Predicting treatment failure in the subacute injury phase using the Orebro Musculoskeletal Pain Questionnaire: an observational prospective study in a workers' compensation system.

OBJECTIVE: The goal of the present study was to examine if patient scores on a brief biopsychosocial screening questionnaire--the Orebro Musculoskeletal Pain Questionnaire (OMPQ)--could predict clinical discharge status ("fit" vs "not fit" for return to work) after a standardized 6-week physical therapy-based work conditioning program. METHODS: The OMPQ was administered to a derivation sample of 200 injured workers with soft tissue injuries before beginning treatment. A clinical cutoff score of 147 was subsequently tested in a second validation sample of 211 injured workers. RESULTS: The OMPQ was able to correctly predict the discharge status of 85% of claimants. CONCLUSIONS: These results suggest that the OMPQ can facilitate clinical decision-making through early identification of individuals likely to fail a unidisciplinary physical therapy program and who may benefit from more complete biopsychosocial treatment.

Fear of movement/(re)injury in chronic pain: a psychometric assessment of the original English version of the Tampa scale for kinesiophobia (TSK).

The Tampa scale for kinesiophobia (TSK) was developed to measure fear of movement/(re)injury in chronic pain patients. Although studies of the Dutch adaptation of the TSK have identified fear of movement/(re)injury as an important predictor of chronic pain, pain-related avoidance behaviour, and disability, surprisingly little data on the psychometric properties of the original English version of the TSK are available. The present study examined the reliability, construct validity and factor structure of the TSK in a sample of chronic pain patients (n=200) presenting for an interdisciplinary functional restoration program. Consistent with prior evaluations of the Dutch version of the TSK, the present findings indicate that the English TSK possesses a high degree of internal consistency and is positively associated with related measures of fear-avoidance beliefs, pain catastrophizing, pain-related disability and general negative affect. The TSK was not related to individual differences in physical performance testing as assessed using standardised treadmill and lifting tasks. Confirmatory factor analyses suggest that the TSK is best characterized by a three-factor trait method model that includes all 17 of the original scale items and takes into account the distinction between positively and negatively keyed items. The results of the present study provide important details regarding the psychometric properties of the original English version of the TSK and suggest that it may be unnecessary to remove the negatively keyed items in an attempt to improve scale validity.

The influence of acute anxiety on assessment of nociceptive flexion reflex thresholds in healthy young adults.

The nociceptive flexion reflex (NFR) is a polysynaptic withdrawal reflex that occurs in response to painful stimulation. In human studies, NFR responsiveness has been used as a direct measure of nociception as well as an indirect measure of supraspinal modulation of nociceptive transmission. Previous studies have suggested that anxiety may influence NFR responding, and therefore it has been recommended that anxiety be reduced by familiarizing participants with assessment methodology prior to formal NFR assessment. The present study was designed to assess the influence of anxiety on NFR threshold. Using a repeated measures design, 40 men and women completed an NFR threshold assessment twice within session one, and twice again during a second session conducted 24h later. Within each assessment session, state anxiety was measured at the beginning of the session and immediately following each NFR threshold assessment. Results indicated that although anxiety increased in response to NFR threshold assessment and was positively related to subjective pain reports, anxiety was not related to observed NFR threshold levels. These findings suggest that individual differences in anxiety do not significantly affect NFR threshold level determinations under standard testing conditions.