RESUMEN
OBJECTIVES: The primary aim was to assess the psychometric properties (including internal consistency, construct validity, criterion validity, criterion-group validity and responsiveness) of the Fear of Pain Questionnaire (FOPQ) for adolescents (FOPQ-A) and parents (FOPQ-P) translated to Brazilian Portuguese (BrP). The secondary aim was to analyze the factor structures and their ability to identify subjects with chronic pain conditions and identify the relationship of the BrP FOPQ-A with saliva brain-derived neurotrophic-factor (BDNF). METHODS: A cross-sectional study was conducted with 286 adolescents aged 11 to 18 (257 healthy adolescents [157 females] and 29 adolescents with chronic pain [16 females]). Parents and adolescents completed the BrP-FOPQ. A team of experts translated the FOPQ according to international guidelines. Convergent validity and factor analysis were performed. Later, a subsample (n=146) was used to correlate the BrP-FOPQ-A with saliva BDNF. RESULTS: The BrP-FOPQ for adolescents and parents presented strong psychometric properties (Cronbach's α equal to 0.92 and 0.91, respectively). BrP-FOPQ-A confirmatory factor analysis yielded a two-factor structure while the factorial analyses of BrP-FOPQ-P demonstrated that the best solution was a three-structure factorial. The BrP-FOPQ-P scores in healthy adolescents and those in chronic pain conditions was 34.13 (16.71) vs 43.14 (18.08), respectively. A generalized mixed model demonstrated that the scores in the BrP-FOPQ-A are higher in those with chronic pain conditions compared to healthy subjects (29.20 [12.77] vs 33.80 [10.76], respectively; Wald χ2= 17.80; df=1, P<0.0001). The model revealed that the BDNF was positively correlated with the score of BrP-FOPQ-A and subjects with chronic pain showed higher levels of BDNF. CONCLUSION: The BrP-FOPQ scores for adolescents and parents were found to be psychometrically robust and reliable instruments, with primary evidence of validity. Higher scores on the BrP-FOPQ-A were correlated positively with saliva BDNF and permitted the identification of subjects with chronic pain conditions.
RESUMEN
Revisão sistemática que objetivou avaliar os efeitos das intervenções "Exposição ao Vivo" (EV) e/ou "Atividades Graduais" (AG) sobre a crença de medo e evitação da dor e sobre a incapacidade, em doentes com lombalgia crônica. A estratégia de busca abrangeu seis bases de dados. Os estudos foram comparados de acordo com o desenho, método, resultados, nível de evidência e grau de recomendação. Seis artigos foram analisados, dos quais quatro estudos indicaram que a EV reduziu o medo e evitação da dor e três mostraram redução da incapacidade após a EV, em análise individual de cada paciente. Os estudos de maior nível de evidência e grau de recomendação (2b, B) favorecem a recomendação do uso da "Exposição ao Vivo" para redução do medo e evitação da dor em pacientes com lombalgia crônica. A presença de poucos estudos e as limitações metodológicas encontradas indicam a necessidade de maior investigação sobre o tema.(AU)
The aim of this systematic review was to evaluate the effects of cognitive behavioral interventions "Exposure in Vivo" (EV) and/or "Graded Activity" (GA) to the fear-avoidance beliefs and disability, in chronic low back pain patients. The search strategy was composed by indexed and free terms, had inclusion criteria and included six data bases. The studies were compared considering the design, method, results, evidence level and recommendation grade. Six articles were analyzed: three were randomized control trials and three were single experimental cross case. Four studies indicate that EV reduced fear-avoidance beliefs. Three showed disability reduction after EV in single analyses of each patient. The higher evidence level studies and better recomendation studies (2b, B) support the recommendation of EV to reduce fear-avoidance beliefs in chronic low back pain patients. Considering few studies available and methologic limitations is important to amply the exploration about this theme.(AU)
Asunto(s)
Humanos , Dolor de la Región Lumbar/psicologíaRESUMEN
Revisão sistemática que objetivou avaliar os efeitos das intervenções "Exposição ao Vivo" (EV) e/ou "Atividades Graduais" (AG) sobre a crença de medo e evitação da dor e sobre a incapacidade, em doentes com lombalgia crônica. A estratégia de busca abrangeu seis bases de dados. Os estudos foram comparados de acordo com o desenho, método, resultados, nível de evidência e grau de recomendação. Seis artigos foram analisados, dos quais quatro estudos indicaram que a EV reduziu o medo e evitação da dor e três mostraram redução da incapacidade após a EV, em análise individual de cada paciente. Os estudos de maior nível de evidência e grau de recomendação (2b, B) favorecem a recomendação do uso da "Exposição ao Vivo" para redução do medo e evitação da dor em pacientes com lombalgia crônica. A presença de poucos estudos e as limitações metodológicas encontradas indicam a necessidade de maior investigação sobre o tema.
The aim of this systematic review was to evaluate the effects of cognitive behavioral interventions "Exposure in Vivo" (EV) and/or "Graded Activity" (GA) to the fear-avoidance beliefs and disability, in chronic low back pain patients. The search strategy was composed by indexed and free terms, had inclusion criteria and included six data bases. The studies were compared considering the design, method, results, evidence level and recommendation grade. Six articles were analyzed: three were randomized control trials and three were single experimental cross case. Four studies indicate that EV reduced fear-avoidance beliefs. Three showed disability reduction after EV in single analyses of each patient. The higher evidence level studies and better recomendation studies (2b, B) support the recommendation of EV to reduce fear-avoidance beliefs in chronic low back pain patients. Considering few studies available and methologic limitations is important to amply the exploration about this theme.