III.

The beliefs and attitudes of health care providers may contribute to chronic low back pain (LBP) disability, influencing the recommendations that they provide to their patients. An excessively biomedical style of undergraduate training can increase negative beliefs and attitudes about LBP, whereas instruction following a biopsychosocial model could possibly lessen these negative beliefs in health care professionals. The objectives of this study were to determine the effectiveness of 2 brief educational modules with different orientations (biomedical or biopsychosocial) on changing the beliefs and attitudes of physical therapy students and the recommendations that they give to patients. The intervention in the experimental group was based on the general biopsychosocial model, whereas the sessions in the control group dealt with the basics of the biomechanics of back pain. The participants completed the Fear-Avoidance Beliefs Questionnaire (FABQ), Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), and Rainville et al. Clinical Cases questionnaire before and after the interventions. The participants attending the biopsychosocial session displayed a reduction in fear-avoidance beliefs (P<.001) and Pain-Impairement beliefs (P<.001), which was strongly correlated with an improvement in clinicians' activity and work recommendations. However, the students assigned to the biomechanics sessions increased their fear-avoidance scores (P<.01), and their recommendations for activity levels worsened significantly (P<.001). Our results confirm the possibility of modifying the behaviour of students through the modification of their beliefs and attitudes. We also conclude that a strictly biomedical education exacerbates maladaptive beliefs, and consequently results in inadequate activity recommendations. The implications of this study are important for both the development of continuing medical education and the design of the training curriculum for undergraduate students.

Purpose The purpose of the study was to investigate if changes in psychological variables are related to the outcome in pain and disability in patients with chronic anterior knee pain. Methods A longitudinal observational study on 47 patients with chronic anterior knee pain was performed in a secondary healthcare setting. Pain was measured with the visual analogue scale and disability with the Lysholm scale. The psychological variables, such as anxiety, depression, pain coping strategies, catastrophizing and fear to movement beliefs, were studied by using self-administered questionnaires. Results Among the pain coping strategies, only the catastrophizing subscale showed a significant reduction. Similarly, anxiety, depression and kinesiophobia were significantly reduced after treatment. Those patients who decreased the catastrophizing, kinesiophobia, anxiety and depression showed a greater improvement in pain and disability after a purely biomedical treatment. A multiple regression analysis revealed that changes in catastrophizing predicted the amount of improvement in pain severity and that changes in both catastrophizing and anxiety predicted changes in disability after treatment. Conclusion What has been found suggests that clinical improvement in pain and disability is associated with a reduction in catastrophizing and kinesiophobia. Therefore, co-interventions to reduce catastrophizing thinking and kinesiophobia may enhance the results. Level of evidence Prospective Cohort Study, Level I for prognosis.

Well-being research and its measurement have grown in the last two decades. The objective of this study was to adapt and validate the Flourishing Scale in a sample of Spanish adults. This was a cross-sectional study using a non-probabilistic sample of 999 Spanish general adult population participants. The psychometric properties of the scale were analysed from an exploratory and confirmatory perspective. Exploratory factor analysis showed a one-factor solution explaining 42.3% of the variance; an internal consistency of .846; temporal reliability correlation of .749; convergent validity with the Satisfaction with Life Scale of .521 and criterion validity with positive and negative affect (PANAS), pessimism and optimism (LOT-R) ranging from .270 to .488. Confirmatory factor analysis testing the one-factor solution showed a χ 2 of 65.57 df = 20; CFI of .982, RMSEA of .06, average variance extracted index of .518 and composite reliability index of .841. Results showed that the Spanish version of the FS is a reliable and valid method for measuring high levels of well-being.

Introduction The Satisfaction with Life Scale (SWLS) has shown strong evidence of acceptability, reliability, validity and invariance for gender, whereas there is mixed evidence of invariance by culture and age and the literature has not explored the roles of marital status and educational level. The SWLS should be invariant by marital status and educational level to be able to compare scores between groups. We aimed to explore the invariance of the SWLS by marital status and educational level. Method A convenience sample of 726 Spanish adults participated in a survey. We tested a one-factor model using confirmatory factor analysis. We tested the configural, metric and scalar invariance of the factorial structure of the SWLS by gender, age, marital status and level of education. Results The results show a scalar invariance by gender and educational level and a partial scalar invariance by marital status. Women and individuals in a relationship show greater subjective well-being while no differences are observed among people with different educational levels. Discussion The SLWS is valid for comparisons between genders, age, educational levels but not for marital status. It is essential to verify its invariance to interpret mean differences and significance values appropriately.