Tag Archives: low back pain

Clinical Practice, Outcome Measures, Psychosocial Factors

Short Form Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-10)

Evidence suggests that clinicians are limited in their ability to identify psychosocial factors in patients presenting with musculoskeletal (MSK) pain.(1,2) As such, it is important to use screening tools to improve clinical recognition and the contribution of psychosocial factors in MSK pain disorders.(3-5)

The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) has had several studies demonstrate its clinical utility in the identification of psychosocial factors.(6-8) However, calls were made to reduce the 21-item ÖMPSQ to a shorter form. A shorter version of the ÖMPSQ would improve practicality and reduce the burden on patients, clinicians and researchers.

The ÖMPSQ short version (ÖMPSQ-10) has recently been shown to be valid in identifying potential risk of pain-related disability and long-term work absence.(9) The ÖMPSQ-10 includes 10 items selected from the full version.(9)  These items are scored 0-10, where 0 refers to absence of impairment and 10 to severe impairment.

The total score will range between 1 and 100, with a score >50 correlating with greater long-term sick leave and poorer outcomes (high risk patient).(9)

In conclusion, the ÖMSPQ-10 is appropriate for clinical and research purposes, since it is nearly as accurate as the longer version.(9) It can also be used to monitor patient progress (e.g. administer the ÖMSPQ-10 monthly or every 3-months to monitor changes over time).

Easily administer, score and interpret outcome measures – including the ÖMSPQ-10- through Erepsonline. For more information on selecting and viewing outcome measures, see the Erepsonline Video Tutorials, or check out the Quick Start Quide

 

References:

  1. Bishop A, Foster NE. Do physical therapists in the United kingdom recognize psychosocial factors in patients with acute low back pain? Spine 2005;30:1316-22.[PMID: 15928559]
  2. Hill JC, Vohora K, Dunn KM, et al. Comparing the STarT back screening tool’s subgroup allocation of individual patients with that of independent clinical experts. Clin J Pain2010;26:783-7. [PMID: 20842014]
  3. Australian Acute Musculoskeletal Pain Guidelines Group. Evidence-based mamagement of acute musculoskeletal pain. Brisbane: Australian Government: National Health and Medical Research Council, 2003. [pdf]
  4. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of internal medicine 2007;147:478-91. [PMID: 17909209]
  5. van Tulder M, Becker A, Bekkering T, et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006;15 Suppl 2:S169-91. [PMID: 16550447]
  6. Gabel CP, Burkett B, Neller A, Yelland M. Can long term impairment in General Practitioner Whiplash patients be predicted using screening and Patient Report Outcomes? Int J Rehabil Res 2008; 31(1): 79-80.
  7. Gabel CP, Melloh M, Yelland M, Burkett B, Roiko A. Predictive Ability of a Modified Örebro Musculoskeletal Pain Questionnaire in an Acute Low Back Pain Working Population. Eur Spine J 2011; 20(3): 449-57.
  8. Gabel CP, Burkett B, Yelland M, Melloh M, Osborne J. The Örebro Musculoskeletal Screening Questionnaire: validation of a modified primary care musculoskeletal screening tool in an acute work injured population. Man Ther 2012;17(6):554-65
  9. Linton, S. J., Nicholas, M., & MacDonald, S. (2011). Development of a short form of the Orebro Musculoskeletal Pain Screening Questionnaire. Spine, 36(22), 1891-1895.[PMID: 21192286]
Clinical Practice, Outcome Measures

The Fear Avoidance Beliefs Questionnaire (FABQ): The importance of its utilisation in clinical practice

The Fear Avoidance Belief Questionnaire (FABQ) was developed by Waddell to investigate the fear-avoidance beliefs of patients with chronic low back pain.(1) The Rehabilitation Measures Database states that the FABQ “focuses specifically on how a patient’s fear-avoidance beliefs about physical activity and work may affect and contribute to their low back pain (i.e. the cognitive/affective components of pain that are differentiated from specific tissue damage, injury, and nociception) and resulting disability.”(2)

The FABQ has been demonstrated to be valid and reliable in a chronic LBP population and appears to be a useful screening tool for identifying acute low back pain patients who will not return to work by 4 weeks. (1,3)

The FABQ consists of 2 subscales:

  • The Physical Activity subscale (FABQPA)
    • FABQPA of 15 or greater is considered a high score.
  • The Work subscale (FABQW).
    • FABQW of 34 or greater is considered a high score.

A patient with work related low back pain and a “positive” FABQ-W test result (score >34) has a higher probability of not returning to work in four-weeks.

Not only can the FABQ help determine the probability of current and future work loss and disability, the FABQ can also help healthcare professionals choose clinical interventions that have an increased probability of a successful outcome (i.e. the FABQ can predict successful outcomes from clinical interventions or predict decreased probability of successful outcomes).

For example, the FABQ can be used for the following clinical prediction rules:

  • Sacroiliac Joint Manipulation
    • A low FABQW score (less than 19) is one of 5 variables in a clinical prediction rule that increased the probability of success from sacroiliac region manipulation in individuals with low back pain.(4)
  • Stabilization Exercise
    • A low FABQPA score (less than 9) would decrease the probability of success of a stabilisation exercise program in individuals with low back pain.(5)
  • A predictor of 6-month outcomes following 4-weeks of physical therapy.
    • FABQW scores greater than 20 indicated an increased risk of reporting no improvement in 6-month ODQ scores.(6)

*The Oswestry Disability Questionnaire (ODQ) is considered the ‘gold  standard’ of low back functional outcome tools.

In conclusion, healthcare professionals should be administering the FABQ within clinical practice. The FABQ can help determine the probability of current and future work loss and disability, as well as indicate increased risk of poor treatment outcomes. Practitioners utilising manipulation and exercise therapy in the management of low back pain, can derive information from the FABQ to determine the probability of success – or lack thereof – when deciding to implement these two clinical interventions.

 

Easily administer, score and interpret outcome measures – including the FABQ – through Erepsonline. For more information on selecting and viewing outcome measures, see the Erepsonline Video Tutorials, or check out the Quick Start Quide

 

 

References:

  1. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 1993; 52:157-168
  2. Mordini N. (2014, June). Rehab Measures: Fear-Avoidance Beliefs Questionnaire. Retrieved from: http://www.rehabmeasures.org/Lists/RehabMeasures/PrintView.aspx?ID=1200
  3. Fritz JM, George SZ, Delitto A. The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status. Pain 2001; 94:7-15. 3.
  4. Flynn T, Fritz J, Whitman J, Wainner R, et al. Clinical Prediction Rule for Classifying Patients with Low Back Pain Likely to Respond to a Manipulation Technique. Spine (Phila Pa 1976). 2002;27(24):2835-43.
  5. Hicks G et al.  Prelimary Development of a Clinical Prediction Rule for Determining Which Patients with Low Back Pain Will Respond to Stabilization Exercise Program. Arch Phys Med Rehabil. 2005;86:1753-1762.