McMaster-Toronto Arthritis Patient Preference Disability Questionnaire Sensitivity to Change in Low Back Pain: Influence of Shifts in Priorities

Abstract

ObjectiveTo assess the sensitivity to change of the McMaster Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR) in chronic low back pain (CLBP) and shifts in patients' priorities of disabling activities over time.MethodsA prospective longitudinal survey of 100 patients (38 males) with CLBP in a tertiary care teaching hospital. Evaluation at baseline and 6 months by the MACTAR, Quebec Back Pain Disability Questionnaire (QUEBEC), Hospital Anxiety and Depression scale (HAD), Fear-Avoidance Beliefs Questionnaire (FABQ), Coping Strategies Questionnaire (CSQ), and pain and handicap visual analogue scales (VASs). Patients' perceived improvement or worsening of condition was assessed at 6 months. Effect size (ES) and Standardized response mean (SRM) and effect size (ES) were used to evaluate sensitivity to change of the MACTAR.ResultsThe MACTAR SRM and ES values (SRM = 0.25; ES = 0.37) were among the highest for the instruments evaluated. For patients considering their condition as improved, the SRM was 0.66 and the ES 1. The 3 disability domains, classified by the International Classification of Functioning, Disability and Health (ICF), most often cited as priorities at baseline remained the most cited at follow-up: mobility (40.9% of patients); community, social and civic life (22.7%); and domestic life (22.4%). At 6 months, 48 patients shifted their priorities, for a decrease in MACTAR SRM and ES values for patients considering their condition improved and an increase in these values for those considering their condition deteriorated.ConclusionsAlthough the MACTAR has similar sensitivity to change as other outcome measures widely used in CLBP, shifts in patient priorities over time are common and influence scores and sensitivity to change.

Inflammation-induced decrease in voluntary wheel running in mice: A nonreflexive test for evaluating inflammatory pain and analgesia

“…Similarly, voluntary wheel running could be affected by a decreased willingness to perform the task due to ongoing pain or by the pain induced by movement/impact (mechanical hypersensitivity) of the inflamed tissue during or after the performance of the target behavior. This reflects human patients, whereby a painful condition may induce a loss of motivation and avoidance of activities that may evoke pain in the injured area or that aggravate the pain that they are already suffering [17,33]. Therefore, regardless of the exact mechanistic nature of the changes in weight-bearing or in voluntary wheel running during inflammation, these outcomes might more realistically reflect the “everyday pain experience” as well as the well-being of the mice than the stimulus-evoked reflexes and we assume that the choice of the animal to run or not must reflect in some way its level of discomfort.…”

Measurement properties of patient-specific instruments measuring physical function

“…The Severity of the Main Complaints Scale (SMCS) [81] measures the same construct, as well as the McMaster Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR) does. However, the MACTAR additionally investigates patients' general, emotional, and social health status [82,83].…”

The Patient-Centered Approach in Rheumatologic Painful Diseases: A Narrative Review

“…Catastrophizing can form a feedback loop where the expectation of disability provokes behaviors that support disability, rather than behaviors that confront the problem with positive expectations and activities aimed at recovery [21]. Functional goals, such as the ability to do chores at home, drive, go to work, garden, play sports, and so on, are often more meaningful to the patient than strictly clinical goals, such as achieving certain pain scores or metrics on exercise tests [22]. Clinicians may ask patients to name one or two domains in which their pain limits them: home, work, outdoor activities (including driving, shopping), sports, leisure, and social activities.…”