MIC of Turkish Pain-related Psychological Measures

Responsiveness and Minimal Important Change of Turkish Pain-Related Psychological Measures in Chronic Non-Specific Low Back Pain

This study evaluates the responsiveness and minimal important change of the Turkish versions of the Fear-Avoidance Beliefs Questionnaire, Tampa Scale for Kinesiophobia, and Pain Catastrophizing Scale in adults with chronic non-specific low back pain undergoing a 4-week rehabilitation program.

Study Overview

• Status: Completed
• Conditions: Chronic Low-back Pain
• Intervention / Treatment: Other: Standardized Rehabilitation Program

Detailed Description

Chronic non-specific low back pain is influenced by biological, psychological, and social factors, including fear-avoidance beliefs, kinesiophobia, and pain catastrophizing. The Fear-Avoidance Beliefs Questionnaire (FABQ), Tampa Scale for Kinesiophobia (TSK), and Pain Catastrophizing Scale (PCS) are commonly used to assess these pain-related psychological constructs.

This prospective, single-cohort measurement-property study evaluates the responsiveness of the Turkish versions of the FABQ, TSK, and PCS and examines their correspondence with patient-perceived global improvement. Participants undergo baseline assessment followed by a standardized 4-week rehabilitation program comprising 16 supervised physiotherapy sessions. Outcomes are reassessed after 4 weeks.

Responsiveness is evaluated using distribution-based indices and associations with the Global Rating of Change (GRC). Receiver operating characteristic analyses are used to examine discrimination between participants classified as improved and not improved and to estimate GRC-defined minimal important change values where appropriate.

• Study Type: Observational
• Enrollment (Actual): 124

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • None Selected
    • Istanbul, None Selected, Turkey (Türkiye), 34750
      • Avicenna Ataşehir Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consisted of adults aged 18-65 years with chronic non-specific low back pain lasting more than 12 weeks without a recognizable specific pathoanatomical cause. Participants were recruited from private hospital outpatient clinics and a university-based physiotherapy laboratory. A total of 124 participants were enrolled, of whom 110 completed the 4-week follow-up assessment. Eligible participants provided written informed consent before enrollment.

Description

Inclusion Criteria:

• Adults aged 18-65 years
• Chronic non-specific low back pain persisting for more than 12 weeks without a recognizable specific pathoanatomical cause
• Ability to read and understand Turkish
• Sufficient cognitive ability to complete self-reported questionnaires, defined as a Standardized Mini-Mental Test score ≥24
• Provision of written informed consent

Exclusion Criteria:

• Radiculopathy
• Spinal infection, tumor, osteoporosis, vertebral fracture, recent trauma, or previous lumbar surgery
• Recent spinal injection
• Systemic disease affecting participation or interpretation
• Cognitive impairment
• Myocardial infarction or cerebrovascular event within the previous 12 weeks
• Previous structured exercise therapy or pain neuroscience education for low back pain
• Refusal of treatment
• Inability to comply with the rehabilitation program

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fear-Avoidance Beliefs Questionnaire (FABQ)	Fear-Avoidance Beliefs Questionnaire (FABQ) assesses fear-avoidance beliefs related to physical activity and work. The questionnaire consists of 16 items. The Physical Activity subscale includes items 2-5 and ranges from 0 to 24, while the Work subscale includes items 6, 7, 9-12, and 15 and ranges from 0 to 42. Higher scores indicate greater fear-avoidance beliefs.	Baseline and 4 weeks
Tampa Scale for Kinesiophobia (TSK)	Tampa Scale for Kinesiophobia (TSK) assesses fear of movement or reinjury. The scale consists of 17 items scored on a 4-point Likert scale. After reverse scoring of the relevant items, total scores range from 17 to 68, with higher scores indicating greater kinesiophobia.	Baseline and 4 weeks
Pain Catastrophizing Scale (PCS)	Pain Catastrophizing Scale (PCS) assesses catastrophic thinking related to pain. The scale consists of 13 items scored on a 0-4 Likert scale and provides Rumination, Magnification, Helplessness, and Total scores. Higher scores indicate greater pain catastrophizing.	Baseline and 4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Intensity - Visual Analog Scale (VAS)	Visual Analog Scale (VAS) was used to assess pain intensity at rest and during activity. Pain intensity was recorded on a 10-cm scale, with higher scores indicating greater pain intensity.	Baseline and 4 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Global Rating of Change (GRC)	Global Rating of Change (GRC) assesses the participant's perceived overall change in condition relative to treatment start. It is rated on a 7-point scale from 1 ("no change or worse") to 7 ("much better, a significant improvement"). Scores of 6-7 were classified as improved and scores of 3-5 as not improved.	4 weeks

Collaborators and Investigators

• Sponsor: Acibadem University
• Investigators: Principal Investigator: Elif E Bayraktar, asst. prof., Acibadem University; Study Chair: Irmak Çavuşoğlu, asst. prof., Kırklareli University; Study Director: Nuray Alaca, assoc. prof., Acibadem University; Study Chair: Yağmur İldeniz, MSc, Acibadem University; Study Chair: Asiye Koçak, Avicenna Ataşehir Hospital

Study record dates

Study Major Dates

• Study Start (Actual): December 9, 2024
• Primary Completion (Actual): March 6, 2026
• Study Completion (Actual): March 6, 2026

Study Registration Dates

• First Submitted: February 14, 2024
• First Submitted That Met QC Criteria: February 14, 2024
• First Posted (Actual): February 21, 2024

Study Record Updates

• Last Update Posted (Actual): September 1, 2026
• Last Update Submitted That Met QC Criteria: August 31, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: Rehabilitation; Chronic Low Back Pain; Kinesiophobia; Pain Catastrophizing; Responsiveness; Minimal Important Change; Fear-Avoidance Beliefs
• Additional Relevant MeSH Terms: Mental Disorders; Phobic Disorders; Anxiety Disorders; Kinesiophobia
• Other Study ID Numbers: 2023-21-705

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be publicly shared due to privacy and ethical restrictions. De-identified data may be available from the corresponding author upon reasonable request and subject to applicable ethical and institutional requirements.