FMC Test 2 Units 4-7 *Psychosocial Aspects of Care* Flashcards
When screening for yellow flags, how do you know “which tools” to use?
Firstly we must do a direct observation:
- Posture
- Movement patterns
- Verbalization
Then a subjective exam:
- Which are the standardized screening tools
– There are Unidimensional Tools and Multidimensional Tools
What are some examples of Unidimensional Tools(8)?
What are some advantages and disadvantages?
Examples of Unidimensional Tools:
- FABQ (Fear Avoidance Beliefs Questionnaire)
- TSK-11 (Tampa Scale-11
- Chronic Pain-Acceptance Questionnaire
- Depression Screening Questions
Advantages:
- These tools are designed to robustly assess the domain question
Disadvantages:
- Only provide date regarding a specific domain
– Need to conduct multiple outcome measures
What are some examples of Multidimensional Tools (2)? What are some advantages and disadvantages?
Examples of Multidimensional Tools:
- OSPRO-YF
- Örebro Musculoskeletal pain Questionnaire
Advantages:
- Designed to provide preliminary data over multiple dimensions
Disadvantages:
- May not be robust enough to identify presence of yellow flags (False Negatives)
- Does not provide enough detail when yellow flags identified
When screening for Yellow Flags, “Which Patients” should be screened?
When screening patiets what is recommended?
You can go 2 routes
- All Patients: This reduces risk of
missing someone while increasing therapist workload and number of false-positives.
OR - Select patient groups: Need to determine criteria for when to administer screening process
(This amount to a wait and see approach)
–Higher risk of delaying appropriate psychological rehabilitation principles
–Reduced benefits from delayed therapy
Its Recommend to use a 2-step Screening Process
- Use of Multidimensional tools at Initial Assessment
-Then Provide specific Unidimensional tools based on findings
When Screening for Yellow Flags, “How Often” should patients be screened?
Screening yellow flags throughout POC is recommended
- Assess program with psychological informed PT
–Need to continue, modify, of cease
- Identify emerging yellow flags not present at time of initial patient encounter
- Reassessment every 2 weeks recommended
–Balance between barriers to screen administration and minimal detectible changes
When screening for Yellow Flags, what process should you use in the Initial Screening?
Implement 2-step screening process
- Multidimensional tools followed by Unidimensional
–OSPRO-YF
–Örebro Musculoskeletal Pain Questionnaire (Short form)
–Keele STarT Back Tool (Back screening tool)
- Two step process informed by subjected interview and clinical observations
What screening for Yellow Flags, what takes part in the Subjective Exam?
What should we avoid?
What should we being with?
A clinical Interview: This provides valuable information not assessed on standardized outcomes
–Patient’s affective behaviors, verbalizations, body-language
- Avoid using questions beginning with “Why”
–This places the patient on the defensive and reinforces previous established unhelpful psychosocial beliefs
–Use questions that begin with “what”, “when”, or “how”
-This often provides more detailed answers than “why” questions
What are Common Psychosocial Yellow Flags? (4)
- Behaviors: Extended rest, withdrawn from social life, alcohol consumption, smoking, excessive reliance on passive modalities, reports of extremely high pain levels
- Work: Job dissatisfaction, problems with peers or supervisors, high physical demands, low SES
- Emotions: Fear of increased pain with activity/therapy, depression, irritability
- Diagnosis and Treatment: Conflicting diagnosis, language promoting fear and catastrophizing, expectation of “quick-fix”
What are Overt Pain Behaviors? (5)
Individuals may demonstrate any number of specific behaviors when experiencing pain
- Guarding: abnormally stiff, or rigid movement when changing positions
- Bracing: Maintaining a fully extended limb for weight bearing/acceptance
- Rubbing: Any contact between hand and injured area
- Grimacing: Obvious facial expressions including narrowed eyes, brow furrow, tightened lips
- Sighing: Obvious exaggerated exhalation of air, exemplified by shoulders rising and falling, may see cheeks puff
What is the OSPRO-YF screening tool used for?
What are the 3 things it screens?
Assesses multiple dimensions of pain-associated psychological distress.
- Negative Mood: Presence of depression, anxiety, and/or anger in patients with pain
- Fear Avoidance: Individual is fearful of movement or believes moving may cause more damage; anxiety; catastrophizing, kinesiophobia
- Positive effect/coping: degree individuals accept their pain, self-efficacy beliefs in themselves to overcome the pain and/or participate in rehab program
There are 3 versions: a 17 item, 10 item, and 7 item
What are the pros of the OSPRO-YF screening tool? (4)
- Concise screening tool
- Reliable for multiple body regions
–C-spine, L-spine, shoulder, knee - Assesses multiple pain associated psychological distress dimensions
- Accurately predicts patient score on multiple standardized psychological tools
–Negates need for patient to full out multiple tools
What are the cons of the OSPRO-YF screening tool?
(2)
- Some items require score conversion
- Regression weights provided in study are needed to determine if patient meets cut-off scores or to determine predicted scores of other tools
–Computerized scoring
What is the “Clinical Utility” for the OSPRO-YF screening tool? (3)
- 17 and 10 item versions recommended for clinical use
- The 17-item better distinguishes fear avoidance and pain catastrophizing
–10-item identifies negative coping but not good at differentiating - Proposes alternative scoring method
(No score conversions required, no need for regression tables)
What is the Örebro Musculoskeletal Pain Questionnaire (OMPSQ-10)? (4)
- Shorter form of the questionnaire (10-items vs 25-items)
- Assesses multiple psychological domains
– Pain, distress/anxiety, fear avoidance, self-perceived function, return to work expectancy - As accurate as long form
- Score 0-100
–Scores greater than 50 represent increased risk for future work disability
What is the STarT Back Tool?
- Valid tool for assigning risk of developing chronic LBP (Low, Medium, High)
- 9-items related to multiple dimensions
–Pain catastrophizing, fear, anxiety, depression
- Agree=1 point Disagree=0 points - Total score 3 or less = low risk
- Total score 4 or more =
–subscore items 5-9
- Subscore 3 or less = medium risk
- Subscore 4 or more = high risk
What are 3 Unidimensional outcome measures that are Negative Mood Measures?
- Patient Health Questionnaire
- State-Trait Anxiety Inventory
- State-Trait Anger Expression Inventory
What is the Patient Health Questionnaire? (Unidimensional)
- PHQ-9
–9 item scale
–Score 0-27
- Higher score = higher depressive symptoms
What is the State-Trait Anxiety Inventory?
(Unidimensional)
- 20 item scale
–Score 20-80
–Higher score = higher levels of anxiety
What is the State-Trait Anger Expression Inventory (STAXI)? (Unidimensional)
- 10 item scale
–Score 10-40
–Higher score indicates higher levels of anger
What are 4 Unidimensional outcome measures that are Fear Avoidance Measures?
-FABQ
- Pain Catastrophizing Scale
- Tampa Scale of Kinesiophobia-11
- Pain Anxiety Symptom Scale-20
What is the FABQ Tool?
- The “Fear Avoidance Based Questionnaire” Developed by Waddell
- Consist of 16-items
- Has 2 subscales
- Predictive of Outcomes
–FABQ-Pa (Physical Activity) > 15 considered high
–FABQ-W > 34 was associated with deceased return to work 4 weeks after initial exam
-LR+ = 3.33
(Certain items should not be included in final scoring: Item 1 in PA, and Item 8,13,14 in W) - Guide Treatment
– High FABQ score = Active exercise program
– Low FABQ score = Manual Therapy
What is the Pain Catastrophizing Scale?
Developed by Sullivan, Bishop and Pivik (Idk if we need this
- 13-item questionnaire
– 0-52; Higher scores = Higher Pain Catastrophizing
- Assesses the degree of negative attitude/catastrophizing a patient may display in the presence of pain or anticipation of pain onset
What is the Tampa Scale of Kinesiophobia-11?
- A shortened version of the TSK (17 items)
– Higher scores = greater fear of movement and/or injury / re-injury
– Found to be as reliable and responsive to change as the long form
What is the Pain Anxiety Symptoms Scale-20?
- A 20 item scale measuring pain-related anxiety
–Score 0-100, Higher score = higher levels of pain-related anxiety
