title: Development and Validation of the Behavioral Avoidance Test-Back Pain (BAT-Back) for Patients With Chronic Low Back Pain.
abstract: Pain-related fear and avoidance of physical activities are central elements of the fear-avoidance model of musculoskeletal pain. Pain-related fear has typically been measured by self-report instruments. In this study, we developed and validated a Behavioral Avoidance Test (BAT) for chronic low back pain (CLBP) patients with the aim of assessing pain-related avoidance behavior by direct observation.
  
  
  
  The BAT-Back was administered to a group of CLBP patients (N=97) and pain-free controls (N=31). Furthermore, pain, pain-related fear, disability, catastrophizing, and avoidance behavior were measured using self-report instruments. Reliability was assessed with intraclass correlation coefficient and Cronbach α. Validity was assessed by examining correlation and regression analysis.
  
  
  
  The intraclass correlation coefficient for the BAT-Back avoidance score was r=0.76. Internal consistency was α=0.95. CLBP patients and controls differed significantly on BAT-Back avoidance scores as well as self-report measures. BAT-Back avoidance scores were significantly correlated with scores on each of the self-report measures (rs=0.27 to 0.54). They were not significantly correlated with general anxiety and depression, age, body mass index, and pain duration. The BAT-Back avoidance score was able to capture unique variance in disability after controlling for other variables (eg, pain intensity and pain-related fear).
  
  
  
  Results indicate that the BAT-Back is a reliable and valid measure of pain-related avoidance behavior. It may be useful for clinicians in tailoring treatments for chronic pain as well as an outcome measure for exposure treatments.
authors.affiliation: *Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg †MediClin Clinic for Acute Psychosomatics and Rehabilitation Center Am Hahnberg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Holzapfel
authors.forename: Jenny
authors.initials: J
authors.lastname: Riecke
authors.forename: Winfried
authors.initials: W
authors.lastname: Rief
authors.forename: Jessica
authors.initials: J
authors.lastname: Schneider
authors.forename: Julia A
authors.initials: JA
authors.lastname: Glombiewski
mesh_terms: D001007:Anxiety; D001362:Avoidance Learning; D058443:Catastrophization; D059350:Chronic Pain / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D015928:Cognitive Behavioral Therapy; D003863:Depression; D004185:Disability Evaluation; D005239:Fear; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D011594:Psychometrics; D012044:Regression Analysis; D015203:Reproducibility of Results; D057566:Self Report