Centralization: Prevalence and Effect on Treatment Outcomes Using a Standardized Operational Definition and Measurement Method

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

“…Both FS estimates and FABQ-PA classification are based on item response theory (IRT) methods. 44,61 Literature supports the psychometric and practical strength of the FS scores estimated using the IRT-based lumbar CAT administration, 8,25,30,70,[76][77][78] but additional prospective study is needed to validate whether a single-item screening scale represents the construct of fear-avoidance beliefs of physical activities well. IRT methods are complex, but the advantages are clinically logical and practical.…”

Change in Psychosocial Distress Associated With Pain and Functional Status Outcomes in Patients With Lumbar Impairments Referred to Physical Therapy Services

“…Compared to those with intake and discharge FS data, patients without discharge FS data reported fewer acute symptoms, fewer centralizing symptoms, and more noncentralizing symptoms, 68 and more had high PD risk and were receiving Medicaid benefits (P<.05). Similar analyses indicated (TABLE 3) that there were no meaningful differences in level of fear-avoidance beliefs of physical activities, sex, intake PD risk, or intake pain intensity scores between patients contributing pain data to all analyses and those with missing discharge data (P>.05).…”

“…Similar analyses indicated (TABLE 3) that there were no meaningful differences in level of fear-avoidance beliefs of physical activities, sex, intake PD risk, or intake pain intensity scores between patients contributing pain data to all analyses and those with missing discharge data (P>.05). For patients without discharge pain data, compared to those with intake and discharge pain data, there were more with subacute symptoms, more with no comorbid conditions, fewer with 4 or more comorbid conditions, more with centralizing symptoms, 68 fewer with no surgery, more who were younger patients, and fewer who were receiving HMO, PPO, Medicare, and Medicaid benefits (P<.05). Patients received on average 5.9 visits (n = 655; SD, 2.8; range, 2-19; median, 5.9) over an average episode duration of 28.6 days (n = 656; SD, 20.6; range, 2-205; median, 24.5).…”

“…The eleven variables included for risk adjustment were intake FS, 10,22,24,33,44,46 intake pain intensity, [66][67][68] 44,47 and number of comorbid conditions. 10,21,45 These eleven variables were specifically selected for inclusion in our linear-regression models, because the previously cited studies demonstrated that each variable influenced FS or pain outcomes in predictive models.…”

Letter to the editor on: Hanna B. Albert, Eva Hauge, Claus Manniche (2011) Centralization in patients with sciatica: are pain responses to repeated movement and positioning associated with outcome or types of disc lesions? Eur Spine J. doi:10.1007/s00586-011-2018-9

“…Only 11 of 176 of the analyzed patients had been initially categorized as peripheralizers. Former research shows that not all centralizers are apparent in the initial assessment, some are identified in subsequent assessment sessions [6]. Thus, some of these peripheralizers on day 1 may have subsequently become centralizers and so may distort some of the conclusions on prognosis.…”