Study design. Cross sectional.

Objectives. In literature it has been suggested that a strong relationship exists between psychosocial factors and disability in patients with chronic low back pain (CLBP). However, most studies only focus on self reported disability. This study was performed to analyze the relationship between psychological factors and performance based and self-reported disability, as measured with and Functional Capacity Evaluation (FCE) and the Roland Morris Disability Questionnaire (RMDQ), in patients with CLBP.

Methods. The study was performed in an outpatient rehabilitation setting. The study sample consisted of 92 patients with CLBP admitted for multidisciplinary treatment. Prior to treatment, all patients completed questionnaires to measure psychological factors (distress, depression, self efficacy, fear avoidance, pain cognitions and coping style) and self-reported disability, and performed a standardized set of tests in FCE.

Relationships among the variables were measured by means of Pearson correlation coefficients.

Results. Out of 28 relations analyzed, correlations were either non-significant or weak. Correlations between psychosocial factors and FCE were all non-significant, except for one. Results of subgroups will be presented.

Conclusion. The suggested strong relationship between psychological factors and performance based and self-reported disability measures could not be confirmed in this study. This may implicate that the relationship between psychological factors and disability may not be as unambiguous as suggested for patients with CLBP.

Background Context. In the assessment and treatment of patients with chronic low back pain (CLBP) the bio- psycho-social model is used world wide. Psychological distress has been reported to have a strong relationship with self reported disability. The relationship between psychosocial distress measured with the SCL-90-R and self reported disability measured with the RMDQ has not been investigated.

Purpose. To analyze the relationship between psychosocial distress measured with the Symptom Checklist-90-Revised (SCL-90-R) and self reported disability measured with the Roland Morris Disability Questionnaire (RMDQ) in patients with CLBP.

Study design/Setting. This cross sectional study was performed in an outpatient pain rehabilitation setting.

Patient sample. The study sample consisted of 152 patients with CLBP.

Outcome measures. Scores on SCL-90-R and the RMDQ.

Methods. All patients admitted for multidisciplinary treatment completed the SCL-90-R and RMDQ prior to treatment. Pearson’s correlation coefficients between SCL-90-R (Global Severity Index and subscales) and RMDQ were calculated.

Results. Correlation coefficients between SCL-90-R (Global Severity Index and subscales) and RMDQ ranged from 0.18 to 0.31 (p< 0.05).

Conclusion. The relationship between psychosocial distress measured with the SCL-90-R and self reported disability measured with the RMDQ in CLBP patients is weak. For clinical practice it is important to unravel the components and their suggested relationships in the bio-psycho-social model. This research has demonstrated that these relationships cannot be confirmed with the combined use of the SCL-90-R and the RMDQ. Further research is needed to determine which combination of instruments is most suitable to use in clinical practice, and to confirm or refute the suggested impact of psychosocial distress on self reported disability.

Introduction: Pain related fear and pain intensity have been identified as factors that potentially negatively influence Functional Capacity Evaluation (FCE) performances in patients with chronic low back pain (CLBP). Conflicting results have been reported in the literature. The objective of this study was to analyze the relationships between pain intensity and pain-related fear on the one hand, and performances during an FCE on the other hand in two samples of patients with CLBP.

Methods: Two cross sectional observation studies were performed with two samples of patients with CLBP (study 1: n=79; study 2: n=58). Pain related fears were operationally defined as the score on the Tampa Scale of Kinesiophobia in study 1, and the Fear Avoidance Beliefs Questionnaire (FABQ) in study 2. Pain intensity was measured with a Numeric Rating Scale in both studies. Avoidance behavior observed during FCE was in both studies operationally defined as the unwillingness to engage in high intensity performance levels of three different functional activities: high intensity lifting, prolonged standing in a forward bend position, and fast repetitive bending at the waist.

Results: A total of 25 correlations between pain and pain related fear, and performance variables were calculated, out of which 7 were significant (p< 0.05). The strength of these significant correlations ranged from r=−0.23 to r=−0.50. Multivariate linear regression analyses revealed non-significant relationships in most instances. Pain and pain related fear contributed little if any to these models.

Conclusions: The relation between pain and pain related fear and FCE performance is weak or non-existent in these samples of patients with CLBP. The hypothesis that pain and pain related fear are important factors in FCE performance was not supported in this study. Possible explanations will be discussed during the presentation.

Purpose: Functional Capacity Evaluations (FCEs) are batteries of tests designed to measure patients’ ability to perform work-related activities. Although FCEs are used world-wide, it is unknown how patients’ performances compare between countries or settings. This study was performed to explore similarities and differences in FCE performance of patients with chronic low back pain (CLBP) between three international settings that utilise the same FCE protocol.

Methods: Standardised FCEs were performed on three cohorts of patients with CLBP: a sample from an outpatient rehabilitation context in the Netherlands (n=121), a Canadian sample in a Worker’s Compensation context (n=273), and a Swiss sample in an inpatient rehabilitation context (n=170). Patients were undergoing FCE as part of their usual clinical care. Means and standard deviations of maximum performance on the FCE material handling items were calculated and differences compared using ANO VA. Multivariable linear regression was used to determine the relationship between country of origin and FCE performance while controlling for potential confounders including, age, sex, duration of back pain problems, and self-reported pain and disability ratings.

Results: Compared to the Dutch sample, the mean performance of patients in the Canadian and Swiss samples was consistently lower on all FCE items. This association remained statistically significant after controlling for potential confounders.

Conclusions: Considerable differences were observed between settings in maximum weight handled on the various FCE items. Future FCE research should examine the effects of a number of potentially influential factors, including variability in evaluator judgements across settings, the evaluator-patient interaction and patients’ expectations of the influence of FCE results on disability compensation.

Accepted: Disability & Rehabilitation 2006