Development and Validation of the Behavioral Avoidance Test—Back Pain (BAT-Back) for Patients With Chronic Low Back Pain. Issue 11 (November 2016)

• Record Type: Journal Article
• Authors: Holzapfel, Sebastian; Riecke, Jenny; Rief, Winfried; Schneider, Jessica; Glombiewski, Julia A.
• Is Part Of: Clinical journal of pain. Volume 32:Issue 11(2016)
• Publication Date: 2016-11
• Subjects: Behavioral Avoidance Test -- chronic low back pain -- fear-avoidance model -- avoidance behavior -- tailored treatment; Pain -- Periodicals; Pain -- Treatment -- Periodicals; Analgesia -- Periodicals; 616.047205
• DOI: 10.1097/AJP.0000000000000349
• Languages: English
• ISSNs: 0749-8047

Abstract

Abstract : Objectives: Pain-related fear and avoidance of physical activities are central elements of the fear-avoidance model of musculoskeletal pain. Pain-related fear has typically been measured by self-report instruments. In this study, we developed and validated a Behavioral Avoidance Test (BAT) for chronic low back pain (CLBP) patients with the aim of assessing pain-related avoidance behavior by direct observation. Materials and Methods: The BAT-Back was administered to a group of CLBP patients (N=97) and pain-free controls (N=31). Furthermore, pain, pain-related fear, disability, catastrophizing, and avoidance behavior were measured using self-report instruments. Reliability was assessed with intraclass correlation coefficient and Cronbach α. Validity was assessed by examining correlation and regression analysis. Results: The intraclass correlation coefficient for the BAT-Back avoidance score was r =0.76. Internal consistency was α=0.95. CLBP patients and controls differed significantly on BAT-Back avoidance scores as well as self-report measures. BAT-Back avoidance scores were significantly correlated with scores on each of the self-report measures ( r s=0.27 to 0.54). They were not significantly correlated with general anxiety and depression, age, body mass index, and pain duration. The BAT-Back avoidance score was able to capture unique variance in disability after controlling for other variables (eg, pain intensity and pain-related fear). Discussion: Results indicate that the BAT-Back is a reliable and valid measure of pain-related avoidance behavior. It may be useful for clinicians in tailoring treatments for chronic pain as well as an outcome measure for exposure treatments. Abstract : Supplemental Digital Content is available in the text.