Michiel F. Reneman

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: Spearmans correlation coefficients (ρ values) of the test and retest data of the VAS for disability; validity study: ρ 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 ρ values varied from 0.60 to 0.77; and in the validity study ρ 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.

Concurrent Validity of Questionnaire and Performance-Based Disability Measurements in Patients with Chronic Nonspecific Low Back Pain

This study aimed to investigate the concurrent validity of two approaches to disability measurement in patients with chronic nonspecific low back pain (CLBP). It was hypothesized that if both are measuring the same construct, the instruments would lead to similar disability results and would correlate strongly (r > 0.75). The study compared the results of self-reported and performance-based measures of disability in 64 consecutive patients with CLBP. Participants mean age was 38.0 years, the mean duration of the current episode of back pain 9.9 months, and 90% were off work due to CLBP. The self-report measures used were: the Roland Disability Questionnaire (Roland); the Oswestry Disability Questionnaire (Oswestry); and the Quebec Back Pain Disability Questionnaire (Quebec). Performance was measured using the Isernhagen Work Systems Functional Capacity Evaluation (FCE). The mean scores from the self-report measure are as follows: Roland 13.5 (scale 0–24), Oswestry 28.2 (scale 0–100), Quebec 37.8 (scale 0–100) consistent with moderate to severe disability. In contrast the results from the performance-based measures suggested that the subjects should be able to work at a physical intensity level of moderate to heavy. Little to moderate correlation was observed between the self-report and performance-based measures (Spearman rank correlations: Roland-FCE (−0.20), p > 0.05; Oswestry-FCE (−0.52), p < 0.01; Quebec-FCE (−0.50), p < 0.01). Results are interpreted to suggest that both performance-based and self-report measures of disability should be used in order to obtain a comprehensive picture of the disability in patients with CLBP.

Test-Retest Reliability of Lifting and Carrying in a 2-day Functional Capacity Evaluation

The objectives of this study were to establish test-retest reliability of lifting and carrying of a functional capacity evaluation (FCE) on two consecutive days and to verify the need for a 2-day protocol. A cohort of 50 patients (39 men, 11 women) with nonspecific low back pain were evaluated using a 2-day FCE protocol. Intraclass correlation coefficients (ICC) were calculated for weight lifted and carried. Predictive relationschips between test and retest were explored by means of a regression analysis. The results of ICC were lifting low 0.87, lifting overhead 0.87, and carrying 0.77. Performances on day 2 were on an average 6–9% higher. Other than the amount of weight handled on day 1, no variable was found to predict performance on day 2. It was concluded that test-retest reliability of lifting and carrying was good, and the need for a 2-day protocol could not be confirmed.

Psychometric properties of Chronic Pain Acceptance Questionnaires: A systematic review

Background: Theoretically, acceptance of chronic pain (CP) is an important determinant in the functional status and well‐being of patients with CP. Several questionnaires that aim to measure acceptance of CP have been developed. An overview of the psychometric properties of these questionnaires is unavailable.

Responsiveness and Minimal Clinically Important Change of the Pain Disability Index in Patients With Chronic Back Pain

Study Design. Prospective cohort study. Objective. The objective of this study was to test the responsiveness and minimal clinically important change (MCIC) of the Pain Disability Index (PDI) in patients with chronic back pain (CBP). Summary of Background Data. Treatment of patients with CBP is primarily focused on reduction of disability. For disability measurement, the PDI is a widely used questionnaire. There are, however, no data available on responsiveness and MCIC. Methods. Two hundred forty-two patients with CBP were included in this study. Patients filled in the PDI at baseline and at discharge. The PDI consists of 2 subscales: 1 measuring voluntary activities and 1 measuring obligatory activities. PDI was anchored at 2 self-reported global perceived effect (GPE) scales for complaints and self-care, respectively. Responsiveness was considered sufficient when Area Under the Receiver Operating Characteristics (ROC) Curve (AUC) was higher than 0.70. To test interpretability, change scores and MCIC were calculated. MCIC was tested by determination of optimal cut-off point of the ROC curve and determination of specificity and sensitivity of the optimal cut-off point. Results. AUCs were 0.76 and 0.77 depending on the external criterion. The subscale obligatory activities did not meet the criteria for responsiveness (AUC: 0.63–0.69). MCIC of the PDI was 9.5 points for GPE “complaints” and 8.5 for GPE “self-care.” Conclusion. The total score of the PDI as well as the subscale of voluntary activities is responsive. Partly because of floor effects, the subscale obligatory activities are not sufficiently responsive in patients with CBP. However, the responsiveness of this subscale in other patient groups should be further tested. In patients with CBP, change can be considered clinically important when PDI score has decreased 8.5 to 9.5 points.

A conceptual definition of vocational rehabilitation based on the ICF: Building a shared global model

Background The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification system by the World Health Organization (WHO) to understand functioning. The objective of this discussion paper is to offer a conceptual definition for vocational rehabilitation (VR) based on the ICF. Method We presented the ICF as a model for application in VR and the rationale for the integration of the ICF. We also briefly reviewed other work disability models. Results Five essential elements of foci were found towards a conceptual definition of VR: an engagement or re-engagement to work, along a work continuum, involved health conditions or events leading to work disability, patient-centered and evidence-based, and is multi-professional or multidisciplinary. Conclusions VR refers to a multi-professional approach that is provided to individuals of working age with health-related impairments, limitations, or restrictions with work functioning and whose primary aim is to optimize work participation. We propose that the ICF and VR interface be explored further using empirical and qualitative works and encouraging stakeholders’ participation.

Relationship Between Kinesiophobia and Performance in a Functional Capacity Evaluation

Fear of movement and (re)injury (kinesiophobia) has been postulated to play an important role in the performance in a Functional Capacity Evaluation (FCE). This study was performed to analyze the relationship between kinesiophobia and performance in an FCE. Kinesiophobia and FCE performance of 54 male and 10 female patients (mean age 38.0) suffering chronic low back pain (mean length of episode 9.9 months, 93% off work) were assessed. Kinesiophobia was assessed using the Dutch Version of the Tampa Scale for Kinesiophobia (scale 17–68). A lifting task and an FCE were operationalizations of avoidance. FCE results were transformed into a single measure using the classification of the Dictionary of Occupational Titles (FCE-DOT, scale 1–5). Correlations between the variables were calculated. The results are: kinesiophobia mean 41.6 (SD 7.3), lifting mean 29.5 kg (SD 11.6), FCE-DOT mean 3.6 (SD 0.6). Correlations between kinesiophobia and lifting was r = 0.01 (p = 0.93) and between kinesiophobia and FCE-DOT was ρ = − 0.04 (p = 0.75). The results indicate that the patients were substantially kinesiophobic, yet they were able to lift a mean of 29.5 kg and were physically able to perform moderate to heavy work. The strength of the correlations was very low. The relationship between kinesiophobia and avoidance, operationalized as lifting and an FCE, could not be confirmed in this study.

Neck Pain and Disability Scale and Neck Disability Index: validity of Dutch language versions

PurposeTo investigate the validity of the Neck Pain and Disability Scale Dutch Language Version (NPAD-DLV) and the Neck Disability Index (NDI)-DLV.MethodsNPAD–DLV, NDI–DLV, Short-Form-36 Health Survey (SF-36)-DLV, visual analog scale (VAS)pain and VASdisability were administered to 112 patients with non-specific chronic neck pain in an outpatient tertiary rehabilitation setting. Twenty seven hypotheses were formulated regarding validity. NPAD–DLV and NDI–DLV were evaluated for content validity (normal distribution total scores, missing items, floor and ceiling effects), internal consistency (Cronbach’s alpha and Spearman Item–total correlations), construct validity (Pearson correlations with SF-36 domains, VASpain and VASdisability and Pearson correlation between total scores of NPAD–DLV and NDI–DLV).ResultsNPAD–DLV and NDI–DLV scores were distributed normally. Missing items were negligible. Floor and ceiling effects were absent in NPAD–DLV and in NDI–DLV two items had floor effects and one item had a ceiling effect. Cronbach’s alpha of NPAD–DLV was 0.93 and of NDI–DLV 0.83. Item–total correlations ranged for NPAD–DLV from 0.45 to 0.73 and for NDI–DLV from 0.40 to 0.64. The correlation between, respectively, NPAD–DLV and NDI–DLV and: SF-36 domains ranged from −0.36 to −0.70 and from −0.34 to −0.63; VASpain was 0.54 and 0.43; VASdisability was 0.57 and 0.52. The correlation between the total scores of NPAD–DLV and NDI–DLV was 0.77. Twenty six hypotheses were not rejected and one hypothesis was rejected.ConclusionThe NPAD–DLV and NDI–DLV are valid measures of self-reported neck-pain related disability.

Towards Consensus in Operational Definitions in Functional Capacity Evaluation: a Delphi Survey

Introduction The problem of inconsistent terminology in functional capacity evaluation (FCE) has been widely addressed in the international literature. Many different terms seem to be used interchangeably while other terms appear to be interpreted differently. This may seriously hinder FCE research and clinical use. To gain consensus in operational definitions in FCE and conceptual framework to classify terminology used in FCE. Methods A Delphi Survey with FCE experts was conducted which consisted of three rounds of questioning, using semi and full structured questions. The expert group was formed from international experts in FCE. Experts were selected if they met any of the following criteria: at least one international publication as first author and one as co-author in the field of FCE; or an individual who had developed an FCE that was subject of investigation in at least one publication in international literature. Consensus of definitions was considered when 75% or more of all experts agreed with a definition. Results In total, 22 international experts from 6 different countries in Australia, Europe and North America, working in different health related sectors, participated in this study. Conclusion Consensus concerning conceptual framework of FCE was met in 9 out of 20 statements. Consensus on definitions was met in 10 out of 19 definitions. Experts agreed to use the ICF as a conceptual framework in which terminology of FCE should be classified and agreed to use pre-defined terms of the ICF. No consensus was reached about the definition of FCE, for which two potential eligible definitions remained. Consensus was reached in many terms used in FCE. For future research, it was recommended that researchers use these terms, use the ICF as a conceptual framework and clearly state which definition for FCE is used because no definition of FCE was consented.

dose or content? Effectiveness of pain rehabilitation programs for patients with chronic low back pain: A systematic review

Summary The influence of dose on outcome of pain rehabilitation programs remains unclear. Dose has not been the primary aim and could not be isolated from content in studies. ABSTRACT We sought to systematically analyze the influence of dose of pain rehabilitation programs (PRPs) for patients with chronic low back pain (CLBP) on disability, work participation, and quality of life (QoL). Literature searches were performed in PubMed, Cochrane Library, Cinahl, and Embase up to October 2012, using MeSH terms, other relevant terms and free‐text words. Randomized controlled trials in English, Dutch, and German, analyzing the effect of PRPs, were included. One of the analyzed interventions had to be a PRP. Outcomes should be reported regarding disability, work participation, or QoL. To analyze dose, the number of contact hours should be reported. Two reviewers independently selected titles, abstracts, and full‐text articles on the basis of inclusion and exclusion criteria. Data were extracted and risk of bias was assessed. Effect sizes (ES) were calculated for each intervention, and influence of dose variables was analyzed by a mixed model analysis. Eighteen studies were identified, reporting a wide variety of dose variables and contents of PRPs. Analyses showed that evaluation moment, number of disciplines, type of intervention, duration of intervention in weeks, percentage of women, and age influenced the outcomes of PRPs. The independent effect of dose variables could not be distinguished from content because these variables were strongly associated. Because dose variables were never studied separately or reported independently, we were not able to disentangle the relationship between dose, content, and effects of PRPs on disability, work participation, and QoL.