, when compared to 'overactives'. The results of this study can be incorporated into patient education and highlight potential treatment avenues for individuals with chronic pain who are habitually overactive.

Effects of long-term opioid analgesics on cognitive performance and plasma cytokine concentrations in patients with chronic low back pain: a cross-sectional pilot study.

INTRODUCTION: Cognitive performance and inflammation are altered in people with chronic low back pain (CLBP). Yet, the magnitude of these changes has been unclear because of the potential influence of opioid analgesics. OBJECTIVES: This cross-sectional pilot study aimed to explore whether patients with CLBP receiving long-term opioid analgesics differed from patients not taking opioids on measures of cognitive performance and plasma cytokine concentrations. METHODS: Patients with CLBP who were either taking (N = 18) or not taking (N = 22) opioids daily for 3 or more months were recruited from a tertiary care private hospital and compared with healthy adults (N = 20). All groups were administered validated questionnaires to assess depression, anxiety, and stress; a cognitive test of memory, attention, and executive function; and a peripheral blood draw to measure proinflammatory (IL-1ß, IL-2, IL-8, IL-12p70, TNF-α, and IFN-γ), anti-inflammatory (IL-4, IL-10, and IL-13), and pleiotropic (IL-6) cytokine concentrations. Patients also completed pain-specific questionnaires. RESULTS: Patients receiving opioid analgesics performed significantly (P < 0.05) worse in attention and had significantly (P < 0.05) lower pain self-efficacy beliefs than those patients not taking opioids. Patient groups did not differ in mean pain severity or pain interference scores, tests of memory and executive function, and mean plasma cytokine concentrations, despite long-term opioid analgesics. CONCLUSION: Patients receiving long-term opioid analgesics for CLBP have minor differences when compared with patients not taking opioids. This has important clinical implications when considering long-term treatment for patients with CLBP.

Seeking virtual social support through blogging: A content analysis of published blog posts written by people with chronic pain.

OBJECTIVE: People with chronic pain often have limited avenues for social support. Social isolation often develops as their abilities to engage in daily social and vocational activities decrease. With recent advancements in technology and increasing use of social media, virtual platforms such as blogging may provide opportunities for social support. This study analyzed published blog posts of people with chronic pain to investigate how social support occurs through blogging for chronic pain blog users and the nature of such online interactions. METHODS: A total of 810 blog posts published from January 2014 to December 2015 on 44 publicly accessible chronic pain blogs were collected and analyzed through qualitative phenomenological thematic analysis. RESULTS: The Virtual Online Support Sequence (VOSS) was identified through the exchange of online comments; this sequence defines the process by which virtual social support can be established through the process of chronic pain blogging. Three subthemes were also identified in relation to social support in the online blogging environment: (a) the virtual community of pain blogging; (b) establishing social support through the VOSS; and (c) recounting everyday experiences related to pain. CONCLUSIONS: These findings suggest that blogging can be useful in seeking, receiving and providing social support for people with chronic pain. Understanding this mechanism behind establishing virtual social support may potentially encourage people with chronic pain to pursue additional support online if they have limited face-to-face opportunities.

What do clinicians consider when assessing chronic low back pain? A content analysis of multidisciplinary pain centre team assessments of functioning, disability, and health.

Beyond expert suggestions as to the appropriate subject matter for chronic pain assessments, little is known about the actual content of multidisciplinary pain centre (MPC) clinical assessments. The International Classification of Functioning, Disability and Health Low Back Pain Core Set (ICF LBP-CS) provides a universal language to support the consistent description of LBP-related assessments across disciplines within multidisciplinary teams (MDTs). This study sought to map the content of MPC clinical assessments to the ICF to: (1) identify and compare the content of clinical MDT assessments using a cross-disciplinary framework and (2) examine the content validity of the LBP-CS. A qualitative examination of MPC team clinical assessments of chronic low back pain was undertaken. Multidisciplinary team (pain medicine, psychiatry, nursing, physiotherapy, occupational therapy, and psychology) assessments were audio-recorded and transcribed. Concepts were extracted from transcripts using a meaning condensation procedure and then linked to the ICF. Across 7 MDT assessments, comprised 42 discipline-specific assessments and 241,209 transcribed words, 8596 concepts were extracted. Contextual factors (ie, the person and environment), except for physiotherapy, accounted for almost half of each discipline's assessments (range: 49%-58%). Concepts spanned 113 second-level ICF categories, including 73/78 LBP-CS categories. Overall, the findings revealed novel insights into the content of MPC clinical assessments that can be used to improve health care delivery. International Classification of Functioning, Disability and Health-based assessment profiles demonstrated unique contributions from each discipline to chronic low back pain assessment. Finally, users of the LBP-CS can be confident that the tool exhibits sound content validity from the perceptive of MDT assessments of functioning, disability, and health.

A critical and interpretive literature review of birthing women's non-elicited pain language.

BACKGROUND: Standardised pain assessment i.e. the McGill Pain Questionnaire provide an elicited pain language. Midwives observe spontaneous non-elicited pain language to guide their assessment of how a woman is coping with labour. This paper examined the labour pain experience using the questions: What type of pain language do women use? Do any of the words match the descriptors of standardised pain assessments? What type of information doverbal and non-verbal cues provide to the midwife? METHODS: A literature search was conducted in 2013. Studies were included if they had pain as the primary outcome and examined non-elicited pain language from the maternal perspective. A total of 12 articles were included. FINDINGS: The analysis revealed six categories in which labour pain can be viewed: 'positive', 'negative', 'physical', 'emotional', 'transcendent' and 'natural'. Women's language comprised i.e. prefixes and suffixes, which indicate the qualities of pain, and figurative language. Language indicated location of pain, gave insight into other life phenomena i.e. death, and shared similarities with standardised pain assessmentdescriptors. Labour cues were 'functional', 'dysfunctional,' or 'neutral' (part of the physiological childbirth process), and were verbal, non-verbal, emotional, psychological, physical behaviour or reactions, or tactile. CONCLUSION: Labour can bring about a spectrum of sensations and therefore emotions from happiness and pleasure to suffering and grief. Spontaneous pain language comprises verbal language and non-verbal behaviour. Narratives are an effective form of pain communication in that they provide details regarding the quality, nature and dimensions of pain, and details notcaptured in quantitative data.

Patient Experience of Wearing Compression Garments Post Burn Injury: A Review of the Literature.

This review was conducted to critically appraise the literature regarding the patient's lived experience of, and adherence to, wearing compression garments post burn injury. Scholarly articles were identified from searches of the following databases: Pubmed, Cochrane Central, CINAHL, PsycINFO, and OT Seeker. Combinations of key words including compression therapy/garment, pressure therapy/garment, burn(s), adherence, and patient experience were utilized. Retrieved studies were included in the review if they were written in English, reported on adult burn populations, and the patient's lived experience of wearing compression garments. Included studies were critically appraised and content analysis was completed on the results sections of the two qualitative studies. Nine studies investigating patient's lived experiences were retained: one systematic review, one randomized controlled trial, five cross-sectional surveys, and two qualitative studies. An adherence framework provided a conceptual basis to categorize reported patient's lived experiences. Results identified a strong focus on patient and treatment-related experiences with limited investigation of condition, patient-provider and health care system experiences. Minimal investigation has been completed regarding the impact of these patient's lived experiences on the adherence to wearing compression garments. Additional research using qualitative methods is required to gain a deep understanding of patient's experiences and perspectives of wearing compression garments and how these experiences influence on their adherence to wearing them. Identification of key experiences that lead to patients removing their compression garments may lead to modification of treatment and system approaches to better align with patients' needs and development of potential interventions that promote adherence.

Rasch analysis supported the construct validity of self-report measures of activity and participation derived from patient ratings of the ICF low back pain core set.

OBJECTIVE: To investigate whether measures of activity limitations and participation restrictions with sound internal construct validity could be derived from patient ratings of the International Classification of Functioning, Disability and Health Low Back Pain Core Set (LBP-CS). STUDY DESIGN AND SETTING: The LBP-CS Self-Report Checklist (LBP-CS-SRC) was developed to permit patients to self-rate their functioning according to an extended set of activity and participation categories from the LBP-CS. Rasch analysis was used to examine the validity of the LBP-CS-SRC with a sample of 308 adults with chronic low back pain attending two tertiary-referral outpatient services in Brisbane, Australia. RESULTS: The activity limitations and participation restrictions qualifier scales functioned satisfactorily, and the LBP-CS-SRC person response validity was good. After deletion of six misfitting items, the dimensionality results supported using the instrument as distinct measures of activity limitations (17 items) and participation restrictions (10 items). The activity and participation measures both had good person separation reliability, and no component items exhibited meaningful differential item functioning. CONCLUSION: The results demonstrate that measures of activity and participation with sound internal construct validity can be derived from patient ratings of LBP-CS categories. The LBP-CS-SRC can be used in clinical practice and epidemiologic research to support understanding of patients' perspectives on functioning.

Self-reported disability according to the International Classification of Functioning, Disability and Health Low Back Pain Core Set: Test-retest agreement and reliability.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) Low Back Pain Core Set (LBP-CS) has been proposed as a tool to facilitate the description and measurement of chronic low back pain (CLBP) related disability. Patient ratings of ICF categories may serve as a practical and effective method for acquiring patient input on activity limitations and participation restrictions. OBJECTIVE: To investigate the test-retest agreement and reliability of patient ratings of activity and participation according to the LBP-CS. METHODS: A cross-sectional repeated-measures questionnaire study was undertaken with thirty-one medically stable adults with CLBP who presented for treatment at two public Australian hospitals. Participants completed the LBP-CS Self-Report Checklist (LBP-CS-SRC) on two occasions (mean = 12.5 (SD = 4.5) days between administrations). The LBP-CS-SRC permits patients to self-rate their functioning according to the LBP-CS activity and participation categories and enables the derivation of activity limitation and participation restriction scales. RESULTS: Patient ratings of individual LBP-CS categories generally exhibited good - excellent test-retest agreement (percentage exact agreement: 74.19-100.00%) and reliability (kappa: 0.53-1.00). The test-retest reliability coefficients of the LBP-CS-SRC activity (ICC = 0.94) and participation (ICC = 0.90) scales were excellent. The minimum detectable change values for the activity and participation scales were 8.11 and 15.26, respectively. CONCLUSIONS: This study is the first to demonstrate that patients can provide reliable ratings of functioning using the LBP-CS. The LBP-CS-SRC was shown to be acceptably reliable and precise to support understanding of patients' perspectives on disability in rehabilitation practice and research.