Eli's Rehab Report

Screening for elevated levels of fear-avoidance beliefs regarding work or physical activities in people receiving outpatient therapy. Hart DL, Werneke, MW, George SZ, Matheson JW, Wang YC, Cook KF, Mioduski JE, Choi SW. Phys Ther. 2009 Aug;89(8):770-85.

A simple pre-treatment questionnaire could improve your outcomes. Researchers found that using the Fear-Avoidance Beliefs Questionnaire (FABQ) at intake could identify elevated levels of fear-avoidance beliefs in patients who were receiving outpatient rehab, according to a press release from the American Physical Therapy Association (APTA). The FABQ, a short, self-report questionnaire, assesses pain-related fear in patients with various neuromusculoskeletal conditions.

Researchers collected FABQ data from 17,804 people with common conditions who were receiving outpatient rehab in 121 clinics across the U.S., APTA reported. To minimize measurement error related to short-term tests such as the FABQ, researchers used Item Response Theory (IRT) methods to analyze the FABQ items. IRT methods are psychometric techniques that evaluate whether items mean the same thing to different respondents, also known as differential item functioning (DIF).

The findings: Researchers discovered that DIF was negligible for sex, age, symptom acuity, surgical history, pain intensity, and condition severity and impairment -- variables known to affect functional outcomes. "The lack of practically important DIF allowed us to identify single screening items that could be used to accurately and efficiently classify people with elevated levels of fear-avoidance beliefs regardless of the impairment being treated," said Dennis L. Hart, PT, PhD, researcher and director of consulting and research at Focus On Therapeutic Outcomes, Inc., in White Stone, Va.

"Therapists do not routinely screen for elevated levels of fear in patients, although evidence suggests that identifying fear-avoidance beliefs and managing those beliefs accordingly may reduce fear and help to predict or improve outcomes," said Hart.

How: Test results indicating elevated levels of fear could point to patients' fear of activities that are part of their therapeutic interventions. Then, the therapist could adjust accordingly for better outcomes.