Background & Aims

Patients with chronic musculoskeletal disorders often show fear of movements that they relate to pain exacerbation and/or (re)injury and consequently develop avoidance behavior [7,10]. Pain-related fear seems to have a greater impact on disability than pain intensity [3,12]. As a main predictor for chronification, it is necessary to monitor pain-related fear in clinical practice [5,7]. To measure avoidance behavior in shoulder pain patients, the Avoidance of Daily Activities (ADAP) Scale was recently developed [1,2].

To analyze the psychometric properties of the adapted version of the ADAP Scale for measuring pain-related fear of movement in chronic shoulder pain patients.

Methods

Experts (with experience in research/education and treatment of shoulder pain), physiotherapists and shoulder pain patients were recruited in accordance with the COSMIN guideline [9]. Inclusion criteria for patients were: shoulder pain for > 3 months, age > 18-years. Shoulder pain of neurological or rheumatological origin and participants with visual impairment and insufficient knowledge of German language were excluded.
Data was collected by providing the ADAP Scale as an online questionnaire to patients recruited at outpatient physiotherapy clinics in northern Germany. Image titles were translated into German language and the anchors on the 0-10 NRS were changed to “strongly fear-inducing” and “not at all fear- inducing”. Afterwards, participants were asked to rate the comprehensibility, relevance, acceptance and feasibility of the ADAP Scale on a 5-point-Likert-Scale.
A descriptive data analysis and qualitative thematic content analysis of open-ended questions was performed.

Results

The mean age of participants was 41.33 years (SD 15.37) and 55% were female. Three participants were experts, 20 physiotherapists and 17 patients with shoulder pain.
The most fear-inducing item was “carrying on shoulder, hip and back” (mean 5.88 points (SD 2.67)) and the least fear-inducing item “drinking” (mean 0.71 points (SD 1.72)). 100% of the experts, 90% of the physiotherapists and 64.7% of the patients confirmed that measuring pain-related fear is “somewhat relevant” or “highly relevant”. All participants agreed on the acceptability of the ADAP Scale. 85% of the participants thought that the titles fit the images, 90% of them rated the response options as comprehensible. 95% of the participants stated that it is feasible to use the ADAP Scale in clinical practice.

Conclusions

The here tested version of the ADAP Scale showed high ratings for acceptability, feasibility, comprehensibility and relevance. The next step is therefore to test the psychometric properties of the adapted version with a larger sample size and estimate its validity.

References

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Presenting Author

Larissa Pagels

Poster Authors

Larissa Pagels

Pain and Exercise Research Luebeck, Institution of Health Sciences, University of Luebeck

Lead Author

Topics

  • Assessment and Diagnosis