Establishing the biopsyschosocial profile of people who suffer with low back pain: Development, content validity and inter-rater agreement of a rating scale based on the Pain and Disability Drivers Management model

Introduction : L’établissement du profil biopsychosocial des personnes souffrant de lombalgie est une étape essentielle pour personnaliser les soins. Le Modèle de Gestion des Vecteurs de Douleur et d’Incapacité a été proposé afin d’établir ce profil. Ce modèle comprend cinq domaines contenant des éléments qui sont des vecteurs de douleur et/ou d’incapacité. Chaque domaine comporte deux catégories de sévérité. Le développement d’un outil clinique permettant d’établir ce profil faciliterait l’intégration du modèle en clinique. Les objectifs de ce projet sont : 1) Développer une échelle dans le but d’établir rapidement le profil et en valider le contenu. 2) Estimer l’accord inter-évaluateur de cette échelle. Méthodes : Le premier objectif s’est déroulé en trois étapes : 1) Génération des items à partir d’une revue exhaustive de la littérature, 2) Modifications de l’échelle en fonction de la rétroaction des physiothérapeutes recrutés et 3) Analyses statistiques pour évaluer la validité de contenu. Afin de valider chaque item de l’échelle, nous avons utilisé un index de validité de contenu sur l’item (IVC-I) avec un seuil de 0.78 pour trois critères : la clarté, la présentation et l’applicabilité clinique de l’item. Afin de valider l’échelle dans sa globalité, nous avons utilisé un index de validité de contenu sur la moyenne (IVC-M) de l’échelle nouvellement développée afin d’établir le profil à partir de deux vignettes cliniques. Une des vignettes présentait un cas simple de lombalgie alors que l’autre vignette présentait un cas plus complexe. Nous avons utilisé la proportion d’accord pour chaque domaine de chaque vignette pour déterminer l’accord interévaluateurs. Résultats : Pour le premier objectif, nous avons développé une échelle de cotation à cinq items et à quatre options de cotation. Un total de 42 physiothérapeutes a été recruté et a permis d’affiner l’échelle. Les analyses statistiques de la dernière version ont permis de valider le contenu de l’échelle. Nous avons observé que, pour chaque item, les IVC-I des trois critères présentaient des résultats au-dessus du seuil (entre 0.94 et 1.0). Concernant l’échelle dans sa globalité, le résultat (IVC-M=0.95) appuie sa validation. Pour le second objectif, nous avons recruté 72 physiothérapeutes. Pour les deux vignettes, l’accord pour chaque domaine était faible à bonne. Conclusion : Nous avons développé et validé le contenu de la première échelle permettant d’établir le profil biopsychosocial basé sur le Modèle de Gestion des Vecteurs de Douleur et d’Incapacité des personnes souffrant de lombalgie. L’accord inter-évaluateurs de cette échelle est faible à bonne dans un échantillon de physiothérapeutes nouvellement formés au modèle.Abstract: Background: Establishing the biopsychosocial profile of people with low back pain (LBP) is an essential step to personalize care. The Pain and Disability Drivers Management model (PDDM) has been proposed in order to establish this profile. This model includes five domains containing elements that are drivers of pain and\or disability. Each domain includes two categories of severity. The development of a clinical tool to establish this profile would facilitate the integration of the model in clinical practice. The objectives of this project are: 1) To develop a rating scale in order to rapidly establish the patient profile and to validate its content. 2) To estimate the inter-rater agreement of this scale. Methods: The first objective consisted of three steps: 1) Item generation from a comprehensive literature review, 2) Scale refinement according to the participants’ feedback, and 3) Statistical analyses to assess the content validity. To validate each item, we used Item level-Content Validity Index (I-CVI) with a 0.78 threshold for three criteria: clarity, presentation, and clinical applicability of the item. To validate the overall scale, we performed an Average-Content Validity Index (Ave-CVI) with a 0.9 threshold. For the second objective, the recruited physiotherapists used the newly developed scale to establish the profile from two clinical vignettes. The first vignette presented a typical clinical presentation of low back pain and the second one presented an atypical presentation. We used the proportion of agreement per domain of each vignette to determine the inter-rater agreements. Results: For the first objective, we developed a 5 item-rating scale with four scoring options. A total of 42 participants were recruited and allowed refining the scale. The statistical analyses of the latter version allowed validating the content of the scale. We observed, for each item, the I-CVI of the three criteria presented results above the threshold (between 0.94 and 1.0). For the overall scale, the result (Ave-CVI=0.95) supports its validation. For the second objective, we recruited 72 physiotherapists. For the two vignettes, the inter-rater agreements were poor to good. Conclusion: We developed and validated the content of the first scale in order to establish the biopsychosocial profile based on the PDDM for people who suffer with LBP. The inter-rater agreement of this scale is poor to good in a sample of physiotherapists newly trained on the model

Development and content validity of a rating scale for the pain and disability drivers management model

Abstract Background Establishing the biopsychosocial profile of patients with low back pain (LBP) is essential to personalized care. The Pain and Disability Drivers Management model (PDDM) has been suggested as a useful framework to help clinicians establish this biopsychosocial profile. Yet, there is no tool to facilitate its integration into clinical practice. Thus, the aim of this study is to develop a rating scale and validate its content, to rapidly establish the patient’s biopsychosocial profile, based on the five domains of the PDDM. Methods The tool was developed in accordance with the principles of the COSMIN methodology. We conducted three steps: 1) item generation from a comprehensive review, 2) refinement of the scale with clinicians’ feedback, and 3) statistical analyses to assess content validity. To validate the item assessing with Likert scales, we performed Item level-Content Validity Index (I-CVI) analyses on three criteria (clarity, presentation and clinical applicability) with an a priori threshold of > 0.78. We conducted Average-Content Validity Index (Ave-CVI) analyses to validate the overall scale with a threshold of > 0.9. Results In accordance with the PDDM, we developed a 5-item rating scale (1 per domain) with 4 score options. We selected clinical instruments to screen for the presence or absence of problematic issues within each category of the 5 domains. Forty-two participants provided feedback to refine the scale’s clarity, presentation, and clinical applicability. The statistical analysis of the latest version presented I-CVI above the threshold for each item (I-CVI ranged between 0.94 and 1). Analysis of the overall scale supported its validation (Ave-CVI = 0.96 [0.93;0.98]). Conclusion From the 51 biopsychosocial elements contained within the 5 domains of the PDDM, we developed a rating scale that allows to rapidly screen for problematic issues within each category of the PDDM’s 5 domains. Involving clinicians in the process allowed us to validate the content of the first scale to establish the patient’s biopsychosocial profile for people with low back pain. Future steps will be necessary to continue the psychometric properties analysis of this rating scale

OMERACT Core outcome measurement set for shared decision making in rheumatic and musculoskeletal conditions:a scoping review to identify candidate instruments

ObjectivesShared decision making (SDM) is a central tenet in rheumatic and musculoskeletal care. The lack of standardization regarding SDM instruments and outcomes in clinical trials threatens the comparative effectiveness of interventions. The Outcome Measures in Rheumatology (OMERACT) SDM Working Group is developing a Core Outcome Set for trials of SDM interventions in rheumatology and musculoskeletal health. The working group reached consensus on a Core Outcome Domain Set in 2020. The next step is to develop a Core Outcome Measurement Set through the OMERACT Filter 2.2.MethodsWe conducted a scoping review (PRISMA-ScR) to identify candidate instruments for the OMERACT Filter 2.2 We systematically reviewed five databases (Ovid MEDLINE®, Embase, Cochrane Library, CINAHL and Web of Science). An information specialist designed search strategies to identify all measurement instruments used in SDM studies in adults or children living with rheumatic or musculoskeletal diseases or their important others. Paired reviewers independently screened titles, abstracts, and full text articles. We extracted characteristics of all candidate instruments (e.g., measured construct, measurement properties). We classified candidate instruments and summarized evidence gaps with an adapted version of the Summary of Measurement Properties (SOMP) table.ResultsWe found 14,464 citations, read 239 full text articles, and included 99 eligible studies. We identified 220 potential candidate instruments. The five most used measurement instruments were the Decisional Conflict Scale (traditional and low literacy versions) (n=38), the Hip/Knee-Decision Quality Instrument (n=20), the Decision Regret Scale (n=9), the Preparation for Decision Making Scale (n=8), and the CollaboRATE (n=8). Only 44 candidate instruments (20%) had any measurement properties reported by the included studies. Of these instruments, only 57% matched with at least one of the 7-criteria adapted SOMP table.ConclusionWe identified 220 candidate instruments used in the SDM literature amongst people with rheumatic and musculoskeletal diseases. Our classification of instruments showed evidence gaps and inconsistent reporting of measurement properties. The next steps for the OMERACT SDM Working Group are to match candidate instruments with Core Domains, assess feasibility and review validation studies of measurement instruments in rheumatic diseases or other conditions. Development and validation of new instruments may be required for some Core Domains

The Role of Artificial Intelligence (AI) in Health Promotion and Disease Reduction: A Rapid Review Protocol

A rapid review will be conducted to identify the latest evidence on how AI is used in health promotion and disease reduction among OECD countries

Optimizing management of low back pain through the pain and disability drivers management model: A feasibility trial.

IntroductionSelf-reported levels of disability in individuals with low back pain (LBP) have not improved in the last decade. A broader perspective and a more comprehensive management framework may improve disability outcomes. We recently developed and validated the Low Back Pain and Disability Drivers Management (PDDM) model, which aims to identify the domains driving pain and disability to guide clinical decisions. The objectives of this study were to determine the applicability of the PDDM model to a LBP population and the feasibility of conducting a pragmatic trial, as well as to explore clinicians' perceived acceptability of the PDDM model's use in clinical settings.MethodsThis study was an one-arm prospective feasibility trial. Participants included physiotherapists working with a population suffering from LBP and their patients aged 18 years or older presenting with a primary complaint of LBP that sought a new referral and deemed fit for rehabilitation from private and public clinical settings. Clinicians participated in a one-day workshop on the integration of the PDDM model into their clinical practice, and were asked to report various LBP-related outcomes via self-reported questionnaires (i.e., impact of pain on physical function, nervous system dysfunctions, cognitive-emotional factors, work disabilities) at baseline and at six-week follow-up. Physiotherapists' acceptability of the use of the PDDM model and appreciation of the training were assessed via semi-structured phone interviews. Analyses focused on a description of the model's applicability to a LBP population, feasibility outcomes and acceptability measures.ResultsApplicablity of the PDDM model was confirmed since it successfully established the profile of patients according to the elements of each categories, and each of the 5 domains of the model was represented among the study sample. Trial was deemed feasible contingent upon few modifications as our predefined success criteria for the feasibility outcomes were met but feasibility issues pertaining to data collection were highlighted. Twenty-four (24) clinicians and 61 patients were recruited within the study's timeframe. Patient's attrition rate (29%) and clinicians' compliance to the study protocol were adequate. Clinicians' perceived acceptability of the use of the model in clinical settings and their appreciation of the training and online resources were both positive. Recommendations to improve the model's integration in clinical practice, content of the workshop and feasibility of data collection methods were identified for future studies. A positive effect for all patients' reported outcome measures were also observed. All outcome measures except for the PainDetect questionnaire showed a statistically significant reduction post-intervention (pConclusionThese findings provide preliminary evidence of the potential of the PDDM model to optimize LBP management as well as conducting a future larger-scale pragmatic trial to determine its effectiveness.Trial registrationClinicaltrial.gov: NCT03949179

How to objectively assess and observe maladaptive pain behaviors in clinical rehabilitation: a systematic search and review

Abstract Background Cognitive-affective factors influence the perception of pain and disability. These factors can lead to pain behaviors (PB) that can persist and become maladaptive. These maladaptive PB will further increase the risk of chronicity or persistence of symptoms and disability. Thus, clinicians must be prepared to recognize maladaptive PB in a clinical context. To date, in the context of assessment in a rehabilitation setting, PB in clinical settings are poorly documented. The main objective of this study was to identify direct observation methods and critically appraise them in order to propose recommendations for practice. As a secondary objective, we explored and extracted the different observable PB that patients could exhibit and that clinicians could observe. Methods We conducted a comprehensive review on four databases with a generic search strategy in order to obtain the largest range of PB. For the first objective, a two-step critical appraisal used clinical criteria (from qualitative studies on barriers to implement routine measures) and psychometric criteria (from Brink and Louw critical appraisal tool) to determine which observation methods could be recommended for clinical practice. For the second objective, we extracted PB found in the literature to list potential PB that patients could exhibit, and clinicians could observe. Results From the 3362 retrieved studies, 47 met the inclusion criteria for the first objective. The clinical criteria allowed us to select three observation methods. After the psychometric step, two observation methods were retained and recommended for clinical practice: the Behavioral Avoidance Test-Back Pain (BAT-Back) and the Pain Behaviour Scale (PaBS). For the second objective, 107 studies met the inclusion criteria. The extraction of the PB allowed us to list a large range of PB and classify the data in 7 categories of PB. Conclusion Our results allowed us to recommend two observation methods for clinical practice. However, these methods have limitations and are validated only in chronic low back pain populations. With the extraction of PB presented in the literature, we contribute to better prepare clinicians to recognize PB in all patients who are experiencing pain

Patient Portals for Patient with Cancer: A Scoping Review Protocol

We began a scoping review to 1) map the characteristics of portals used by cancer patients, and health or health care outcomes measured; 2) describe the representation of diversity using the PROGRESS-Plus framework, and; 3) identify the individual attributes associated with involvement and frequency of portal use

Decisional needs assessment for patient-centred pain care in Canada: the DECIDE-PAIN study protocol

Introduction The 2021 Action Plan for Pain from the Canadian Pain Task Force advocates for patient-centred pain care at all levels of healthcare across provinces. Shared decision-making is the crux of patient-centred care. Implementing the action plan will require innovative shared decision-making interventions, specifically following the disruption of chronic pain care during the COVID-19 pandemic. The first step in this endeavour is to assess current decisional needs (ie, decisions most important to them) of Canadians with chronic pain across their care pathways.Methods and analysis DesignGrounded in patient-oriented research approaches, we will perform an online population-based survey across the ten Canadian provinces. We will report methods and data following the CROSS reporting guidelines.SamplingThe Léger Marketing company will administer the online population-based survey to its representative panel of 500 000 Canadians to recruit 1646 adults (age ≥18 years old) with chronic pain according to the definition by the International Association for the Study of Pain (eg, pain ≥12 weeks). ContentBased on the Ottawa Decision Support Framework, the self-administered survey has been codesigned with patients and contain six core domains: (1) healthcare services, consultation and postpandemic needs, (2) difficult decisions experienced, (3) decisional conflict, (4) decisional regret, (5) decisional needs and (6) sociodemographic characteristics. We will use several strategies such as random sampling to improve survey quality. AnalysisWe will perform descriptive statistical analysis. We will identify factors associated with clinically significant decisional conflict and decision regret using multivariate analyses.Ethics and dissemination Ethics was approved by the Research Ethics Board at the Research Centre of the Centre Hospitalier Universitaire de Sherbrooke (project #2022-4645). We will codesign knowledge mobilisation products with research patient partners (eg, graphical summaries and videos). Results will be disseminated via peer-reviewed journals and national and international conferences to inform the development of innovative shared decision-making interventions for Canadians with chronic pain

Core outcome measurement set for shared decision making in rheumatic and musculoskeletal conditions: A scoping review to identify candidate instruments

OBJECTIVES Shared decision making (SDM) is a central tenet in rheumatic and musculoskeletal care. The lack of standardization regarding SDM instruments and outcomes in clinical trials threatens the comparative effectiveness of interventions. The Outcome Measures in Rheumatology (OMERACT) SDM Working Group is developing a Core Outcome Set for trials of SDM interventions in rheumatology and musculoskeletal health. The working group reached consensus on a Core Outcome Domain Set in 2020. The next step is to develop a Core Outcome Measurement Set through the OMERACT Filter 2.2. METHODS We conducted a scoping review (PRISMA-ScR) to identify candidate instruments for Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation the OMERACT Filter 2.2 We systematically reviewed five databases (Ovid MEDLINE®, Embase, Cochrane Library, CINAHL and Web of Science). An information specialist designed search strategies to identify all measurement instruments used in SDM studies in adults or children living with rheumatic or musculoskeletal diseases or their important others. Paired reviewers independently screened titles, abstracts, and full text articles. We extracted characteristics of all candidate instruments (e.g., measured construct, measurement properties). We classified candidate instruments and summarized evidence gaps with an adapted version of the Summary of Measurement Properties (SOMP) table. RESULTS We found 14,464 citations, read 239 full text articles, and included 99 eligible studies. We identified 220 potential candidate instruments. The five most used measurement instruments were the Decisional Conflict Scale (traditional and low literacy versions) (n=38), the Hip/Knee-Decision Quality Instrument (n=20), the Decision Regret Scale (n=9), the Preparation for Decision Making Scale (n=8), and the CollaboRATE (n=8). Only 44 candidate instruments (20%) had any measurement properties reported by the included studies. Of these instruments, only 57% matched with at least one of the 7-criteria adapted SOMP table. CONCLUSION We identified 220 candidate instruments used in the SDM literature among people with rheumatic and musculoskeletal diseases. Our classification of instruments showed evidence gaps and inconsistent reporting of measurement properties. The next steps for the OMERACT SDM Working Group are to match candidate instruments with Core Domains, assess feasibility and review validation studies of measurement instruments in rheumatic diseases or other conditions. Development and validation of new instruments may be required for some Core Domains