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Attitude and belief of pain-therapists are important when trying to help chronic pain patients: The Norwegian version of the Pain Attitudes and Beliefs Scale (PABS) improved by Rasch analysis

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Scandinavian Journal of Pain
From the journal Scandinavian Journal of Pain Volume 13 Issue 1

In this issue of the Scandinavian Journal of Pain Nicolaas Eland and his co-workers apply Rasch analysis to evaluate the measurement properties of the Pain Attitudes and Beliefs Scale (PABS) [1]. Low back pain is one of the leading causes of disability worldwide [2], and our treatment options still insufficient [3]. Pain is weakly associated with structural changes and biomedical findings [4], and the psychosocial component is of major importance in the development of back pain related disability [5]. Hence, treatment is often targeted to reduce pain related fear avoidance behaviour and regain functioning including return to work. There is a wide range of psychological, cognitive and behavioural strategies applied in the treatment [6], and information and guidance from the health care providers are generally included in a multimodal management. One would assume that attitudes and beliefs among health care providers heavily influence the service delivery and also the effect of the treatment. It is an important part of the context sensitive therapeutic effect. However, surprisingly few studies include this perspective. Standardized measurements with validated measurement properties are needed in order to assess these beliefs. Hence, the work by Eland et al. [1] should contribute to increased attention to the care-provider delivery of the treatment through better measurements that focus on this aspect of pain management.

1 Rasch analysis

Rasch analysis was developed by Georg Rasch and published in 1960 [7], and it is one of a series of methods based on item response theory [8].These approaches have been extensively applied within social sciences for decades, and they are becoming increasingly popular within health sciences over the last years. The Rasch analysis tests the deviation of the observed pattern of responses against the expected according to a probabilistic model [9]. One of the advantages of the Rasch approach compared with traditional approaches like factor analysis is the common metric applied for the items and persons. Furthermore, additional person measures can be included, providing evaluation of invariance of the measurement. This is particularly important for measurements of attitudes and beliefs where gender, age, and cultural differences are likely to influence the measurements. Furthermore, Rasch analysis can address the limitation of raw scores based on ordinal measurements. The measurement units are transformed to logits that have the same size (i.e. interval) over the entire continuum. Hence, one can avoid the challenge of score = 2 not being twice of score = 1 on a Lickert-type scale. Dimensionality of a measurement can be evaluated and valid sum scores calculated.

2 Pain Attitudes and Beliefs Scale (PABS)

PABS is one of the most commonly applied measurements health care providers’ attitudes towards patients and beliefs in the therapy they are providing to chronic pain patients [10]. However measurement properties of the PABS have been questioned. PABS was originally designed to differentiate between biomedical and biopsychosocial pain attitudes among health care providers when managing patients with unspecific low back pain [10]. PABS contains two subscales labelled “biomedical” (10 items) and “biopsychosocial” (9 items), with each item scored on a 6 point Lickert scale. The original instrument was derived from a 36 item pool, and the authors integrate these items in the analysis in order to improve the measurement properties of the scale [10]. Nicolaas D. Eland, Alice Kvåle, Raymond W.J.G. Ostelo, and Liv Inger Strand in this issue of the Scandinavian Journal of Pain [1] identified two strictly unidimensional, invariant subscales each consisting of seven items and free from any form of misfit. They also provide transformation tables in order to convert ordinal scores to unbiased and normally distributed interval-level scores, which is important when parametric statistical analysis is desired [11]. The respondents of PABS in the present study were physiotherapists. The responses may vary across health care professions, and the results of Rasch analysis are population dependent. Hence, PABS need to be validated in other populations and invariance to health care profession should be evaluated.

In the future improved knowledge derived from clinical trials will result when measurements of attitudes and beliefs of the health care providers are documented along with the specifications of the interventions applied.

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2016.06.009.

Oslo University Hospital, Department of Physical Medicine and Rehabilitation, Pbox 4950, Nydalen, 0424 Oslo, Norway.

  1. Conflict of interest: None declared.

References

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Published Online: 2016-10-01
Published in Print: 2016-10-01

© 2016 Scandinavian Association for the Study of Pain

Articles in the same Issue

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  5. Clinical pain research
  6. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  7. Editorial comment
  8. Patient Reported Outcomes (PROs) are sensitive outcome-variables in patients with chronic pain: Importance of self-efficacy
  9. Observational study
  10. Using patient reported outcomes in oncology clinical practice
  11. Editorial comment
  12. Cortical reorganization of the healthy hand in upper-limb complex regional pain syndrome(CRPS): Is reorganizations of common beliefs about CRPS necessary?
  13. Original experimental
  14. An exploration into the cortical reorganisation of the healthy hand inupper-limb complex regional pain syndrome
  15. Editorial comment
  16. Is there hope for the most complicated chronic pain patients facing back surgery?
  17. Educational case report
  18. A preoperative interdisciplinary biopsychosocial opioid reduction program in patients on chronic opioid analgesia prior to spine surgery: A preliminary report and case series
  19. Editorial comment
  20. Pain management in the Emergency Department – Still a long way to go?
  21. Clinical pain research
  22. Mandatory documentation of pain in the emergency department increases analgesic administration but does not improve patients’ satisfaction of pain management
  23. Editorial comment
  24. Pain relief during childbirth: Efficacy and safety of prolonging labour-analgesia with morphine directly into the lumbar cerebro-spinal-fluid (CSF)
  25. Systematic review
  26. Prolonging the duration of single-shot intrathecal labour analgesia with morphine: A systematic review
  27. Editorial comment
  28. The intricate relationship amongst pain intensity, fear and avoidance
  29. Systematic review
  30. A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain
  31. Editorial comment
  32. Local infiltration analgesia(LIA), risk of local anaesthetic systemic toxicity (LAST) and kidney failure from NSAID in elderly patients
  33. Topical review
  34. Local infiltration analgesia in knee and hip arthroplasty efficacy and safety
  35. Editorial comment
  36. Analysis of pain-intensity measurements
  37. Topical review
  38. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance
  39. Editorial comment
  40. The relationship between chronic pain and cardiovascular disease: Squaring the circle?
  41. Systematic review
  42. Assessing the relationship between chronic pain and cardiovasculardisease: A systematic review and meta-analysis
  43. Editorial comment
  44. Optimists fare better when chronic pain strikes – Or does pain related disability make us pessimists?
  45. Observational study
  46. Constructs of health belief and disabling distal upper limb pain
  47. Editorial comment
  48. Attitude and belief of pain-therapists are important when trying to help chronic pain patients: The Norwegian version of the Pain Attitudes and Beliefs Scale (PABS) improved by Rasch analysis
  49. Observational study
  50. Rasch analysis resulted in an improved Norwegian version of the Pain Attitudes and Beliefs Scale(PABS)
  51. Editorial comment
  52. Anxiety could play a larger role than depression in migraine headache
  53. Clinical pain research
  54. The relative importance of anxiety and depression in pain impact in individuals with migraine headaches
  55. Editorial comment
  56. Bringing the lab to the people: Experimental pain testing in the general population
  57. Clinical pain research
  58. Pressure and cold pain threshold reference values in a large, young adult, pain-free population
  59. Editorial comment
  60. Improving pain treatment in children
  61. Clinical pain research
  62. A randomized controlled trial of amitriptyline versus gabapentin for complex regional pain syndrome type I and neuropathic pain in children
  63. Editorial comment
  64. Gut gateway to generalized pain
  65. Original experimental
  66. A low fermentable oligo-di-mono saccharides and polyols(FODMAP) diet reduced pain and improve ddaily life in fibromyalgia patients
  67. Editorial comment
  68. Measuring outcomes of pain management
  69. Clinical pain research
  70. Osteoarthritis patients with pain improvement are highly likely to also have improved quality of life and functioning. A post hoc analysis of a clinical trial
  71. Clinical pain research
  72. Construct validity and reliability of Finnish version of Örebro Musculoskeletal Pain Screening Questionnaire
  73. Observational study
  74. Total sleep deprivation and pain perception during cold noxious stimuli in humans
  75. Corrigendum
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https://doi.org/10.1016/j.sjpain.2016.09.002

Articles in the same Issue

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  5. Clinical pain research
  6. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  7. Editorial comment
  8. Patient Reported Outcomes (PROs) are sensitive outcome-variables in patients with chronic pain: Importance of self-efficacy
  9. Observational study
  10. Using patient reported outcomes in oncology clinical practice
  11. Editorial comment
  12. Cortical reorganization of the healthy hand in upper-limb complex regional pain syndrome(CRPS): Is reorganizations of common beliefs about CRPS necessary?
  13. Original experimental
  14. An exploration into the cortical reorganisation of the healthy hand inupper-limb complex regional pain syndrome
  15. Editorial comment
  16. Is there hope for the most complicated chronic pain patients facing back surgery?
  17. Educational case report
  18. A preoperative interdisciplinary biopsychosocial opioid reduction program in patients on chronic opioid analgesia prior to spine surgery: A preliminary report and case series
  19. Editorial comment
  20. Pain management in the Emergency Department – Still a long way to go?
  21. Clinical pain research
  22. Mandatory documentation of pain in the emergency department increases analgesic administration but does not improve patients’ satisfaction of pain management
  23. Editorial comment
  24. Pain relief during childbirth: Efficacy and safety of prolonging labour-analgesia with morphine directly into the lumbar cerebro-spinal-fluid (CSF)
  25. Systematic review
  26. Prolonging the duration of single-shot intrathecal labour analgesia with morphine: A systematic review
  27. Editorial comment
  28. The intricate relationship amongst pain intensity, fear and avoidance
  29. Systematic review
  30. A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain
  31. Editorial comment
  32. Local infiltration analgesia(LIA), risk of local anaesthetic systemic toxicity (LAST) and kidney failure from NSAID in elderly patients
  33. Topical review
  34. Local infiltration analgesia in knee and hip arthroplasty efficacy and safety
  35. Editorial comment
  36. Analysis of pain-intensity measurements
  37. Topical review
  38. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance
  39. Editorial comment
  40. The relationship between chronic pain and cardiovascular disease: Squaring the circle?
  41. Systematic review
  42. Assessing the relationship between chronic pain and cardiovasculardisease: A systematic review and meta-analysis
  43. Editorial comment
  44. Optimists fare better when chronic pain strikes – Or does pain related disability make us pessimists?
  45. Observational study
  46. Constructs of health belief and disabling distal upper limb pain
  47. Editorial comment
  48. Attitude and belief of pain-therapists are important when trying to help chronic pain patients: The Norwegian version of the Pain Attitudes and Beliefs Scale (PABS) improved by Rasch analysis
  49. Observational study
  50. Rasch analysis resulted in an improved Norwegian version of the Pain Attitudes and Beliefs Scale(PABS)
  51. Editorial comment
  52. Anxiety could play a larger role than depression in migraine headache
  53. Clinical pain research
  54. The relative importance of anxiety and depression in pain impact in individuals with migraine headaches
  55. Editorial comment
  56. Bringing the lab to the people: Experimental pain testing in the general population
  57. Clinical pain research
  58. Pressure and cold pain threshold reference values in a large, young adult, pain-free population
  59. Editorial comment
  60. Improving pain treatment in children
  61. Clinical pain research
  62. A randomized controlled trial of amitriptyline versus gabapentin for complex regional pain syndrome type I and neuropathic pain in children
  63. Editorial comment
  64. Gut gateway to generalized pain
  65. Original experimental
  66. A low fermentable oligo-di-mono saccharides and polyols(FODMAP) diet reduced pain and improve ddaily life in fibromyalgia patients
  67. Editorial comment
  68. Measuring outcomes of pain management
  69. Clinical pain research
  70. Osteoarthritis patients with pain improvement are highly likely to also have improved quality of life and functioning. A post hoc analysis of a clinical trial
  71. Clinical pain research
  72. Construct validity and reliability of Finnish version of Örebro Musculoskeletal Pain Screening Questionnaire
  73. Observational study
  74. Total sleep deprivation and pain perception during cold noxious stimuli in humans
  75. Corrigendum
  76. Corrigendum to ‘Reliability of pressure pain threshold testing in healthy pain free young adults’ [Scand. J. Pain 9 (2015) 38–41]
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