Development of the body-relatedness observation scale: A feasibility study

Abstract

Aim One characteristic of somatoform disorder (DSM-IV) and somatic symptom disorder (dsm-5) is the troubled relation of patients to their body. To assess body-relatedness in its full range, observation by a physical therapist may add valuable information to self-report questionnaires. This study examines the feasibility of the Body-Relatedness Observation Scale (BROS), an instrument for the standardized observation of patients with somatic symptom disorder by a physical therapist. Methods In cross-sectional analyses the factorial validity and inter-rater reliability of observer scores were studied. Physical therapists observed 191 patients performing two short exercises lying face up. Fourteen potential indicators of body-relatedness were selected for observation, covering four domains: execution of instructions, perception of the body, muscle tension, and behavioural adaptation to somatic symptoms. Results Inter-rater reliabilities were excellent for four observation scores (ICC\u202f>\u202f0.75 or Kappa>0.80), substantial for two (0.60\u202f<\u202fICC\u202f<\u202f0.75 or 0.60\u202f<\u202fKappa<0.80), fair for two (0.40\u202f<\u202fICC\u202f<\u202f0.60 or 0.20\u202f<\u202fKappa<0.40) and poor for six. Items in particular relating to patients ability to perceive the body had low inter-rater reliabilities. Categorical principal components analysis with the eight reliable scores indicated a 1-factor structure including seven items with Cronbach s alpha 0.69. Conclusion This initial analysis of a structured physical therapeutic observation for people with somatic symptom disorder indicated modestly sound psychometric quality of observations of execution of instructions, muscle tension and behavioural adaptation, but not of patient s ability to perceive the body adequately. This shows that these observations are feasible when restricted to observable behaviour and it indicates the viability of further validation of the BROS.