The Chronic Illness Problem Inventory as a measure of dysfunction in chronic pain patients.

Assessment of physical and psychosocial dysfunction is recognized as essential in chronic pain patient evaluation. One instrument, the Sickness Impact Profile (SIP), has demonstrated good reliability and validity as a measure of dysfunction among chronic pain patients. An alternate measure, the Chronic Illness Problem Inventory (CIPI), is shorter and more easily scored than the SIP, but as yet has not been applied widely to chronic pain problems. In the present study, 95 chronic low back pain patients completed the SIP, the CIPI, activity diaries, the McGill Pain Questionnaire (MPQ), and the Center for Epidemiologic Studies-Depression scale (CES-D), before participating in a chronic pain treatment study. Overt pain behaviors were also coded from videotapes of a standardized assessment protocol. Seventy-five subjects completed the measures post-treatment. The results indicate that although the SIP and the CIPI are significantly correlated and appear to be measuring similar constructs, there is also substantial unshared variance between them, suggesting that they may tap somewhat different aspects of dysfunction in chronic pain. The CIPI shows promise as a useful alternative measure of dysfunction in chronic low back pain patients, but requires further validation for this purpose.     

Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain

To determine the reliability and concurrent validity of a visual analogue scale (VAS) for disability as a single-item instrument measuring disability in chronic pain patients was the objective of the study. For the reliability study a test-retest design and for the validity study a cross-sectional design was used. A general rehabilitation centre and a university rehabilitation centre was the setting for the study. The study population consisted of patients over 18 years of age, suffering from chronic musculoskeletal pain; 52 patients in the reliability study, 344 patients in the validity study. Main outcome measures were as follows. Reliability study: Spearman's correlation coefficients (rho values) of the test and retest data of the VAS for disability; validity study: rho values of the VAS disability scores with the scores on four domains of the Short-Form Health Survey (SF-36) and VAS pain scores, and with Roland-Morris Disability Questionnaire scores in chronic low back pain patients. Results were as follows: in the reliability study rho values varied from 0.60 to 0.77; and in the validity study rho values of VAS disability scores with SF-36 domain scores varied from 0.16 to 0.51, with Roland-Morris Disability Questionnaire scores from 0.38 to 0.43 and with VAS pain scores from 0.76 to 0.84.The conclusion of the study was that the reliability of the VAS for disability is moderate to good. Because of a weak correlation with other disability instruments and a strong correlation with the VAS for pain, however, its validity is questionable.     

Cross-validation of the Back Pain Classification Scale with chronic, intractable pain patients

The current study investigated the utility of the Back Pain Classification Scale with chronic, intractable low back pain and headache patients. Subjects consisted of 50 chronic low back pain and 50 chronic headache patients referred to a university based Pain Center for evaluation. Data indicated that subjects were a representative sample of severely intractable chronic pain patients typically referred for Pain Center evaluation and treatment. Each was administered the Back Pain Classification Scale as part of a thorough physical and psychological/behavioral evaluation. All subjects were classified by blind review of medical records into one of two categories: (1) presence of psychopathologically based pain complaint with little or no pathophysiological findings and (2) presence of pathophysiologically based pain complaints with little or no psychopathological findings. Subjects were also independently classified from blind review of their scores on the Back Pain Classification Scale into one of these two categories. Findings revealed that the Back Pain Classification Scale accurately predicted the actual classification of 80% of the low back pain patients (i.e., 30% above baseline prediction rate) and only 60% of the chronic headache patients (i.e., only equal to the baseline prediction rate). Furthermore, the scale was found to be most accurate in predicting low back pain patients with primary psychopathologically based pain. It was concluded that the Back Pain Classification Scale was an empirically valid instrument to use with chronic low back pain patients, but not with chronic headache patients. This lack of utility with chronic headache patients was also viewed as support for the construct validity of the scale. Wider use of the scale with chronic low back pain patients was suggested.     

Reliability and validity of the Japanese-language version of the physical performance test (PPT) battery in chronic pain patients

PURPOSE: To prepare a Japanese-language version of the Physical Performance Test (PPT) Battery and assess its reliability and validity. METHOD: Activity limitations by pain were evaluated by means of the Japanese-language version of the PPT Battery in 82 patients with chronic pain in the limbs and trunk. Two self-report questionnaires, one related to sensory evaluation of pain, and the other related to affective evaluation of pain, and the Functional Independence Measure (FIM), which evaluates activities of daily living, were simultaneously administered to the subjects. RESULTS: The results for reliability showed that the ICC values for inter-rater reliability and intra-rater reliability were 0.91 or more for every item. The results for validity showed significant associations between the scores for all of the items on the Japanese-language version of the PPT Battery and the total scores on the FIM (p < 0.01). Significant associations were found between 5 of the 8 items on the Japanese-language version of the PPT Battery and affective state due to the pain. CONCLUSIONS: The Japanese-language version of the PPT Battery was shown to possess adequate reliability and validity as a scale for evaluating the activity limitations of patients with chronic limb or trunk pain. The results also suggested that it might be possible to improve the activity limitations of patients with chronic pain by improving their affective state in response to the pain.     

The sickness impact profile: a global measure of disability in chronic low back pain

This investigation examines the utility of the Sickness Impact Profile (SIP) for assessing disability associated with chronic pain and presents normative data on a sample of 107 patients experiencing chronic low back pain (CLBP). The results support the validity of the SIP as a measure of functional status with CLBP patients. Specifically, the psychosocial dimension was significantly correlated with the emotional distress categories of the MMPI and the physical dimension score was inversely associated with standing/walking and positively correlated with time spent lying down. In addition, the SIP appears to be a measure with sufficient sensitivity to detect pre-/post-treatment changes. Patients suffering from CLBP show significant impairment in physical, psychosocial, and work and recreational activities. The greatest impairment reported was in the area of work, but disability ratings for recreation, home management, social interaction, emotional behavior, and sleep and rest were also comparatively high. Based upon its reliability, validity, breadth of assessment, and ease of administration, the SIP appears to be well suited for the assessment of patients suffering from chronic pain and evaluating the efficacy of multidisciplinary pain units.     

Health locus of control questionnaire for patients with chronic low back pain: psychometric properties of the Brazilian–Portuguese version

Background and Purpose . Low back pain is common among Brazilians, especially affecting those who are working. Psychosocial factors, such as the health locus of control, are associated with low back pain prognoses. Although the multidimensional health locus of control questionnaire is widely employed in individuals with low back pain, a Brazilian–Portuguese version is not yet available. The aim of the present study was to translate and adapt the multidimensional health locus of control (MHLC) questionnaire, and to investigate its psychometric properties in a Brazilian population with non‐specific chronic low back pain. Method . Translation and adaptation of the questionnaire was carried out in the first phase of the study. In the second phase it was administered to Brazilians with non‐specific chronic low back pain to evaluate its intra‐examiner reliability (n = 20), concurrent validity, internal consistency (n = 40), and floor and ceiling effects. To evaluate concurrent validity the Brazilian–Portuguese version of the Roland–Morris disability questionnaire was used as the comparison. Results . The sub‐scales demonstrated good to excellent reliability with intra‐class coefficient (ICC) values of 0.75 for the external subscale (95% confidence interval (95% CI): 0.46–0.89), 0.87 for the internal sub‐scale (95% CI: 0.69–0.94) and 0.90 for the chance sub‐scale (95% CI: 0.77–0.96). For concurrent validity, the external and chance sub‐scales correlated positively with disability (Pearson's r = 0.58; p < 0.001 and Pearson's r = 0.35; p = 0.025), respectively, while the internal sub‐scale correlated negatively with disability (Pearson's r = ?0.33; p = 0.037). The questionnaire had acceptable internal consistency, with a Cronbach's alpha value of 0.65 (95% CI: 0.46–0.80) for external sub‐scale, 0.77 (95% CI: 0.64–0.87) for internal sub‐scale and 0.83 (95% CI: 0.73–0.90) for chance sub‐scale. Conclusions . The Brazilian–Portuguese version of the MHLC questionnaire has acceptable measurement properties similar to that observed with the original English language version. Copyright © 2008 John Wiley & Sons, Ltd.     

Reliability and validity of the Japanese-language version of the physical performance test (PPT) battery in chronic pain patients

Purpose.?To prepare a Japanese-language version of the Physical Performance Test (PPT) Battery and assess its reliability and validity.

Method.?Activity limitations by pain were evaluated by means of the Japanese-language version of the PPT Battery in 82 patients with chronic pain in the limbs and trunk. Two self-report questionnaires, one related to sensory evaluation of pain, and the other related to affective evaluation of pain, and the Functional Independence Measure (FIM), which evaluates activities of daily living, were simultaneously administered to the subjects.

Results.?The results for reliability showed that the ICC values for inter-rater reliability and intra-rater reliability were 0.91 or more for every item. The results for validity showed significant associations between the scores for all of the items on the Japanese-language version of the PPT Battery and the total scores on the FIM (p < 0.01). Significant associations were found between 5 of the 8 items on the Japanese-language version of the PPT Battery and affective state due to the pain.

Conclusions.?The Japanese-language version of the PPT Battery was shown to possess adequate reliability and validity as a scale for evaluating the activity limitations of patients with chronic limb or trunk pain. The results also suggested that it might be possible to improve the activity limitations of patients with chronic pain by improving their affective state in response to the pain.     

Cross-cultural adaption of the Manniche questionnaire for German-speaking low back pain patients.

OBJECTIVE: To develop and validate a cross-cultural version of the Manniche Low Back Pain Rating Scale (MRS) for use in German-speaking low back pain patients. BACKGROUND: Clinical intervention research in back pain would be enormously facilitated if a small number of relevant, patient-centred questionnaires became internationally used. MRS seems to be particularly suitable for cross-cultural adaptation due to its coverage of multidimensional back pain-specific health domains. METHODS: MRS was translated and back-translated, pretested and reviewed by a committee. The German version was tested in 126 patients with low back pain from all countries of German-speaking Europe. Reliability (subsample n = 20), dimensionality and construct validity was assessed. Single-dimensionality, higher correlations of MRS with the physical scales compared with the mental scales of the MOS SF-36, a moderate to good correlation with the Roland Morris Questionnaire and a low correlation with the Finger Floor Distance were hypothesized. RESULTS: Spearman's Rho for test-retest reliability was 0.98 (p < 0.001); Cronbach's alpha 0.95. Factor analysis revealed only 1 factor with an Eigenvalue >1 [3.25]. MRS was strongly correlated with the Roland Morris Questionnaire (r = 0.91), and slightly correlated with the Finger Floor Distance (r = 0.23). Correlations of MRS with domains of the SF-36 "Physical Functioning", "Role Physical" and "Bodily Pain" were higher (r -0.66 to -0.72) than with "Role Emotional", "Mental Health" and "Social Functioning" (r -0.34 to -0.61). CONCLUSION: The German version of the MRS seems to be reliable, uni-dimensional and construct valid for the assessment of functional status in German-speaking low back pain patients.     

Oswestry功能障碍指数评定慢性腰痛患者的效度分析

目的:探讨中文版Oswestry功能障碍指数(CODI)的效度,为临床应用提供客观依据。方法:107例慢性腰痛患者参加测试,患者根据自己情况独立完成CODI、视觉模拟评分法(VAS)和健康状况调查问卷(SF-36)3个量表。应用因子分析对CODI进行分析来检验其结构效度;应用Person相关分析计算CODI每一条目与所属领域和其他领域的相关系数来检验其内容效度和区分效度;比较CODI和VAS、CODI和SF-36的Person相关系数来检验其同期效度。结果:患者对CODI的条目8回答率较低(32.7%),没有纳入统计分析。CODI的9个条目提取出3个公因子,累计方差贡献率为76.3%;每一条目与所属领域的相关系数r=0.78—0.89(P0.05),且每一条目与所属领域的相关系数均高于该条目与其他领域的相关系数;CODI的三大领域得分和VAS评分的相关系数分别为r=0.88,0.81,0.76(P0.05);CODI的三大领域得分与SF-36各项目分值相关性r=-0.36—-0.87(P0.05)。结论:CODI具有良好的结构效度、内容效度、区分效度和同期效度,可用于慢性腰痛患者的临床评定。     

A comparison of five low back disability questionnaires: reliability and responsiveness.

BACKGROUND AND PURPOSE: The aim of this study was to examine 5 commonly used questionnaires for assessing disability in people with low back pain. The modified Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire, the Waddell Disability Index, and the physical health scales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were compared in patients undergoing physical therapy for low back pain. SUBJECTS AND METHODS: Patients with low back pain completed the questionnaires during initial consultation with a physical therapist and again 6 weeks later (n=106). Test-retest reliability was examined for a group of 47 subjects who were classified as "unchanged" and a subgroup of 16 subjects who were self-rated as "about the same." Responsiveness was compared using standardized response means, receiver operating characteristic curves, and the proportions of subjects who changed by at least as much as the minimum detectable change (MDC) (90% confidence interval [CI] of the standard error for repeated measures). Scale width was judged as adequate if no more than 15% of the subjects had initial scores at the upper or lower end of the scale that were insufficient to allow change to be reliably detected. RESULTS: Intraclass correlation coefficients (2,1) calculated to measure reliability for the subjects who were classified as "unchanged" and those who were self-rated as "about the same" were greater than.80 for the Oswestry and Quebec questionnaires and the SF-36 Physical Functioning scale and less than.80 for the Waddell and Roland-Morris questionnaires and the SF-36 Role Limitations-Physical and Bodily Pain scales. None of the scales were more responsive than any other. DISCUSSION AND CONCLUSION: Measurements obtained with the modified Oswestry Disability Questionnaire, the SF-36 Physical Functioning scale, and the Quebec Back Pain Disability Scale were the most reliable and had sufficient width scale to reliably detect improvement or worsening in most subjects. The reliability of measurements obtained with the Waddell Disability Index was moderate, but the scale appeared to be insufficient to recommend it for clinical application. The Roland-Morris Disability Questionnaire and the Role Limitations-Physical and Bodily Pain scales of the SF-36 appeared to lack sufficient reliability and scale width for clinical application.     

腰腿痛评价量表的可行性研究

目的：编制一种可对腰腿痛患者的症状,体征和功能状态进行评估的腰痛评价表并探讨了其可行性。方法对８０例患者应用本量表和Ｆａｉｒｂａｎｋ腰痛评分表评估的结果作相关分析,以评价标准效度,并对本量表作了重测信度检验;还将患者分为椎管外性（３０例）和椎管内性（５０例）两组,比较两组在本量表的评价结果。结果８０例患者的本量表的总积分与Ｆａｉｒｂａｎｋ表的积分的相关分析显示为正相关,其相关系数为０．７３,并且在     

Characterizing patient dysfunction in Alzheimer's-type dementia

Although Alzheimer's-type dementia (ATD) is characterized by global intellectual deterioration, few systematic efforts have been made to characterize overall dysfunction of ATD patients. The Sickness Impact Profile (SIP) was administered to ATD patients and family members to determine the concurrent validity of family member assessments of functional status. Using the Mini-Mental State score and modified Dementia Rating Scale as validation criteria, family member SIP scores showed consistently higher correlations with the Mini-Mental State and modified Dementia Rating Scale than did patient scores. Comparing family member SIP scores for ATD and nondemented patients revealed that ATD patients maintained high levels of psycho-social dysfunction at both initial evaluation and 1-year follow-up. By contrast, ATD patients showed high levels of physical dysfunction relative to nondemented patients only at follow-up. Physical deterioration over time is also suggested by comparison of ATD patient initial and follow-up scores. This study documents the well-known psychosocial dysfunction in ATD and emphasizes the importance of physical dysfunction as the disease progresses.     

The impact of psychologic factors on measurement of functional status. Assessment of the sickness impact profile

In this study the relationship between four psychologic health constructs (depression, anxiety, patient response bias, and hostility) and the Sickness Impact Profile (SIP) measurement of functional status was evaluated. The SIP, Carroll Depression Rating Scale (CDRS); and the Minnesota Multiphasic Personality Inventory (MMPI) were administered to 332 patients hospitalized for treatment of combined medical and psychiatric problems. Pearson's product-moment correlation was high between CDRS and SIP Total score (r = 0.67) and between CDRS and SIP Psychosocial subscale (r = 0.72); correlation was lower between CDRS and SIP Physical subscale (r = 0.44). Six MMPI scales (depression, anxiety, psychasthenia, lie, K, hostility) correlated with SIP Total score (r = 0.18 to 0.50), with SIP Psychosocial score (r = 0.28 to 0.65) and less well with SIP Physical subscale (r = 0.07 to 0.25). Factor analysis of the SIP categories showed two factors with eigenvalues greater than 1. Promax factor rotation showed all SIP Psychosocial categories and all measured psychologic variables loaded most heavily on factor 1. SIP Physical categories loaded most heavily on factor 2. Stepwise multiple regression analysis showed that psychologic variables account for 49% of the SIP total variance, 62% of SIP Psychosocial subscale variance, but only 19% of SIP Physical subscale variance. The CDRS accounts for the major portion of the explained variance with only minor additional contributions from the MMPI scales. We conclude that 1) the SIP discriminates psychosocial and physical dysfunction even in medical patients with extensive psychiatric comorbidity; 2) the SIP measures at least two dimensions of health, one of which is strongly related to depression; and 3) constructs measured by MMPI scales do not have substantial independent contribution to SIP variance.     

Transcultural adaptation and validation of Hindi version of Quebec Back Pain Disability Scale

Abstract

Purpose: To transculturally adapt the Quebec Back Pain Disability Scale for Hindi-speaking population and examine its psychometric properties in patients with low back pain.

Materials and methods: The Quebec Back Pain Disability Scale was translated and cross-culturally adapted into Hindi following international guidelines. Hindi version of the scale was completed by 120 patients with low back pain and 60 healthy controls. Patients with low back pain were also administered the Hindi-Roland Morris Disability Questionnaire and Visual Analog Scale. Psychometric evaluation included test–retest reliability, convergent and discriminative validity. Exploratory factor analysis was carried out to determine the factor structure.

Results: The factorial analysis revealed a four-factor solution (bending/carrying, ambulation/reach, prolonged postures and rest). Convergent validity was confirmed by high correlation of Hindi Quebec Back Pain Disability Scale to the Hindi version of Roland Morris Disability Questionnaire (r?=?0.77 and p?<?0.001) as well as Visual Analog Scale (r?=?0.682 and p?<?0.001) scores. Discriminative validity was established by significantly different scores for patients with low back pain and the healthy controls (35.36?±?18.6 vs. 9.13?±?6.08 and p?<?0.001). The translated version of the scale showed remarkable internal consistency (Cronbach α?=?0.98) and the intraclass correlation coefficient of test–retest reliability was excellent (ICC_2,1=0.96). MDC₉₅ and SEM scores obtained were 10.28 and 3.71, respectively.

Conclusion: The Hindi version of Quebec Back Pain Disability Scale has good test–retest reliability, discriminative and convergent validity and is appropriate for clinical and research use in Hindi-speaking low back pain patients.

• Implications for rehabilitation

• Linguistically and culturally adapted questionnaires help researchers make adequate inferences about instruments measuring health and quality of life.

• The translated version would serve as a valid research tool allowing comparability of data across cultures thus, providing opportunities for large multicenter, multicountry trials.

• A Hindi Quebec Back Pain Disability Scale version will help to improve the quality and efficacy of assessment of low back pain by developing in patients, a better understanding of the items which can be easily correlated with the activities of daily living.

     

Pain and impairment beliefs in chronic low back pain: validation of the Pain and Impairment Relationship Scale (PAIRS).

Few validated instruments are available to assess beliefs and attitudes that patients have regarding pain, or ability to function despite discomfort. The Pain and Impairment Relationship Scale (PAIRS) was developed to tap these important beliefs and attitudes in chronic pain patients. Preliminary data indicate that the PAIRS is internally consistent and significantly related to impairment in a highly selected pain clinic sample of patients, including some chronic low back pain patients. The present study was designed to extend the validation of the PAIRS to a more general sample of chronic benign low back pain patients. Furthermore, additional tests supported the discriminant, convergent and divergent validity, as well as the reliability and relative independence from favorable self-report response bias of the PAIRS, by respectively demonstrating that: (1) the impairment beliefs assessed with the PAIRS were more prominent in chronic low back pain (CLBP) patients than in matched non-pain, healthy controls; (2) scores on the PAIRS were significantly related to measures of physical impairment, but not to physicians ratings of disease severity; (3) the impairment beliefs assessed with the PAIRS are readily distinguishable from cognitive distortions and emotional distress; (4) PAIRS scores for chronic low back pain patients are relatively consistent over time; and (5) PAIRS scores are not significantly associated with measures of favorable self-report response bias. We conclude that the PAIRS has demonstrated at least preliminary utility for applications by researchers and clinicians interested in chronic pain.     

Differences in outcome of a multidisciplinary treatment between subgroups of chronic low back pain patients defined using two multiaxial assessment instruments: the multidimensional pain inventory and lumbar dynamometry

OBJECTIVE: To investigate the effects of a multidisciplinary back school programme (Roessingh Back Rehabilitation Programme, RRP) compared with usual care, as well as differences in treatment outcome between subgroups defined using two multiaxial assessment instruments: the Multidimensional Pain Inventory (MPI-DLV) and lumbar dynamometry. DESIGN: Randomized controlled trial. SETTING: Rehabilitation. SUBJECTS: One hundred and sixty-three patients with chronic, aspecific low back pain. INTERVENTION: All subjects were randomly assigned either to a multidisciplinary, physically oriented group treatment or to their usual care. MAIN OUTCOME MEASURES: The Roland Disability Questionnaire and health-related quality of life (EuroQol, EQ5-D) were measured as primary outcomes before randomization and after eight weeks and six months follow-up. RESULT: Only 30-50% of the patients in the RRP group showed improvement and this number is not significantly different from the control group. Subgroup analyses give some first indications that multiaxial measurement instruments can be used to identify subgroups with differences in treatment effects. CONCLUSION: The overall effect of a multidisciplinary treatment is disappointing, however multiaxial assessment before admission might be valuable in clinical practice, resulting in more effective treatments for patients with chronic low back pain.     

恐动症成因分析量表的汉化及信效度检验

目的对恐动症成因分析量表(kinesiophobia causes scale,KCS)汉化并进行信效度检验,评价其在我国相关领域应用的可行性。方法依据量表翻译方法对KCS进行翻译、文化调试,形成中文版KCS。便利抽样选择杭州市2所三级甲等医院疼痛门诊的慢性下腰痛患者231例作为测试对象,检验量表内部一致性;成立专家小组,验证量表的内容效度。结果中文版KCS的Cronbach’s α系数为0.869,折半信度为0.715,重测信度为0.940,内容效度为0.850,20个条目的内容效度指数高于0.800。探索性因子分析共提取7个公因子,解释方差贡献率为80.343%。结论中文版KCS具有较好的信度、效度和区分能力,可作为我国评价、分析恐动症成因的有效工具。     

Pain facility treatment outcome for failed back surgery syndrome

Patients with low back pain in whom diskectomy fails to improve pain have been placed in the surgical literature under the general rubric of failed back surgery syndrome (FBSS).Although FBSS has no agreed-on definition, there are two components to FBSS: patients with FBSS have chronic low back pain, and as a group they have had one or more failed back surgeries.The literature relating to FBSS is briefly reviewed, with the claim that FBSS chronic pain patients (CPPs) are difficult to treat and are generally recalcitrant to all forms of pain treatment. Only two studies addressed FBSS CPP treatment within pain facilities. We therefore wished to perform an FBSS CPP pain facility treatment outcome study. Because of the reported difficulties in treating FBSS CPPs, it was hypothesized that FBSS CPPs should benefit less than non-FBSS CPPs from pain facility treatment. One hundred and ninety CPPs were used as their own controls by rating perceived improvement or nonimprovement on 43 rating scales administered at admission and discharge from a pain facility.The 190 CPPs were divided into three groups: zero surgeries; one surgery; or two or more surgeries. Rating scale change scores for these three groups were then compared using ANOVA. It was concluded that FBSS CPPs as defined by the number of surgical procedures can be as successfully treated at pain facilities, as non-FBSS CPPs.The alternative hypothesis was not confirmed.     

Combined physiotherapy and education is efficacious for chronic low back pain

Manual therapy, exercise and education target distinct aspects of chronic low back pain and probably have distinct effects. This study aimed to determine the efficacy of a combined physiotherapy treatment that comprised all of these strategies. By concealed randomisation, 57 chronic low back pain patients were allocated to either the four-week physiotherapy program or management as directed by their general practitioners. The dependent variables of interest were pain and disability. Assessors were blind to treatment group. Outcome data from 49 subjects (86%) showed a significant treatment effect. The physiotherapy program reduced pain and disability by a mean of 1.5/10 points on a numerical rating scale (95% CI 0.7 to 2.3) and 3.9 points on the 18-point Roland Morris Disability Questionnaire (95% CI 2 to 5.8), respectively. The number needed to treat in order to gain a clinically meaningful change was 3 (95% CI 3 to 8) for pain, and 2 (95% CI 2 to 5) for disability. A treatment effect was maintained at one-year follow-up. The findings support the efficacy of combined physiotherapy treatment in producing symptomatic and functional change in moderately disabled chronic low back pain patients.     

The Northwick Park Therapy Dependency Assessment scale: a psychometric analysis from a large multicentre neurorehabilitation dataset

Abstract

Purpose: To assess the internal reliability, construct and concurrent validity and responsiveness of the Northwick Park Therapy Dependency Assessment (NPTDA) scale. Method: A cohort of 2505 neurorehabilitation patients submitted to the UK Rehabilitation Outcomes Collaborative database. Cronbach’s coefficient-α was used to assess internal reliability and factor analysis (FA) to assess construct validity. We compared NPTDA scores at admission and discharge to determine responsiveness. Results: Coefficient-α for the whole scale was 0.74. The exploratory FA resulted in a four-factor model (Physical, Psychosocial, Discharge planning and Activities) that accounted for 43% of variance. This model was further supported by the confirmatory FA. The final model had a good fit: root-mean-square error of approximation of 0.069, comparative fit index/Tucker–Lewis index of 0.739/0.701 and the goodness of fit index of 0.909. The NPTDA scores at admission and discharge were significantly different for each of the factors. Expected correlations were seen between the admission scores for the NPTDA, the Rehabilitation Complexity Scale (r?=?0.30, p?<?0.01) and the Functional Independence Measure (r?=??0.25, p?<?0.01). Conclusions: The scale demonstrated acceptable internal reliability and good construct and concurrent validity. NPTDA may be used to describe and quantify changes in therapy inputs in the course of a rehabilitation programme.

• Implications for Rehabilitation

• The Northwick Park Therapy Dependency Assessment (NPTDA) is designed as a measure therapy intervention, which reflects both quantitative and qualitative aspects of the inputs provided (including staff time and the different types of intervention) during inpatient rehabilitation.

• The scale demonstrated acceptable internal reliability and good construct and concurrent validity.

• NPTDA is responsive to change in the therapy inputs provided during neurorehabilitation between admission and discharge.