Reliability and Validity of the Pain Anxiety Symptom Scale in Persian Speaking Chronic Low Back Pain Patients

Study Design. Psychometric testing of the Persian version of Pain Anxiety Symptom Scale 20. Objective. The aim of this study was to assess the reliability and construct validity of the PASS-20 in nonspecific chronic low back pain (LBP) patients. Summary of Background Data. The PASS-20 is a self-report questionnaire that assesses pain-related anxiety. The Psychometric properties of this instrument have not been assessed in Persian-speaking chronic LBP patients. Methods. One hundred and sixty participants with chronic LBP completed the Persian version of PASS-20, Tampa Scale of Kinesiophobia (TSK), Fear-Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), trait form of the State-Trait Anxiety (STAI-T), Oswestry Low Back Pain Disability Index (ODI), Beck Depression Inventory (BDI-II), and Visual Analogue Scale (VAS). To evaluate test-retest reliability, 60 patients filled out the PASS-20, 6 to 8 days after the first visit. Test-retest reliability (intraclass correlation coefficient [ICC], standard error of measurement [SEM], and minimal detectable change [MDC]), internal consistency, dimensionality, and construct validity were examined. Results. The ICCs of the PASS-20 subscales and total score ranged from 0.71 to 0.8. The SEMs for PASS-20 total score was 7.29 and for the subscales ranged from 2.43 to 2.98. The MDC for the total score was 20.14 and for the subscales ranged from 6.71 to 8.23. The Cronbach alpha values for the subscales and total score ranged from 0.70 to 0.91. Significant positive correlations were found between the PASS-20 total score and PCS, TSK, FABQ, ODI, BDI, STAI-T, and pain intensity. Conclusion. The Persian version of the PASS-20 showed acceptable psychometric properties for the assessment of pain-related anxiety in Persian-speaking patients with chronic LBP. © 2017 Wolters Kluwer Health, Inc. All rights reserved

Attention demands of postural control in non-specific chronic low back pain subjects with low and high pain-related anxiety

Impaired postural control in chronic low back pain (CLBP) has been attributed to deficits in sensory and motor functions. However, it is not known if pain-related anxiety affects motor and cognitive function of postural control. The aim of this study was to compare the interactive effects of postural and cognitive function in CLBP patients with high and low pain-related anxiety and healthy subjects. Thirty-eight patients with nonspecific CLBP (19 with low and 19 with high pain-related anxiety levels) and 20 asymptomatic subjects participated. Postural control was assessed by center of pressure (COP) parameters including mean total sway velocity, area, anterior�posterior (A�P), and medial�lateral (Med�Lat) range. Postural task was assessed during four conditions (eyes open with and without ankle vibration�eyes closed with and without ankle vibrations). Participants performed the postural task with or without auditory Stroop task. Average reaction time and error ratio of auditory Stroop test were calculated as measures of the cognitive task performance. Significantly reduced sway area was observed in CLBP patients with high pain-related anxiety and control subjects during the dual-task condition as compared with the single task. In addition, A�P range was significantly reduced in CLBP patients with high pain-related anxiety during dual tasking when eyes were closed with ankle vibration. In addition, only the CLBP subjects with high pain-related anxiety showed significantly longer reaction times by increasing the difficulty of standing postural task. Pain-related anxiety may influence the postural cognitive interactions in CLBP patients. Furthermore, it may be considered as a contributing factor for postural strategies adopted by CLBP patients. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature

Attention demands of postural control in non-specific chronic low back pain subjects with low and high pain-related anxiety

Impaired postural control in chronic low back pain (CLBP) has been attributed to deficits in sensory and motor functions. However, it is not known if pain-related anxiety affects motor and cognitive function of postural control. The aim of this study was to compare the interactive effects of postural and cognitive function in CLBP patients with high and low pain-related anxiety and healthy subjects. Thirty-eight patients with nonspecific CLBP (19 with low and 19 with high pain-related anxiety levels) and 20 asymptomatic subjects participated. Postural control was assessed by center of pressure (COP) parameters including mean total sway velocity, area, anterior�posterior (A�P), and medial�lateral (Med�Lat) range. Postural task was assessed during four conditions (eyes open with and without ankle vibration�eyes closed with and without ankle vibrations). Participants performed the postural task with or without auditory Stroop task. Average reaction time and error ratio of auditory Stroop test were calculated as measures of the cognitive task performance. Significantly reduced sway area was observed in CLBP patients with high pain-related anxiety and control subjects during the dual-task condition as compared with the single task. In addition, A�P range was significantly reduced in CLBP patients with high pain-related anxiety during dual tasking when eyes were closed with ankle vibration. In addition, only the CLBP subjects with high pain-related anxiety showed significantly longer reaction times by increasing the difficulty of standing postural task. Pain-related anxiety may influence the postural cognitive interactions in CLBP patients. Furthermore, it may be considered as a contributing factor for postural strategies adopted by CLBP patients. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature

A successful implementation of an idea to a nationally approved plan: Analyzing Iran's national health roadmap using the kingdon model of policymaking

Introduction: Hospital beds, human resources, and medical equipment are the costliest elements in the health system and play an essential role at the time of treatment. In this paper, different phases of the NEDA 2026 project and its methodological approach were presented and its formulation process was analysed using the Kingdon model of policymaking. Methods: Iran Health Roadmap (NEDA 2026) project started in March 2016 and ended in March 2017. The main components of this project were hospital beds, clinical human resources, specialist personnel, capital medical equipment, laboratory facilities, emergency services, and service delivery model. Kingdon model of policymaking was used to evaluate NEDA 2026 development and implementation. In this study, all activities to accomplish each step in the Kingdon model was described. Results: The followings were done to accomplish the goals of each step: collecting experts' viewpoint (problem identification and definition), systematic review of the literature, analysis of previous experiences, stakeholder analysis, economic analysis, and feasibility study (solution appropriateness analysis), three-round Delphi survey (policy survey and scrutinization), and intersectoral and interasectoral agreement (policy legislation). Conclusion: In the provision of an efficient health service, various components affect each other and the desired outcome, so they need to be considered as parts of an integrated system in developing a roadmap for the health system. Thus, this study demonstrated the cooperation process at different levels of Iran's health system to formulate a roadmap to provide the necessary resources for the health sector for the next 10 years and to ensure its feasibility using the Kingdon policy framework. © Iran University of Medical Sciences