Cross-cultural adaptation, validation and psychometric evaluation of the International Hip Outcome Tool 12 (iHOT12) to Hebrew.

BACKGROUND: The "International Hip Outcome Tool 12" (iHOT12) is a self-administered patient-reported outcome tool for measuring health-related quality of life and physical functioning in young and active patients with hip pathology. Since the iHOT12 has become widely used, we sought to translate and validate it for Hebrew-speaking populations. The aims of this study were: (1) To translate and culturally adapt the iHOT12 into Hebrew using established guidelines. (2) To test the new Hebrew version for validity, and (3) reliability. METHODS: The iHOT12 was translated and culturally adapted from English to Hebrew (iHOT12-H) according to the COSAMIN guidelines. For validity, the iHOT12-H and Western Ontario and McMaster universities osteoarthritis index (WOMAC) were completed by 200 patients with hip pathology. Exploratory factor analysis was used to assess structural validity. Subsequently, 51 patients repeated the iHOT12-H within a 2-week interval. Intraclass Correlation Coefficient (ICC), Cronbach alpha, and Standard Error of Measurement (SEM) were calculated to assess reliability. RESULTS: Construct validity: iHOT12-H correlated strongly to the WOMAC scores (r = -0.82, P < 0.001, Spearman). Factor analysis revealed a two-factor structure. Cronbach's alpha was 0.953 confirming internal consistency to be highly satisfactory. Test-retest correlation of the iHOT12-H was excellent with an ICC = 0.956 (95% CI 0.924-0.974). There was no floor or ceiling effect. CONCLUSION: The iHOT12 Hebrew version has excellent reliability, good construct validity and can be used as a measurement tool for physical functioning and quality of life in young, physically active patients with hip pathology. This study will serve Israeli researchers in evaluating treatment effectiveness for these patients. Moreover, it will also enable multinational cooperation in the study of hip pathology.

Qualitative exploration of physical therapists' experiences providing telehealth physical therapy during COVID-19.

BACKGROUND: Physical therapists are trained to provide treatment to patients through a mixture of strategies. The coronavirus (COVID-19) pandemic resulted in social distancing restrictions, and physical therapists, some without previous experience, adopted telehealth physical therapy modalities to treat their patients. OBJECTIVES: The objective of this study was to explore physical therapists' experiences of providing telehealth physical therapy during the COVID-19 pandemic. DESIGN AND METHODS: A multisite qualitative semi-structured interview study was conducted. Seventeen physical therapists were interviewed by videoconference or by phone, and the interviews were transcribed and analyzed thematically. RESULTS: Three main themes emerged from the study. Firstly, physical therapists experienced professional challenges with diagnosing and treating patients hands-off and becoming more verbal. Secondly, telehealth physical therapy was perceived as not feasible or effective for certain patients, attesting to the digital care divide. Lastly, participants' perceptions of patient-therapist communication varied, expressing both communicative advantages and challenges. CONCLUSIONS: Physical therapists who practiced telehealth physical therapy during the COVID-19 period experienced information and communication technology as professionally challenging. Physical therapists adapted positively to the use of telehealth physical therapy but perceived that not every patient could benefit from it. The study emphasized the need for a better understanding of physical therapists' hands-off skills for practicing telehealth physical therapy and considers the need to establish a patient classification for telehealth physical therapy.

Predicting persisting disability in musculoskeletal pain patients with the STarT MSK screening tool: Results from a prospective cohort study.

BACKGROUND: The STarT MSK screening tool aims to categorise musculoskeletal patients into three risk groups for treatment stratification. The tool has been translated and validated into Hebrew. However, its ability to predict persistent disability in patients has yet to be evaluated. OBJECTIVE: The primary aim of this study was to assess the ability of the Hebrew version of the STarT MSK tool to predict persistent disability in patients experiencing musculoskeletal pain. METHODS: A prospective observational cohort study was conducted, recruiting 135 patients with musculoskeletal pain in five common areas: back, neck, shoulder, knee, or multisite pain over the age of 21. At the first consultation, all patients completed demographic information, the Focus On Therapeutic Outcomes (FOTO) questionnaire (function, pain, and fear avoidance score), and the STarT MSK questionnaire. The patients completed the FOTO questionnaire again at the end of the physiotherapy treatments. RESULTS: 25 patients (18.5%) were classified into the low-risk group, 68 patients (50.3%) into the medium-risk group, and 42 (31.1%) into the high-risk group. The baseline STarT MSK tool score demonstrated an excellent ability to identify patients at high risk of developing persistent disability (AUC = 0.795, 95% CI 0.716-0.873). CONCLUSIONS: The Hebrew version of the STarT MSK tool can differentiate between three chronic risk groups and has high predictive validity for chronicity. This may provide a tool to assist clinicians in identifying patients who require more intensive care, and thus, potentially prevent the transition to chronic disabling pain.

Cross-cultural adaptation, reliability, and validity of the pain self-efficacy questionnaire - Hebrew version.

PURPOSE: This study aims to translate, culturally adapt, and evaluate the psychometric properties of the Hebrew Pain Self-Efficacy Questionnaire (PSEQ). METHODS: The study was designed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations for patient-reported outcome measurement instruments. The PSEQ was initially translated into Hebrew and cross-culturally adapted. The Hebrew version of the PSEQ (PSEQ-H) was administered to participants suffering from chronic musculoskeletal pain, along with other self-report measures of pain (NPRS, FABQ, HADS, PCS, and SF-12). Eight hypotheses on expected correlations of the PSEQ-H with other instruments were formulated a priori to assess construct validity. Structural validity was assessed using confirmatory factor analysis. Floor and ceiling effects, test-retest, and internal consistency reliability were also assessed. RESULTS: The translation process retained the unidimensional model of the PSEQ. The PSEQ-H demonstrates excellent internal consistency (Cronbach's α = 0.97) and test-retest reliability (ICC = 0.88), and no significant floor and ceiling effects were observed. Construct validity was found satisfactory as 75% (six) of the analyses between the PSEQ-H and the other self-reported measures met the hypotheses. Factor analysis confirmed the single-factor structure of the questionnaire. CONCLUSIONS: The PSEQ-H version was found to have excellent reliability, good construct, and structural validity, and can be used with heterogeneous chronic musculoskeletal pain populations. Future studies should test the PSEQ-H's responsiveness and psychometric properties with specific pain populations.

Impact of an Enhanced Transtheoretical Model Intervention (ETMI) Workshop on the Attitudes and Beliefs Regarding Low Back Pain of Primary Care Physicians in the Israeli Navy.

Low back pain (LBP) is a major cause of discomfort and disability. Physicians' attitudes and beliefs influence the way patients with LBP are diagnosed and treated. The objective of the study is the assessment of military primary care physicians' attitudes towards LBP and the effect of an enhanced transtheoretical model intervention (ETMI) workshop on them. We evaluated the impact of a 90-min ETMI workshop on the attitudes and beliefs of primary care physicians in the Israeli Navy on LBP. Outcomes were assessed using the Attitudes to Back Pain Scale in Musculoskeletal Practitioners questionnaire (ABS-mp). Participants responded before and after the workshop, and responses were compared to a control group of primary care physicians in the Air and Space Force. The intervention group included 22 participants and the control group included 18 participants. Both groups were heterogenic (gender, age, seniority). In both groups, primary care physicians reported the common use of non-steroidal anti-inflammatory drugs (NSAIDs) and over-the-counter (OTC) pain medications and often included physical activity and physiotherapy in the treatment plan. Physicians mentioned reassurance and suggestions of early return to physical activity as part of their appointment. There was a positive correlation between questionnaire items suggesting the physician tended to a biomedical approach and reporting the use of imaging modalities (r = 0.451, p = 0.005). After attending the workshop, physicians were significantly more likely to recommend an early return to physical activity (18 ± 0.48 vs. 16.4 ± 0.52, p = 0.04). An ETMI workshop had a minor impact on the attitudes and beliefs of primary care physicians regarding LBP, but a statistically significant impact was noted on return to physical activity recommendations. These findings may be important in the military setting.

Physiotherapists' perceptions of implementing evidence-based practice for patients with low back pain through the Enhanced Transtheoretical Model Intervention: a qualitative study.

BACKGROUND: Physiotherapists have been urged to implement evidence-based practice for the management of low back pain (LBP). However, recent evidence suggests that many fail to do so, specifically in accordance with eliciting and addressing psychosocial factors that impact pain. The Enhanced Transtheoretical Model Intervention (ETMI) for the Treatment of patients with LBP was developed in Israel according to the clinical guidelines and demonstrated clinically and cost-effectiveness. OBJECTIVES: This study's purpose is to explore physiotherapists' perceptions of implementing evidence-based practice through the ETMI approach. DESIGN: Qualitative study. METHODS: Qualitative semi-structured interviews were conducted with 26 physiotherapists. The interviews were audio-recorded, transcribed, coded, and analyzed thematically to identify prevalent themes. RESULTS: Three main themes were identified from the transcripts, consisting of barriers and facilitators of implementing the intervention, and a meta-theme referring to shifts in the perceptions of professional role and identity. CONCLUSION: The findings suggest that physiotherapists believed that implementing ETMI and adopting a psychosocial approach to LBP can be achieved by overcoming issues around communication skills, patient reassurance, and inter-professional collaboration. Therapists also highlighted the need for physiotherapy training to gain skills in combined physical and psychological approaches.

Cross-cultural adaptation and validation of the Hebrew version of the Injustice Experience Questionnaire - long and short versions.

PURPOSE: To translate, validate, and culturally adapt the Injustice Experience Questionnaire (IEQ) and IEQ Short Form (IEQ-SF) into Hebrew, as measuring tools for examining feelings of injustice in cases of accidents and chronic pain. METHODS: The translation was performed in several steps following the cross-cultural adaptation process. A sample of 150 patients suffering from traumatic injury fill out a battery of questionnaires: IEQ, IEQ-SF, Hospital Anxiety and Depression Scale (HADS), Numeric Pain Rating Scale (NPRS), and Pain Catastrophizing Scale (PCS), which were used for calculating construct validity. A test-retest was performed on 41 patients. RESULTS: The IEQ and IEQ-SF found Cronbach's alpha of 0.92 and 0.84, respectively. Test-retest reliability for IEQ (ICC: 0.94) was found to be excellent. Spearman's correlation coefficient between IEQ and PCS was 0.68, NPRS (severe pain: 0.45, average pain: 0.51), HADS (anxiety: 0.62, depression: 0.60). The correlation between IEQ-SF and PCS was 0.67, with HADS (anxiety: 0.52, depression: 0.48). A weak correlation was found for NPRS (severe pain: 0.30, average pain: 0.34). CONCLUSIONS: The Israeli translation and cross-cultural adaptation of the IEQ and IEQ-SF questionnaires were found to be valid and reliable.Implications for rehabilitationThe perception of injustice is a significant mental and psychological factor for recovery after accidents and injuries.This study translated, validated and culturally adapted the Injustice Experience Questionnaire (IEQ) and the short form into Hebrew.The questionnaires were found to be valid and reliable in Hebrew.

Verbal Instruction for Pelvic Floor Muscle Contraction among Healthy Young Males.

Teaching Pelvic Floor Muscle (PFM) contraction is a challenging task for clinicians and patients, as these muscles cannot be directly visualized. Thus, this study's objective is to compare the effectiveness of six verbal instructions for contracting the PFM among young men, as observed with transabdominal ultrasound imaging. Thirty-five male physiotherapy students, mean age 25.9 ± 1.9 years, participated in the study. A 6 MHz 35-mm curved linear array ultrasound transducer (Mindray M5) was placed in the transverse plane, supra-pubically, and angled 15-30° from the vertical plane. During crook lying, participants received six verbal instructions for contracting the PFM, with bladder base displacement and endurance evaluated. Following the instructions, "squeeze your anus", "shorten the penis", and "elevate the scrotum", over 91% of the participants performed a cranial (upward) bladder base displacement. During instruction six, "draw in", which involves breathing, the PFM, and the transversus abdominis, only 25% performed cranial bladder base displacement (p < 0.001), and the endurance was the lowest (p < 0.001). Our findings suggest that several simple verbal instructions can be used for teaching PFM contraction to young males. Moreover, two instructions should be avoided: "draw in" and the general instruction "squeeze your PFM", as they did not produce effective elevation of the bladder base.

Physiotherapy services during the COVID-19 pandemic: A mediated model of physiotherapists' self-efficacy, tele-physiotherapy role stressors, and motivation to provide tele-physiotherapy.

BACKGROUND: Occupational self-efficacy is a stable predictor for professionals' motivation to engage with new methods and tasks. Yet, the delivery of tele-physiotherapy (Tele-PT) by physiotherapists (PTs) during the coronavirus disease of 2019 (COVID-19) outbreak without advance training may have had the potential to increase work stress and damage their motivation, regardless of their occupational self-efficacy. OBJECTIVES: The present study examined whether the relations between PTs' overall occupational self-efficacy and motivation to provide Tele-PT was mediated by role stress (i.e. role conflict and ambiguity). DESIGN AND METHOD: Between February 4 and April 23, 2021, 150 Israeli PTs completed an online survey that measured their overall occupational self-efficacy, their role stress induced by the provision of Tele-PT, their motivation to provide Tele-PT, and their demographic characteristics. RESULTS: PTs' overall occupational self-efficacy was positively associated with PTs' motivation to provide Tele-PT (r= 0.328, p < .01) and fully mediated by role conflict (0.1757, 95% CI = [0.0231, 0.3797]) and by role ambiguity (0.1845, 95% CI = [0.0196, 0.4184]) (components of role stress) caused by the provision of Tele-PT. CONCLUSIONS: It is important to investigate the predictors and mediators of the motivation to provide Tele-PT because in the post-COVID-19 era health organizations are likely to adopt many tele-medicine services, and they need to find ways to mitigate perceived challenges.

Can the Enhanced Transtheoretical Model Intervention (ETMI) Impact the Attitudes and Beliefs Regarding Low Back Pain of Family Medicine Residents.

BACKGROUND: Low back pain has been the leading cause for disability worldwide for several decades, and clinical guidelines for its management clearly emphasize a multifactorial approach. Yet, current guidelines are still not well implemented by clinicians. OBJECTIVES: To explore the attitudes of family medicine residents regarding low back pain and to determine whether they positively correlate with their treatment approaches. To test if these attitudes can be affected by the Enhanced Transtheoretical Model Intervention (ETMI), a guideline-based workshop. METHODS: Participants completed an online questionnaire regarding their attitudes toward low back pain and clinical habits, after which they attended an online ETMI educational workshop. One month later all participants were asked to complete the questionnaire a second time. Statistical analysis was conducted to explore the attitudes of the residents and clinical approaches, as well as any associations between them, as well as possible differences pre- and post-intervention. RESULTS: The participants exhibited highly psychologically oriented attitudes. Correlations between the attitudes and treatment did not show consistent coherency. Results regarding the participants clinical approaches were revealed to have two distinct and opposed inclinations: biomedically and biopsychosocially. Last, results for the re-activation subscale were significantly higher post-intervention. CONCLUSIONS: Family medicine residents seem to be highly psychologically oriented regarding low back pain; however, they do not necessarily treat their patients accordingly. Their clinical choices seem to follow two different approaches: guideline-consistent and non-guideline-consistent. An ETMI guideline-based workshop may sway their attitudes toward re-activation of patients. Further research is needed to determine whether similar results would arise in larger physician populations.

Implementation of the Enhanced Transtheoretical Model Intervention (ETMI) for Low Back Pain Patients in Primary Care: Study Protocol.

BACKGROUND: Self-management, an active life routine, and adherence to physical activity are effective in the management of low back pain (LBP). However, delivering effective education and reassurance to patients can be a difficult for practitioners. The enhanced transtheoretical model intervention (ETMI) has shown to be successful and cost effective. The intervention focuses on educating practitioners to reassure patients, empower them to increase physical activity, and improve their self-efficacy. OBJECTIVES: To assess whether ETMI can be implemented among primary care practitioners and to examine whether it reduces pain, disability, and fear avoidance as well as decreasing healthcare utilization. This protocol outlines the methodology for the implementation of ETMI through a hybrid implementation-effectiveness design. METHODS: Two qualitative and mixed-method studies provided a basis for an implementation prospective cohort study. Discussions are followed by a prospective cohort study with pre-and post-intervention measures as well as descriptions retrieving economic and therapeutic outcome data from the Maccabi Healthcare Services (MHS) databases. In addition, a fourth qualitative study was conducted at the midpoint of the implementation to evaluate the process by measuring the perceptions and practice of practitioners. The intervention group was 220 primary care practitioners and their patients (~n=10,000) from the central district of MHS. The control data was provided by other care districts with similar socioeconomic makeup (~n=40,000). CONCLUSIONS: We evaluated the process and outcomes of the implementation of ETMI. We investigated the relationship between the care received (ETMI against treatment as usual) and healthcare utilization, costs, and patient-clinical outcomes.

Short-term Results and Return to Duty Following Hip Arthroscopy in Soldiers.

BACKGROUND: Over the past several years there has been a marked increase in the number of Israel Defense Forces (IDF) soldiers having hip arthroscopy based on magnetic resonance arthrography diagnosis of hip labral tears and/or impingement. OBJECTIVES: To detail characteristics of soldiers who underwent hip arthroscopy and assess outcomes and rate of return to duty. METHODS: A retrospective chart review was conducted of all soldiers who underwent hip arthroscopy 2018 to 2020, and soldiers referred for hip arthroscopy during 2021. Demographic, medical, and military service data were collected from the computerized patient record. RESULTS: Our study comprised 117 soldiers (29% combatants, 24% females) who underwent hip arthroscopy, mean age 22 ± 3 years, range 18-42; 45% had physiotherapy before surgery; 31% were diagnosed during or within 3 months of having back pain and 20% had been referred for psychological assistance (not related to the hip pain); 15.4% had serious adverse events. The mean time to return to any duty (including clerical work) was 8.0 ± 0.6 months; 56% of the soldiers never returned to service and were discharged from the military. During the one-year follow-up, only 6% returned to their full pre-symptom activity. CONCLUSIONS: The short-term results of IDF soldiers who underwent hip arthroscopy during the study period were much inferior to those reported among athletes. The lack of specificity of the diagnostic tools (history, examination, and imaging) used to determine whether surgery for hip pain is likely to be beneficial in this population may be contributing to over-diagnosis and over-treatment.

Patients' Perceptions and Outcome Measures after Undergoing the Enhanced Transtheoretical Model Intervention (ETMI) for Chronic Low Back Pain: A Mixed-Method Study.

This study aimed to evaluate the outcome measures and perceptions of patients with chronic low back pain (CLBP) after being treated with the Enhanced Transtheoretical Model Intervention (ETMI). In this process evaluation mixed-methods study, 30 patients with CLBP electronically completed self-reported measures (function, pain, and fear-avoidance beliefs) before and after ETMI treatment. Subsequently, each patient participated in one-on-one, semi-structured interviews, which were audio-recorded, transcribed, coded, and analyzed thematically. Quantitative analysis showed significant improvements in function (p < 0.001), pain (p < 0.001), and fear-avoidance beliefs (p < 0.001) after receiving ETMI treatment, with a large effect size (Cohen's d = 1.234). Moreover, the average number of physiotherapy sessions was 2.6 ± 0.6 for the ETMI intervention, while the annual average number in Maccabi is estimated at 4.1 ± 1.5. Three main themes emerged from the thematic analysis: (1) communication between the patient and the practitioner; (2) psychosocial treatment elements, and (3) ETMI as a long-term solution for CLBP. The findings of the current study highlight patients' perceived need for an open and sincere dialogue and for receiving reassurance and encouragement about their LBP. Notably, they had no problem with the fact that they did not receive passive treatment. Accordingly, together with the significant improvement in post-treatment outcome measures, patients perceived the ETMI method as a practical tool for self-managing their back problems in the long term.

[ONCOLOGISTS' APPROACHES AND BARRIERS FOR DISCUSSING ADVANCED CARE PLANNING WITH SEVERELY ILL CANCER PATIENTS].

BACKGROUND: Earlier goals of care (GOC) discussions in patients with advanced cancer are associated with less aggressive end-of-life (EOL) care and with better quality of life near death. Despite that, these discussions do not always occur between oncologists and their patients. OBJECTIVES: To evaluate oncologists' agendas concerning EOL discussions and advanced directive (AD), and to identify barriers to these discussions. METHODS: The study included oncologists from Israeli hospitals who were asked to complete a questionnaire in order to assess barriers to EOL conversations. The questionnaire was adapted from Canadian research among clinicians in medical wards. Participants were asked to rank the importance of the various barriers. RESULTS: The questionnaires were completed by 84 physicians. Most physicians in this group (97%) thought it was important to have discussions on GOC with the patient, and 67% thought it was important that the patient would sign an AD form. Respondents perceived patient and family-related factors as the most important barriers. Of these, the most important were the patients' and patients' families difficulty accepting their poor prognosis, rated as important by 90% and 78% respectively, and the patients' difficulty understanding the limitations and complications of life-sustaining treatments, rated as an important by 81% of respondents. While physicians and system factors were ranked lower than patient-related factors, time limitations and desire to maintain hope were also considered important, 80% and 74% respectively. CONCLUSIONS: Oncologists ranked patient and family-related factors as the most important barriers to GOC discussions. Time limitations and the desire to maintain hope were also considered important. DISCUSSION: Further work is required to assess patient preferences and perceptions and to develop targeted interventions.

STarT MSK tool: Translation, adaptation and validation in Hebrew.

BACKGROUND: The Keele STarT MSK Tool divides musculoskeletal patients into three prognostic groups for risk-stratified care. It has shown good predictive and discriminative ability in development and validation samples. OBJECTIVES: This study aimed to translate and validate the STarT MSK in a Hebrew version, among Israeli people living with musculoskeletal (MSK) pain. METHOD: A cross-sectional study, with nested prospective sub-sample. The STarT MSK was translated into Hebrew using published guidelines. A total of 153 adults (18+) who reported living with MSK pain were administered the STarT MSK. Clinical measures included for validity testing included the 12-Item Short-Form Health Survey (SF-12), the Hospital Anxiety and Depression Scale (HADS), the Fear-Avoidance Beliefs Questionnaire (FABQ) and a numerical pain rating scale (NPRS). RESULTS: The STarT MSK was forward and backward translated, with minor changes to ensure cultural adaptation. The test-retest reliability of the STarT MSK total score was excellent (intraclass correlation coefficient 0.92). Internal consistency for the MSK scale was (α = 0.612). The Spearman's correlation coefficients between STarT MSK total score and the validation measures confirmed the hypotheses and were significant. CONCLUSION: The Israeli translation and validation of the STarT MSK suggest that it is a valid and reliable instrument. The STarT MSK discriminated low-, medium- and high-risk groups.

Using the consultation-based reassurance questionnaire to assess reassurance skills among physiotherapy students: reliability and responsiveness.

BACKGROUND: There is a robust body of evidence suggesting that communication skills during consultations are associated with patient satisfaction and adherence. Training practitioners to improve communication and reassurance delivery is therefore desirable. The Consultation-Based Reassurance Questionnaire (CRQ) for people presenting with back pain has not been tested as a tool to examine the reliability and responsiveness of communication training for practitioners. OBJECTIVE: To translate and examine the reliability of the CRQ and to explore its ability to detect change (responsiveness) before and after a single session of training in communication skills. METHODS: Thirty-five simulated consultations were recorded. 36 second-year physiotherapy students took part, either as a simulated patient or a simulated physiotherapist. All videotape simulations were rated independently by two trained observers, using the CRQ. RESULTS: Correlations indicate that the two raters were significantly and highly correlated (r = 0.9, 95% CI 0.797-0.951). The responsiveness statistics were in the moderate range for the total CRQ score, with moderate responsiveness range for data-gathering and relationship-building, and acceptable responsiveness for generic and cognitive reassurance. CONCLUSION: The CRQ Scale shows good reliability and acceptable levels of responsiveness to detect change before and after training in communication skills in physiotherapy students. The scale requires testing in real-life settings to establish better responsiveness.

Patients' prior perceptions and expectations of the Enhanced Transtheoretical Model Intervention for chronic low back pain: A qualitative study.

BACKGROUND: The Enhanced Transtheoretical Model Intervention (ETMI) is an approach for treating chronic low back pain (CLBP), which demonstrated clinical and cost-effectiveness outcomes. ETMI highlights reassurance, return to normal activities and encouragement of recreational physical activity. In order to optimally implement ETMI, it is important to gain an understanding of the expectations and perceptions of patients before they engage with the intervention. OBJECTIVES: To explore CLBP patients' perceptions and expectations of the ETMI method prior to their first consultation with physiotherapist. METHODS: Qualitative semi-structured interviews were conducted with 30 CLBP patients. The interviews were audio-recorded, transcribed, coded, and analysed thematically. Patients were first asked about their expectations of treatment, then they were asked to comment on the ETMI method. RESULTS: Three main themes emerged from the interviews: (1) Patient's perceptions of LBP; (2) patient's expectations from current physiotherapy and (3) Patient's expectations from ETMI method. The patients' perceptions of back pain centred on biomechanical causal factors, a desire for diagnostic tests and beliefs that rest cures the pain. Their expectations from current physiotherapy included pain reduction, passive treatment, a structured exercise program and clear information about LBP. In reference to the ETMI method, patients expected pain reduction, practical tools to self-manage, and a combination of ETMI with passive treatment. CONCLUSION: addressing issues around patient's perceptions and expectations of current physiotherapy and of the ETMI method, prior to their first consultation with physiotherapist, could be beneficial for understanding how to improve the ETMI implementation in the health care system.

Cross-cultural adaptation, validation and psychometric evaluation of the attitudes to back pain scale in musculoskeletal practitioners - Hebrew version.

BACKGROUND: Research suggests that clinician's attitudes and beliefs towards low back pain (LBP) management may affect their patients' treatment course and outcomes. Attitudes to Back pain Scale in musculoskeletal practitioners (ABS-mp) is a questionnaire developed to assess musculoskeletal clinicians' attitudes and beliefs regarding LBP. OBJECTIVE: This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Hebrew version of the ABS-mp questionnaire. DESIGN: Cross-sectional study with nested prospective sub-sample. METHODS: The translation was performed in several steps following the cross-cultural adaptation process. Test-retest and internal consistency reliability of the scales were evaluated along with convergent validity exploration between the ABS-mp and the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS). A convenience sample of 177 physical therapists were requested to participate in the study, out of which 132 have completed the survey, providing a 74% participation rate. RESULTS: The forward-backward translation process revealed minor discrepancies that were addressed by the expert panel. The test-retest reliability of the Hebrew ABS-mp was excellent (ICC = 0.906). Five items were found to be irrelevant for the Israeli physiotherapy health settings and were omitted. For internal consistency, the average inter-item correlation reached appropriate values for the Psychological, Biomedical, Re-activation, and Limitation on Sessions subscales (0.437, 0.265, 0.341, 0.197, respectively). For convergent validity, the ABS-mp's Biomedical subscale and the HC-PAIRS's total score were moderately correlated (0.535). CONCLUSIONS: The Hebrew version of the ABS-mp has been validated and has demonstrated excellent test-retest reliability, good convergent validity and acceptable internal consistency.

STarT back tool retained its predicting abilities in patients with acute and sub-acute low back pain after a transcultural adaptation and validation to Hebrew.

BACKGROUND: The STarT Back Screening Tool (SBT) distributes low back pain (LBP) patients into three prognostic groups for stratified care. This approach has demonstrated beneficial clinical and cost-effectiveness. OBJECTIVES: To translate and validate the SBT by investigating its psychometric properties among Israelis with acute and sub-acute LBP, and to evaluate its ability to predict disability after three months. DESIGN: Prospective study. METHOD: The SBT was transcultural adapted into Hebrew using published guidelines. A total of 150 patients receiving physical therapy for acute or subacute LBP were administered the SBT. Clinical outcomes included the Roland-Morris Disability Questionnaire (RMDQ), the Hospital Anxiety and Depression Scale (HADS), the Fear-Avoidance Beliefs Questionnaire (FABQ) and a numerical pain rating scale (NPRS), collected by an independent interviewer by phone at the start of the physical therapy treatment and after three months. RESULTS: The test-retest reliability of the SBT total score and psychosocial subscale were excellent (intraclass correlation coefficient 0.89 and 0.82). Spearman's correlation coefficient between SBT total score and RMDQ was 0.82, HADS (Anxiety 0.66, Depression 0.76), FABQ (exercise 0.53), NPRS (severe pain 0.48, average pain 0.53). The SBT baseline score showed excellent predictive abilities in discriminating poor disability after three months (ROC curve = 0.825, P < 0.001, 95% CI 0.756-0.894). CONCLUSION: The Israeli translation and cross-cultural adaptation of the SBT is a valid and reliable instrument. The SBT discriminated low, medium and high-risk groups, and predicts disability after three months.