PubMed · 14416285
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S LEVINE, S J ENGLAND. 1960. Temporal factors in avoidance learning.. https://doi.org/10.1037/h0046423
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STUDY DESIGN: Validation of a translated, culturally adapted questionnaire. OBJECTIVES: To translate and culturally adapt the Spanish version of the Fear Avoidance Beliefs Questionnaire (FABQ), and to validate its use in Spanish-speaking patients with low back pain (LBP). SUMMARY OF BACKGROUND DATA: The FABQ is a reliable evaluation instrument for fear avoidance beliefs, which includes two subscales (FAB-Work and FAB-Phys). No validated Spanish version was available. METHODS: Translation/retranslation of the English version of the FABQ was done blindly and independently by a multidisciplinary team. The study was done in 12 primary care centers and 9 hospital outpatient clinics from seven regions in Spain, with 209 acute, subacute, and chronic patients who visited their physician for LBP: 53 in the pilot phase and 156 in the validation phase. Subjects were given the FABQ, two VAS for LBP and referred pain, and the Roland-Morris and SF-12 Questionnaires on their first visit and 14 days later. In the pilot phase, on day 1 test-retest reliability was estimated by giving a second FABQ in which the name and order of the items had been changed. RESULTS: Time necessary to complete the FABQ was [median, P25, P75] 10 minutes (5,15). FABQ values were not normally distributed. Comprehensibility: No request for aid in interpretation was made during the validation phase and no item was left unanswered by >or= 10% of patients. Reliability: Scores [median, P25, P75] of the two FABQ were: 72.00 (47.25, 82.00) and 72.00 (49.50, 83.75), with an intraclass correlation coefficient of 0.9668 (95% confidence interval, 0.9421,0.9823). Mean of kappa values for all items was 0.743. Internal Consistency: Cronbach's alpha was 0.9337. VALIDITY: Values of FAB and FAB-Work were >37% higher for patients on sick leave. For FAB-Phys differences were below 8%. FABQ, FAB-Work and FAB-Phys strongly correlated with disability on days 1 and 15. CONCLUSIONS: The Spanish version of the FABQ has good comprehensibility, internal consistency, and reliability. It cannot be analyzed parametrically, but only nonparametrically. The total FABQ is at least as valid as its subscales and simpler to score, making it more suitable for routine clinical use.
INTRODUCTION: Quantitative sensory testing has demonstrated a promising link between experimentally determined pain sensitivity and clinical pain. However, previous studies of quantitative sensory testing have not routinely considered the important influence of psychological factors on clinical pain. This study investigated whether measures of thermal pain sensitivity (temporal summation, first pulse response, and tolerance) contributed to clinical pain reports for patients with chronic low back pain, after controlling for depression or fear-avoidance beliefs about work. METHOD: Consecutive patients (n=27) with chronic low back pain were recruited from an interdisciplinary pain rehabilitation program in Jacksonville, FL. Patients completed validated self-report questionnaires for depression, fear-avoidance beliefs, clinical pain intensity, and clinical pain related disability. Patients also underwent quantitative sensory testing from previously described protocols to determine thermal pain sensitivity (temporal summation, first pulse response, and tolerance). Hierarchical regression models investigated the contribution of depression and thermal pain sensitivity to clinical pain intensity, and fear-avoidance beliefs and thermal pain sensitivity to clinical pain related disability. RESULTS: None of the measures of thermal pain sensitivity contributed to clinical pain intensity after controlling for depression. Temporal summation of evoked thermal pain significantly contributed to clinical pain disability after controlling for fear-avoidance beliefs about work. CONCLUSION: Measures of thermal pain sensitivity did not contribute to pain intensity, after controlling for depression. Fear-avoidance beliefs about work and temporal summation of evoked thermal pain significantly influenced pain related disability. These factors should be considered as potential outcome predictors for patients with work-related low back pain. SIGNIFICANCE: This study supported the neuromatrix theory of pain for patients with CLBP, as cognitive-evaluative factor contributed to pain perception, and cognitive-evaluative and sensory-discriminative factors uniquely contributed to an action program in response to chronic pain. Future research will determine if a predictive model consisting of fear-avoidance beliefs and temporal summation of evoked thermal pain has predictive validity for determining clinical outcome in rehabilitation or vocational settings.
Despite increasing attention to the phenomenon of deliberate self-harm (DSH), the literature currently lacks a unifying, evidence-based, theoretical framework within which to understand the factors that control this behavior. The purpose of the present paper is to outline such a framework-the Experiential Avoidance Model (EAM) of DSH. The EAM poses that DSH is primarily maintained by negative reinforcement in the form of escape from, or avoidance of, unwanted emotional experiences. Literature on factors that may lead to experiential avoidance is reviewed, along with the mounting empirical evidence that DSH functions to help the individual escape from unwanted emotional experiences. The EAM integrates a variety of research on emotions, experiential avoidance, and DSH within a clinically useful framework that sparks novel research directions.