title: Development and Validation of a Pain Behavior Assessment in Patients with Chronic Low Back Pain.
abstract: OBJECTIVE
  High levels of pain behavior adversely affect the success of multidisciplinary rehabilitation of patients with chronic nonspecific low back pain (CNSLBP). Functional capacity evaluation (FCE) assessment should detect high levels of pain behavior to prevent the inclusion of unsuitable patients to functional rehabilitation programs. The aim of this study was to develop a Pain Behavior Assessment (PBA) and to evaluate its construct validity.
  
  
  METHODS
  The PBA was developed by experts in the field and is literature-based. Inclusion criteria for participants of the validation study were: CNSLBP, age 20-60 years, referral for fitness-for-work evaluation. The PBA was applied by physiotherapists during FCE. Rasch analysis was performed to evaluate the construct validity of the PBA. Internal consistency was indicated by the person separation index (PSI), which corresponds to Cronbach's alpha.
  
  
  RESULTS
  145 male (72.5%) and 55 female patients were included. Rasch analysis removed 11 items due to misfit and redundancy, resulting in a final PBA of 41 items. Item mean fit residual was -0.33 (SD 1.06) and total item Chi square 100.39 (df = 82, p = 0.08). The PSI value was 0.83. DIF analysis for age and gender revealed no bias.
  
  
  CONCLUSIONS
  The PBA is a valid assessment tool to describe pain behavior in CNSLBP patients. The high PSI-value justifies the use of the PBA in individuals. The PBA may help to screen patients for high levels of pain behavior.
authors.affiliation: Physiotherapy and Occupational Therapy, University Hospital Zurich, U OST 153, Gloriastr. 25, 8091, Zurich, Switzerland. Katharina.Meyer@usz.ch.
authors.forename: Katharina
authors.initials: K
authors.lastname: Meyer
authors.affiliation: Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland. klipstein@aeh.ch.|Center of Occupational Health, Militärstrasse 76, 8004, Zurich, Switzerland. klipstein@aeh.ch.
authors.forename: Andreas
authors.initials: A
authors.lastname: Klipstein
authors.affiliation: Research Department and Department of Rheumatology, Rehabilitation Centre Valens, 7317, Valens, Switzerland. peter.oesch@kliniken-valens.ch.
authors.forename: Peter
authors.initials: P
authors.lastname: Oesch
authors.affiliation: Department of Work Rehabilitation, Rehaklinik Bellikon, Suva Care, 5454, Bellikon, Switzerland. beatrice.jansen@rehabellikon.ch.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Jansen
authors.affiliation: Research Department and Department of Rheumatology, Rehabilitation Centre Valens, 7317, Valens, Switzerland. jan.kool@kliniken-valens.ch.|Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, 8400, Winterthur, Switzerland. jan.kool@kliniken-valens.ch.
authors.forename: Jan
authors.initials: J
authors.lastname: Kool
authors.affiliation: Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, 8400, Winterthur, Switzerland. nika@zhaw.ch.
authors.forename: Karin
authors.initials: K
authors.lastname: Niedermann
mesh_terms: D000328:Adult; D059350:Chronic Pain; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000145:classification* / Q000523:psychology / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D062707:Return to Work
keywords: Chronic pain; Low back pain; Pain measurement; Reproducibility of results; Return to work