Validation of the Brazilian version of Knowledge and Attitudes of Pain questionnaire
Validação da versão brasileira do questionário Knowledge and Attitudes of Pain
Natalie Lange Candido; Maria Gabriela Maziero Capello; Guilherme Prevelato Oliveira; Luciano Maia Alves Ferreira; Laura Pereira Generoso; Josie Resende Torres da Silva; Marcelo Lourenço da Silva
Abstract
BACKGROUND AND OBJECTIVES: Health professionals attitudes and beliefs about musculoskeletal pain have a negative influence on patient beliefs and outcomes. However, there is no gold standard for assessing knowledge and attitudes toward pain among these professionals. Thus, the objective of the present study was to translate, adapt and validate the Knowledge and Attitudes of Pain (KNAP) questionnaire into Brazilian Portuguese (KNAP-Br), apply the questionnaire and analyze the correlation of its results with the Neurophysiological Pain Questionnaire (NPQ).
METHODS: After being translated, back-translated and adapted, the NKAP-Br was applied to 60 physical therapy and medicine students for validation. The correlation between the results obtained by multiplying the scores of the questions of the NKAP-Br instrument and the NPQ was evaluated. To assess reliability, another 200 students responded to the initial KNAP-Br (T1), performed the Pain Education Program (PEP) in one week and one week after T1, the participants received access to answer the KNAP-Br end (T2).
RESULTS: Concurrent validity was assessed by the correlation between NPQ and the final KNAP-Br score. A significant correlation was found between the NPQ result (0.3 and p-value=0.0001) and the KNAP-Br score. Intragroups, 84% improved in the KNAP-Br score after studying PEP, 43.50% improved at or above the minimal detectable difference (MDD) and at or above the minimal important difference (MID).
CONCLUSION: The questionnaire was translated and adapted respecting the Brazilian population cultural aspects and presented satisfactory reliability and construct validity, being considered valid for the assessment of knowledge and the interpretation of pain by health professionals.
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: As atitudes e as crenças dos profissionais de saúde sobre dor musculoesquelética têm influência negativa nas crenças e resultados dos pacientes. Entretanto, não existe um padrão ouro para avaliar o conhecimento e as atitudes relativas à dor entre esses profissionais. Dessa forma, o objetivo deste estudo foi traduzir, adaptar e validar o questionário Knowledge and Attitudes of Pain (KNAP) para a língua portuguesa brasileira (KNAP-Br), aplicar o questionário e analisar a correlação dos seus resultados com o Questionário Neurofisiológico de Dor (QND).
MÉTODOS: Após ser traduzido, retrotraduzido e adaptado, o KNAP-Br foi aplicado em 60 estudantes de fisioterapia ou medicina para validação. Foi avaliada a correlação entre os resultados obtidos pela multiplicação dos escores das questões dos instrumentos KNAP-Br e QND. Para avaliação da confiabilidade, outros 200 estudantes responderam o KNAP-Br inicial (T1), realizaram em uma semana o Programa de Educação em Dor (PED) e uma semana após T1 os participantes receberam acesso para responder o KNAP-Br final (T2).
RESULTADOS: A validade concorrente foi avaliada pela correlação entre QND e o escore final do KNAP-Br. Foi encontrada uma correlação significativa entre o resultado do QND (0,3 e valor de p=0,0001) e o escore do KNAP-Br. Intragrupos, 84% melhoraram no escore do KNAP-Br após estudar PED, 43,50% melhoraram igual ou acima da menor diferença detectável (MDD) e igual ou acima da diferença mínima importante (DMI).
CONCLUSÃO: O questionário foi traduzido e adaptado, respeitando os aspectos culturais da população brasileira, e apresentou satisfatória confiabilidade e validade de constructo, sendo considerado válido para avaliação do conhecimento e para a interpretação da dor por profissionais de saúde.
Palavras-chave
References
1 Carvalho RC, Maglioni CB, Machado GB, Araújo JE, Silva JR, Silva ML. Prevalence and characteristics of chronic pain in Brazil: a national internet-based survey study. BrJP. 2018;1(4):331-8.
2 Alkassabi O, Voogt L, Andrews P, Alhowimel A, Nijs J, Alsobayel H. Risk factors to persistent pain following musculoskeletal injuries: a systematic literature review. Int J Environ Res Public Health. 2022;19(15):9318.
3 Beetsma AJ, Reezigt RR, Paap D, Reneman MF. Assessing future health care practitioners’ knowledge and attitudes of musculoskeletal pain; development and measurement properties of a new questionnaire. Musculoskelet Sci Pract. 2020;50:102236.
4 Gardner T, Refshauge K, Smith L, Mcauley J, Hübscher M, Goodall S. Physiotherapists’ beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies. J Physiother. 2017;63(3):132-43.
5 Darlow B, Perry M, Mathieson F, Stanley J, Melloh M, Marsh R, Baxter GD, Dowell A. The development and exploratory analysis of the Back Pain Attitudes Questionnaire (Back-PAQ). BMJ Open. 2014;4(5):e005251.
6 Moran RW, Rushworth WM, Mason J. Investigation of four self-report instruments (FABT, TSK-HC, Back-PAQ, HC-PAIRS) to measure healthcare practitioners’ attitudes and beliefs toward low back pain: Reliability, convergent validity and survey of New Zealand osteopaths and manipulative physiotherapists. Musculoskelet Sci Pract. 2017;32(1):44-50.
7 Louw A, Zimney K, O’hotto C, Hilton S. The clinical application of teaching people about pain. Physiother Theory Pract. 2016;32(5):385-95.
8 Ashar YK, Gordon A, Schubiner H, Uipi C, Knight K, Anderson Z, Carlisle J, Polisky L, Geuter S, Flood TF, Kragel PA, Dimidjian S, Lumley MA, Wager TD. Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: a randomized clinical trial. JAMA Psychiatry. 2022;79(1):13-23.
9 Eneberg-Boldon K, Schaack B, Joyce K. Pain Neuroscience education as the foundation of interdisciplinary pain treatment. Phys Med Rehabil Clin N Am. 2020;31(4):541-51.
10 Alcon CA, Wang-Price S. Non-invasive brain stimulation and pain neuroscience education in the cognitive-affective treatment of chronic low back pain: evidence and future directions. Front Pain Res (Lausanne). 2022;3:959609.
11 Rheel E, Heathcote LC, Van Der Werff Ten Bosch J, Schulte F, Pate JW. Pain science education for children living with and beyond cancer: Challenges and research agenda. Pediatr Blood Cancer. 2022;69(8):e29783.
12 Vicente-Mampel J, Gargallo P, Bautista IJ, Blanco-Gímenez P, de Bernardo Tejedor N, Alonso-Martín M, Martínez-Soler M, Baraja-Vegas L. Impact of pain neuroscience education program in community physiotherapy context on pain perception and psychosocial variables associated with it in elderly persons: a ranzomized controlled trial. Int J Environ Res Public Health. 2022;19(19):11855.
13 Domenech J, Sánchez-Zuriaga D, Segura-Ortí E, Espejo-Tort B, Lisón JF. Impact of biomedical and biopsychosocial training sessions on the attitudes, beliefs, and recommendations of health care providers about low back pain: a randomised clinical trial. Pain. 2011;152(11):2557-63.
14 Pincus T, Vogel S, Santos R, Breen A, Foster N, Underwood M. The attitudes to back pain scale in musculoskeletal practitioners (abs-mp): the development and testing of a new questionnaire. Clin J Pain. 2006;22(4):378-86.
15 Ung A, Salamonson Y, Hu W, Gallego G. Assessing knowledge, perceptions and attitudes to pain management among medical and nursing students: a review of the literature. Br J Pain. 2015;10(1):8-21.
16 Desconsi M, Bartz P, Fiegenbaum T, Candotti C, Vieira A. Tratamento de pacientes com dor lombar crônica inespecífica por fisioterapeutas: um estudo transversal. Fisioter Pesqu. 2019;26(1):15-21.
17 Magalhães M, Costa L, Cabral C, Machado L. Attitudes and beliefs of Brazilian physical therapists about chronic low back pain: a cross-sectional study. Rev Bras Fisioter. (São Carlos (São Paulo, Brazil)). 2012;16:248-53.
18 Nery A, Barbosa M, Souza A, Petto J. Conhecimento dos acadêmicos e profissionais da fisioterapia sobre dor: uma revisão sistemática. ABCS Health Sciences. 2017;42.
19 Mutsaers JHaM, Peters R, Pool-Goudzwaard AL, Koes BW, Verhagen AP. Psychometric properties of the Pain Attitudes and Beliefs Scale for Physiotherapists: a systematic review. Man Ther. 2012;17(3):213-8.
20 Eland ND, Kvåle A, Ostelo R, De Vet HCW, Strand LI. Discriminative validity of the pain attitudes and beliefs scale for physical therapists. Phys Ther. 2019;99(3):339-53.
21 Ferreira PH, Ferreira ML, Latimer J, Maher CG, Refshauge K, Sakamoto A, Garofalo R. Attitudes and beliefs of Brazilian and Australian physiotherapy students towards chronic back pain: a cross-cultural comparison. Physiother Res Int. 2004;9(1):13-23.
22 Rainville J, Bagnall D, Phalen L. Health care providers’ attitudes and beliefs about functional impairments and chronic back pain. Clin J Pain. 1995;11(4):287-95.
23 Moseley L. Unraveling the barriers to reconceptualization of the problem in chronic pain: the actual and perceived ability of patients and health professionals to understand the neurophysiology. J Pain. 2003;4(4):184-9.
24 Catley MJ, O’connell NE, Moseley GL. How good is the neurophysiology of pain questionnaire? A rasch analysis of psychometric properties. J Pain. 2013;14(8):818-27.
25 Svendsen MJ, Nicholl BI, Mair FS, Wood K, Rasmussen CDN, Stochkendahl MJ. One size does not fit all: Participants’ experiences of the selfBACK app to support self-management of low back pain-a qualitative interview study. Chiropr Man Therap. 2022;30(1):41.
26 Kanaan SF, Alhendi ZM, Almhdawi KA, Aldahamsheh Z, Ismail N, Khalil H. Evaluating the effectiveness of a comprehensive education on low back pain treatment outcomes: a controlled clinical study. Clin Rehabil. 2023;37(1):98-108.
27 Nogueira L, Chaves A, Oliveira N, Almeida R, Reis F, Andrade F, et al. Cross-cultural adaptation of the Revised Neurophysiology of Pain Questionnaire into Brazilian Portuguese language. J Bras Psiquiatr. 2018;67(4):273-7.
28 Wellingerné Galambos K, Szok D, Csabai M. A clinical study of an online educational programme for chronic pain patients. Ideggyogy Sz. 2019;72(11-12):413-8.
29 Revicki D, Hays RD, Cella D, Sloan J. Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol. 2008;61(2):102-9.
30 van Kampen DA, Willems WJ, van Beers LW, Castelein RM, Scholtes VB, Terwee CB. Determination and comparison of the smallest detectable change (SDC) and the minimal important change (MIC) of four-shoulder patient-reported outcome measures (PROMs). J Orthop Surg Res. 2013;8:40.
31 Pilatt L, Pedroso B, Gutierrez G. Propriedades psicométricas de instrumentos de avaliação: um debate necessário. RBECT. 2010;3(1):81-91.
32 Campos M, Leal Mdo C, Souza PR Jr, Cunha CB. Consistency between data sources and inter-observer reliability in the study on neonatal and perinatal morbidity and mortality and care in the city of Rio de Janeiro. Cad Saúde Pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública. 2004;20(Suppl 1):S34-43.
Submitted date:
08/18/2022
Accepted date:
02/15/2023
Facebook
Google+
Twitter
LinkedIn
Mendeley
Email