Department for Clinical Psychology and Psychotherapy, Philipps-University Marburg, Hessen, Marburg.
Department for Clinical Psychology and Psychotherapy, University Koblenz-Landau, Landau, Germany.
Clin J Pain. 2021 Apr 1;37(4):265-269. doi: 10.1097/AJP.0000000000000920.
Although several questionnaires assessing fear of movement exist, it is still a challenge to identify individuals who might benefit more from exposure for chronic pain than from other psychological approaches and vice versa. Psychological approaches to chronic pain cannot advance toward the often called-for "tailored approaches" because of limited knowledge about treatment predictors. Our aim was to evaluate the additional predictive value of avoidance behavior based on behavioral observation.
This study examined pretreatment self-report and behavioral measures as predictors of treatment outcome for n=43 patients experiencing disabling chronic low back pain, who took part in a randomized controlled trial in which they received 10 to 15 sessions of exposure treatment. Only patients with elevated fear avoidance based on self-report measures were included. Data were analyzed using regression analyses and classification and regression trees.
Regression analyses showed that higher avoidance behavior at pretreatment as measured by the Behavioral Avoidance Test-Back Pain (BAT-Back) significantly predicted reduction in global disability (with a small to medium effect), but not in specific disability. Self-report measures failed to predict treatment success for both outcome measures. Classification and regression trees divide subgroups who might benefit from exposure treatment through a BAT-Back score of >22 for Pain Disability Index.
There is some preliminary evidence that pretreatment avoidance behavior might be an indicator for reduction in global disability after exposure treatments in patients experiencing disabling chronic low back pain and elevated fear avoidance. We identified preliminary cutoff scores that need further investigation.
虽然有几种评估运动恐惧的问卷，但仍难以确定哪些人通过暴露治疗对慢性疼痛的获益可能大于其他心理方法，反之亦然。由于对治疗预测因素的了解有限，慢性疼痛的心理治疗方法无法朝着通常所说的“量身定制的方法”推进。我们的目的是评估基于行为观察的回避行为的额外预测价值。
本研究考察了预处理的自我报告和行为测量作为 n=43 名患有致残性慢性下腰痛的患者的治疗结果预测因子，这些患者参加了一项随机对照试验，他们接受了 10-15 次暴露治疗。仅纳入基于自我报告测量存在升高的恐惧回避的患者。使用回归分析和分类回归树分析数据。
回归分析显示，行为回避测试-腰痛（BAT-Back）在预处理时测量的回避行为较高，显著预测全球残疾程度的降低（具有小到中等的效果），但不能预测特定残疾程度的降低。自我报告测量未能预测两种结果测量的治疗成功。分类回归树通过 BAT-Back 得分＞22 对疼痛残疾指数将可能从暴露治疗中获益的亚组进行划分。
有一些初步证据表明，在患有致残性慢性下腰痛和升高的恐惧回避的患者中，暴露治疗前的回避行为可能是全球残疾程度降低的指标。我们确定了需要进一步研究的初步临界分数。
