The patient enablement instrument for back pain: reliability, content validity, construct validity and responsiveness

Nielsen, Anne Molgaard; Hartvigsen, Jan; Kongsted, Alice; Öberg, Birgitta; Enthoven, Paul; Abbott, Allan; Lauridsen, Henrik Hein

doi:10.1186/s12955-021-01758-0

Cited by 8 publications

(5 citation statements)

References 51 publications

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“…A key strength of this study is the rigorous method used to develop the AxEL-Q and evaluate its clinimetric performance, in line with the COSMIN recommendations [ 20 , 22 , 23 ]. Other validated questionnaires designed to measure attitude measure levels of agreement with particular statements [ 15 , 17 , 18 , 49 ], in comparison the AxEL-Q appears to be a more sophisticated measure that considers both cognitive and affective components of attitude. However, with up to seventeen questions, we do not anticipate excessive participant burden.…”

Section: Discussionmentioning

confidence: 99%

Development and measurement properties of the AxEL (attitude toward education and advice for low-back-pain) questionnaire

O’Hagan

Skinner

Jones

et al. 2022

Health Qual Life Outcomes

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Introduction Clinician time and resources may be underutilised if the treatment they offer does not match patient expectations and attitudes. We developed a questionnaire (AxEL-Q) to guide clinicians toward elements of first-line care that are pertinent to their patients with low back pain. Methods We used guidance from the COSMIN consortium to develop the questionnaire and evaluated it in a sample of people with low back pain of any duration. Participants were recruited from the community, were over 18 years and fluent in English. Statements that represented first-line care were identified. Semantic scales were used to measure attitude towards these statements. These items were combined to develop the questionnaire draft. Construct validity was evaluated with exploratory factor analysis and hypotheses testing, comparing to the Back Beliefs Questionnaire and modified Pain Self-Efficacy Questionnaire. Reliability was evaluated and floor and ceiling effects calculated. Results We recruited 345 participants, and had complete data for analysis for 313 participants. The questionnaire draft was reduced to a 3-Factor questionnaire through exploratory factor analysis. Factor 1 comprised 9 items and evaluated Attitude toward staying active, Factor 2 comprised 4 items and evaluated Attitude toward low back pain being rarely caused by a serious health problem, Factor 3 comprised 4 items and evaluated Attitude toward not needing to know the cause of back pain to manage it effectively. There was a strong inverse association between each factor and the Back Beliefs Questionnaire and a moderate positive association with the modified Pain Self-Efficacy Questionnaire. Each independent factor demonstrated acceptable internal consistency; Cronbach α Factor 1 = 0.92, Factor 2 = 0.91, Factor 3 = 0.90 and adequate interclass correlation coefficients; Factor 1 = 0.71, Factor 2 = 0.73, Factor 3 = 0.79. Conclusion This study demonstrates acceptable construct validity and reliability of the AxEL-Q, providing clinicians with an insight into the likelihood of patients following first-line care at the outset.

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Section: Discussionmentioning

confidence: 99%

Development and measurement properties of the AxEL (attitude toward education and advice for low-back-pain) questionnaire

O’Hagan

Skinner

Jones

et al. 2022

Health Qual Life Outcomes

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“…The six-item Patient Enablement Index (PEI) captures patients’ feelings, after a consultation, of confidence and empowerment to cope with their symptoms, to stay healthy and to help themselves 56. To increase sensitivity, versions with more response options than the original four (much better/never/same or less/not applicable) have been reported 57–59. Following our feasibility study, we use a modified seven-point agree-disagree Likert response scale with a not applicable option.…”

Section: Methods and Analysismentioning

confidence: 99%

“…56 To increase sensitivity, versions with more response options than the original four (much better/never/same or less/not applicable) have been reported. [57][58][59] Following our feasibility study, we use a modified seven-point agree-disagree Likert response scale with a not applicable option.…”

Section: Patient Enablementmentioning

confidence: 99%

Talking in primary care (TIP): protocol for a cluster-randomised controlled trial in UK primary care to assess clinical and cost-effectiveness of communication skills e-learning for practitioners on patients’ musculoskeletal pain and enablement

Bishop,

Cross,

Dewar-Haggart

et al. 2024

BMJ Open

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IntroductionEffective communication can help optimise healthcare interactions and patient outcomes. However, few interventions have been tested clinically, subjected to cost-effectiveness analysis or are sufficiently brief and well-described for implementation in primary care. This paper presents the protocol for determining the effectiveness and cost-effectiveness of a rigorously developed brief eLearning tool, EMPathicO, among patients with and without musculoskeletal pain.Methods and analysisA cluster randomised controlled trial in general practitioner (GP) surgeries in England and Wales serving patients from diverse geographic, socioeconomic and ethnic backgrounds. GP surgeries are randomised (1:1) to receive EMPathicO e-learning immediately, or at trial end. Eligible practitioners (eg, GPs, physiotherapists and nurse practitioners) are involved in managing primary care patients with musculoskeletal pain. Patient recruitment is managed by practice staff and researchers. Target recruitment is 840 adults with and 840 without musculoskeletal pain consulting face-to-face, by telephone or video. Patients complete web-based questionnaires at preconsultation baseline, 1 week and 1, 3 and 6 months later. There are two patient-reported primary outcomes: pain intensity and patient enablement. Cost-effectiveness is considered from the National Health Service and societal perspectives. Secondary and process measures include practitioner patterns of use of EMPathicO, practitioner-reported self-efficacy and intentions, patient-reported symptom severity, quality of life, satisfaction, perceptions of practitioner empathy and optimism, treatment expectancies, anxiety, depression and continuity of care. Purposive subsamples of patients, practitioners and practice staff take part in up to two qualitative, semistructured interviews.Ethics approval and disseminationApproved by the South Central Hampshire B Research Ethics Committee on 1 July 2022 and the Health Research Authority and Health and Care Research Wales on 6 July 2022 (REC reference 22/SC/0145; IRAS project ID 312208). Results will be disseminated via peer-reviewed academic publications, conference presentations and patient and practitioner outlets. If successful, EMPathicO could quickly be made available at a low cost to primary care practices across the country.Trial registration numberISRCTN18010240.

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“…This provides feedback that the patient developed valuable skills and gained knowledge likely important for self-manage both ongoing and potential future LBP episodes. An initiative has already been taken through the recent development of the PEI for back pain 210 .…”

Section: Self-care Enablement As a Treatment Mediatormentioning

confidence: 99%

Best Practice Physiotherapy for Patients with Low Back Pain in Primary Care : Clinical Outcomes and Explanatory Factors

Fors

2023

Linköping University Medical Dissertations

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Background: Clinical practice guidelines provide general recommendations informing best practice physiotherapy for low back pain (LBP). Despite increased research on LBP, the recommendations have barely changed over the last few decades and the burden of LBP remains. New research strategies have been suggested to further understand the complexity of factors influencing recovery of LBP. Several mechanisms are expected to underpin the benefits of physiotherapy care. How different factors influence and explain treatment outcome in patients in different phases of primary care pathway needs to be better understood for the development of better targeted LBP interventions.The overall aim of this thesis was to investigate if and how best practice physiotherapy primary care for patients with LBP can improve clinical outcome. Methods:The four papers in the thesis are based on two randomised controlled trials (RCT) evaluating best practice physiotherapy for patients with LBP in different phases of the primary care pathway reflecting the variation of patients´ needs. Two papers investigated pre-surgery physiotherapy compared to being on a waiting-list in patients with degenerative lumbar spine disorders who are surgical candidates (n = 197). Effects on walking ability and quadriceps femoris strength were evaluated. Associations between the pre-surgery physical factors with 1-year post-surgery physical activity (PA) level were analysed using multiple linear regression. The dose-response relationship was investigated comparing the effects of attending £11 treatment sessions with ³12 treatment sessions. Multiple mediation analyses and conditional process analyses were used to explore physical and psychosocial factors as mediators and patients´ treatment expectations as a moderator of the treatment´s effects on disability, back pain intensity, health-related quality of life (HRQoL), and self-rated health.

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The patient enablement instrument for back pain: reliability, content validity, construct validity and responsiveness

Cited by 8 publications

References 51 publications

Development and measurement properties of the AxEL (attitude toward education and advice for low-back-pain) questionnaire

Development and measurement properties of the AxEL (attitude toward education and advice for low-back-pain) questionnaire

Talking in primary care (TIP): protocol for a cluster-randomised controlled trial in UK primary care to assess clinical and cost-effectiveness of communication skills e-learning for practitioners on patients’ musculoskeletal pain and enablement

Best Practice Physiotherapy for Patients with Low Back Pain in Primary Care : Clinical Outcomes and Explanatory Factors

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