Investigating the relationship between lifestyle factors, family history, and diabetes mellitus in non-diabetic visitors to primary care centers.

We investigated the risk levels associated with diabetes mellitus. They were assessed based on whether anyone in their family had a history of diabetes. The data collected are measurements of blood pressure, weight, height, and smoking habits, as well as physical activity and educational status. Based on the American Diabetes Association's (ADA) recommendations, the questionnaire included a diabetes risk assessment. The risk of diabetes was 76.3% among participants with a family history of diabetes. There is a 41.1% chance of diabetes among those participants whose fathers had diabetes, and a 39.3% chance of diabetes among those participants whose mothers had diabetes. Additionally, those participants who have siblings with diabetes were 24% at high risk for developing diabetes. The prevalence of the risk of having a family history of diabetes is higher in the women in the family (RR = 3.12; P = 0.0001) as compared to the men in the family (RR = 1.9; P = 0.0001). Risk of diabetes more in the male (1.13 times higher) in the current study based on the ADA scale. There is evidence that various factors, including lifestyle choices, physical attributes, and family history, influence the risk of developing diabetes in the current study. The results of the current study indicate that there is a strong association between patients with T2D and those who have a family history of diabetes. Considering Saudi Arabia's high diabetes risk, evidence-based lifestyle modifications are needed.

Corrigendum: Burden of musculoskeletal disorders in the gulf cooperation council countries, 1990-2019: findings from the global burden of disease study 2019.

[This corrects the article DOI: 10.3389/fmed.2022.855414.].

Perspectives of the Saudi medical students toward the impact of lockdowns on their physical activity level and lifestyle during the COVID-19 pandemic.

Background: Physical activity (PA) level is affected by various factors in university students. Due to the pandemic of COVID-19, the Saudi Ministry of Education announced the closure of schools and universities as a preventive measure. This cross-sectional study aimed to evaluate the impact of the COVID-19 pandemic lockdown on PA levels and other lifestyle aspects among the Saudi medical students and to explore their perspectives toward it. Methods: Three hundred ninety-six medical students have completed the survey, which consisted of three sections: (1) participant's demographic data; (2) five statements about the PA and the lockdown; and (3) the International PA Questionnaire-Short Form (IPAQ-SF). Results: About 63.9% of the participants were female, and 60.4% were of normal weight. Approximately 80% of participants were classified as inactive. Regarding the perspective of the students, 52.8% reported that they were not exercising regularly in the gym before the lockdown, and 46.9% reported that the lockdown and transition to online learning affected their compliance with exercise. During the lockdown and shift to online learning, the majority of participants experienced decreased PA levels, 42.4% experienced weight gain, and 53.6% reported a negative impact on their psychological status. Conclusion: Generally, the results of this study showed that the COVID-19 had a negative influence on the PA level, as well as other lifestyle aspects (e.g., gaining weight) and psychological status of medical students. This study highlights aspects where universities and institutions delivering medical education can use resources to improve students' well-being during pandemics.

Primary Investigation of Low Back Pain among Saudi Arabians: A Cross-Sectional Study.

Low back pain (LBP) is a prevalent disease that affects all ages and is a symptom that induces immobility. Patients' beliefs may influence LBP management, and adjusting detrimental beliefs is required to improve treatment outcomes. Our aim was to evaluate the prevalence of LBP within the Saudi population and beliefs regarding LBP, physical activity, rest, imaging, and medication. People with LBP were targeted with a questionnaire containing sections on demographic information and the validated Back Beliefs Questionnaire (BBQ), in addition to questions regarding imaging, physical activity, rest and medication. A total of 651 responses were received, 559 of them (86%) experienced LBP. The most common age group was those aged 18-21 (n = 221), 80% from females. The average BBQ score was 27.8 (SD = 5.58). The majority of the respondents held the following beliefs, which are contrary to the best available evidence: back pain must be rested (77.1%) and X-rays or scans are required to gain the best medical care for LBP (73.2%). The Saudi population holds unhelpful beliefs that may affect their quality of life. Healthcare professionals working with patients with LBP have an important role in changing detrimental beliefs and behaviors about the condition.

Burden of musculoskeletal disorders in the gulf cooperation council countries, 1990-2019: Findings from the global burden of disease study 2019.

Objective: The purpose of this study was to investigate the burden of musculoskeletal (MSK) health conditions in Gulf Cooperation Council (GCC) countries based on the Global Burden of Disease (GBD) data. Methods: The data for GCC countries were obtained from the 2019 GBD study to evaluate the burden of MSK disorders which include the following countries: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). The main outcome measures were age-standardized prevalence and years of life lived with disability (YLDs) associated with MSK disorders. The burden of MSK disorders attributable to the category of behavioral, metabolic, or environmental/occupational was reported to estimate the risk-attributable fractions of disease. Results: MSK disorders prevalence ranked fifth in Kuwait, sixth in Bahrain, Oman, Qatar, and UAE, and seventh in Saudi Arabia among all the diseases in 2019. For all GCC countries, MSK disorders were ranked the second leading cause of disability as measured by YLDs for the years 1990 and 2019. The age-standardized prevalence of MSK disorders in 2019 for Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and UAE was 18.56% (95% UI: 17.51­19.66), 19.35% (18.25­20.52), 18.23% (17.14­19.36), 18.93% (17.81­20.06), 19.05% (17.96­20.22), and 18.26% (17.18­19.38), respectively. The age-standardized YLDs per 100,000 individuals of MSK disorders in 2019 for Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and UAE were 1,734 (1,250­2,285), 1,764 (1,272­2,322), 1,710 (1,224­2,256), 1,721 (1,246­2,274), 1,715 (1,230­2,274), and 1,681 (1,207­2,235), respectively. For risk factors, high body mass index (BMI) had the highest contribution to MSK disorders YLDs in most GCC countries (Bahrain, Kuwait, Oman, and Saudi Arabia), followed by the exposure to occupational ergonomic factors which had the highest contribution to MSK disorders YLDs in Qatar and UAE. Conclusion: There was an increase in both age-standardized prevalence of MSK disorders and YLDs between 1990 and 2019 that was observed for all GCC countries. Some risk factors such as higher BMI and exposure to occupational ergonomic factors were highly associated with YLDs due to MSK disorders. The results of this study provide guidance for the potential nature of preventative and management programs to optimize the individual's health.

Reassurance regarding educational messages in people with non-specific low back pain: A cross-sectional study.

INTRODUCTION/OBJECTIVES: Educational messages related to Low back pain (LBP) are often contradictory and drive maladaptive beliefs, as they conflict with the latest research evidence. This study aims to examine participants' reassurance levels in relation to educational messages regarding LBP among the Saudi population with the condition compared to those without it, and to assess the association between levels of reassurance and fear avoidance. METHODS: A list of 13 educational messages about LBP was generated from LBP-educational resources in Saudi Arabia, and from expert consensus on a set of evidence-based key messages for people with LBP. Consented respondents with LBP of various durations and those without the condition completed a questionnaire containing questions on demographic characteristics, the absence or presence of LBP and its intensity, and the fear-avoidance beliefs questionnaire (FABQ). We also asked them to rate their level of perceived reassurance regarding the educational messages using a Likert-type scale from 0 to 10. RESULTS: Participants (n = 1652) reported that the 13 educational messages had reassured them about LBP. However, there was no significant difference between participants with and without LBP (p ≥ 0.05). There was an overall weak association between the responses to the 13 educational messages and the fear-avoidance questionnaire. However, reassurance levels regarding most of the educational messages were negatively associated with the FABQ. DISCUSSION AND CONCLUSION: We demonstrate that people with and without LBP need reassurance about the condition. Furthermore, we show that as reassurance increases, fear-avoidance decreases, confirming the complex nature of LBP.

Physical therapists' perceptions of and satisfaction with delivering telerehabilitation sessions to patients with knee osteoarthritis during the Covid-19 pandemic: Preliminary study.

OBJECTIVE: This preliminary study was conducted to explore physical therapists' (PT) perceptions of and satisfaction with delivering telerehabilitation sessions to patients with knee osteoarthritis during the Covid-19 pandemic. STUDY DESIGN: An exploratory preliminary study using an internet-based survey followed by focus group sessions. METHODS: A programme of sessions was administered by 12 PTs from the Physical Therapy Department at Prince Sultan Military Medical City. An internet-based survey containing 17 statements was completed by the PTs. RESULTS: With regard to telephone-delivered care, four statements related to patients' privacy, programme convenience, safe patients time and money achieved consensus agreement (≥75% agreed or strongly agreed), there was majority agreement (≥50% of respondents agreed or strongly agreed) with seven of the statements regarding the effectiveness, affordability and safety of the programme, but there was no consensus with regard to the remaining five statements. In addition, most of the participants (84.6%) believed that a telephone consultation should cost 25% or 50% less than a face-to-face session. CONCLUSION: Despite the lack of physical contact with patients, the PTs agreed that telerehabilitation would offer patients an easy method of being prescribed a therapeutic programme, save time and money, and maintain patient privacy. Further, the PTs reported barriers and suggested adaptations for this method of service delivery.

Are healthcare providers offering the proper education for people with low back pain? Content analysis of educational materials.

BACKGROUND: Low back pain (LBP) is a prevalent disorder and leading cause of disability worldwide. In Saudi Arabia, patients with LBP are dispensed with educational materials to supposedly facilitate their recuperation. OBJECTIVE: Appraise the suitability of educational materials provided for people with LBP in Saudi Arabia to determine whether they meet the needs of patients, inform self-management, and are consistent with clinical practice guidelines. METHODS: A qualitative data collection method was used, and content analyses were conducted to analyse data based on manifest content. Educational items in English and Arabic were collected from relevant health providers in Saudi Arabia. RESULTS: Seventeen educational materials were sourced from: Ministry of Health hospitals (n= 10), military hospitals (n= 4), private hospitals (n= 2), and a multidisciplinary healthcare association (n= 1). Six identified sub-themes comprise: epidemiological/anatomical data about LBP (n= 6); causes/risk factors (n= 10); exercise (n= 14) and physical activity-related (n= 3) recommendations; treatment-related recommendations (n= 2); general health and lifestyle-related recommendations (n= 8); and postural and ergonomics-related recommendations (n= 13). A common theme emerged, that 'the content of educational materials hindered reassurance and self-management for people with LBP.' CONCLUSION: The reviewed educational materials fail to adequately report information that assure patients or inform their self-management among the Saudi population with LBP. Further, reviewed items are heavily influenced by the biomedical model of pain.

Comparison of attitudes and beliefs of physical therapists and primary care physicians regarding low back pain management: A cross-sectional study.

BACKGROUND: The first-line contact for patients seeking care for low back pain (LBP) can potentially change the disease course. The beliefs and attitudes of healthcare providers (HCPs) can influence LBP management. Although referring patients with LBP to physical therapy is common, the first-line contact for patients with LBP in Saudi Arabia is the primary care physician (PCP). Physical therapy will soon be integrated into primary care; therefore, it is rational to compare physical therapists' (PTs) beliefs and attitudes regarding LBP with those of PCPs. OBJECTIVE: We compared PCPs' and PTs' attitudes and beliefs regarding LBP management. METHODS: We employed a cross-sectional, voluntary response sample research design using the Pain Attitudes and Beliefs Scale (PABS). Participants were PTs and PCPs practicing in Saudi Arabia. RESULTS: In total, 153 participants completed the PABS (111 PTs and 52 PCPs). PCPs demonstrated significantly higher PABS biomedical subscale scores than did the PTs. CONCLUSIONS: HCPs in Saudi Arabia should receive additional training to adopt a biopsychosocial approach to managing LBP. In this study, the HCPs' treatment recommendations may not correspond with contemporary clinical guidelines. Research to facilitate the implementation of optimal professional education and training to adopt a biopsychosocial approach is an urgent priority.

Management of Low back pain in Saudi Arabia healthcare system. A Qualitative Study.

BACKGROUND: Patients with chronic low back pain can contribute to a global socioeconomic burden. Current international recommendations emphasize that low back pain management should occur at the primary-care level. However, there is a lack of essential services for low back pain management at the primary-care level in Saudi Arabia. We explored the current state of low back pain management in Saudi Arabia from the perspective of spine surgeons and physiotherapists. METHODS: A qualitative study with semi-structured interviews was conducted on spine surgeons and physiotherapists. A total of 17 healthcare workers, 8 spine surgeons (age range 28-49 years) and 9 physiotherapists (age range 30-49 years) participated in the study. Data were recorded and analyzed thematically. RESULTS: Three main themes were identified from the interview data that outlined current low back pain management in Saudi Arabia: clinical guideline availability and pathways of care, utilization of primary care services, and overutilization of secondary care resources. CONCLUSIONS: This study suggests underutilization of primary care services and overutilization of secondary care services in Saudi Arabia. Therefore, the implementation of local clinical guidelines could improve patient care as well as reduce the cost of low back pain management.

Current Understanding of Pain Neurophysiology among Physiotherapists Practicing in Saudi Arabia.

To ensure the effective management of patients' pain, it is important that physiotherapists have a good understanding of the neuroscience behind pain. A major barrier to adequate pain management is that, for patients, there is limited access to clinicians who are knowledgeable about pain. This study examined the level of knowledge regarding pain neurophysiology among physiotherapists currently practicing in Saudi Arabia. METHOD: The study was a cross-sectional web-based survey that utilized the 12-item Revised Neurophysiology of Pain Questionnaire. Descriptive and inferential statistics were used to describe levels of knowledge regarding pain neurophysiology and to examine differences in knowledge based on the characteristics of the participating physiotherapists (gender, educational level, experience, practice region, and country where their highest educational level was attained). RESULTS: One hundred and eleven physiotherapists (58.6% male) from various regions and educational backgrounds participated in the study. Out of a maximum Revised Neurophysiology of Pain Questionnaire score of 12, the mean ± standard deviation (SD) was 6.7 ± 2.2; 90% of physiotherapists scored 9 (75%) or less. None of the examined characteristics of the participants were associated with knowledge. CONCLUSION: Physiotherapists in Saudi Arabia showed limited knowledge of the neurophysiology of pain; however, this was not related to the personal characteristics that were examined. The continuation of education in modern pain science is recommended for physiotherapists, especially those dealing with patients suffering from chronic pain. CLINICAL RELEVANCE: The physiotherapists who took part in this study displayed limited knowledge of pain neuroscience; this limited knowledge might suggest the need for a more bio-anatomical approach to pain management. There is a need for tailored medical education to address pain neuroscience knowledge in current physiotherapist practitioners.

The Patient-Reported Outcome Measures Used with Low Back Pain and the Attitude of Primary Healthcare Practitioners in Saudi Arabia toward Them.

Background and objectives: The use of appropriate outcome measures can help guide multidimensional low back pain (LBP) management, elucidate the efficacy/effectiveness of interventions, and inform clinicians when selected targets have been achieved and this can be used for educational or research purposes. Aim: This study aimed to explore and describe the use, attitudes, knowledge, and beliefs regarding patient-reported outcome measures used by healthcare practitioners practising in Saudi Arabia who are frequently involved in the healthcare of individuals with LBP. Materials and Methods: A cross-sectional design was undertaken using a web-based survey. An electronic invitation to participate was sent to primary care physicians and physical therapists practising in Saudi Arabia. The survey included three sections: demographic data, a list of the most commonly used patient-reported outcome measures with LBP patients, and statements regarding attitudes, knowledge, and beliefs about outcome measures. Results: A total of 156 practitioners participated: 45 primary care physicians and 111 physical therapists. The numeric pain rating and visual analogue scales were the outcome measures most frequently reported as being often used by both primary care physicians and physical therapists. The majority of participants reported often using 1-2 patient reported outcome measures (PROMs). While most participants indicated that they were confident at selecting the most appropriate PROM, fewer were familiar with the concept of the minimally important clinical difference. A lack of Arabic versions of PROMs was reported as a barrier to using them to assess pain. Conclusions: This study shows that, although primary care physicians and physical therapists in Saudi Arabia frequently use patient-reported outcome measures in their clinical management of patients with LBP, there is a noticeable gap in the knowledge and use of the multidimensional outcome measures for LBP management among the participants. This highlights a need for professional training on the use of standardised outcome measures related to LBP.

Development of a Logic Model for a Programme to Reduce the Magnetic Resonance Imaging Rate for Non-Specific Lower Back Pain in a Tertiary Care Centre.

Tertiary care centres continue to experience over-utilisation of diagnostic imaging services for lower back pain cases that may not be required. Moreover, these services may require additional time and consequently delay access to services that offer conservative management, i.e., physiotherapy, and hence, increase the direct and indirect costs with no added quality of care. A logic model was developed based on qualitative and quantitative studies that explains the plan and process evaluation strategies to reduce imaging for lower back pain in tertiary hospitals. Logic models are useful tools for defining programme components. The delivery of the components is ensured by well-defined process evaluations that identify any needed modifications. The proposed logic model provides a road map for spine clinics in tertiary care hospitals to decrease the number of patient referrals for magnetic resonance imaging and waiting times for consultations and services and promote early access to physiotherapy services.

Low Back Pain-Related Disability Is Associated with Pain-Related Beliefs Across Divergent Non-English-Speaking Populations: Systematic Review and Meta-Analysis.

OBJECTIVES: This systematic review and meta-analysis examined relationships between low back pain (LBP)-related disability and pain beliefs, including pain catastrophizing, pain-related fear, self-efficacy, and back pain beliefs, in non-English-speaking populations. Additionally, the effects of selected cultural factors (i.e., language/geographic area) on the strength of relationships were examined. STUDY DESIGN: Systematic review and meta-analysis. METHODS: Nine databases were searched. Studies included observational or randomized control clinical trials. Eligible studies had to report estimates of the association between pain beliefs and disability. Pooled estimates of correlation coefficients were obtained through random-effects meta-analysis methods. RESULTS: Fifty-nine studies, (n = 15,383) were included. Moderate correlations were identified between disability and pain self-efficacy (chronic LBP r = -0.51, P ≤ 0.001), between disability and pain catastrophizing (acute LBP r = 0.47, P ≤ 0.001; chronic LBP r = 0.44, P ≤ 0.001), and also between disability and pain-related fear (chronic LBP r = 0.41, P ≤ 0.001). Otherwise, weak correlations were identified between disability and most pain beliefs (range r = -0.23 to 0.35, P ≤ 0.001). Pooled correlation coefficients between disability and all pain beliefs (except the Fear Avoidance Belief Questionnaire-Work subscale) represent medium effects and suggest that lower disability was associated with greater pain self-efficacy, less pain-related fear, less catastrophic thinking, and less negative back pain beliefs about the nature and cause of back pain. Results were consistent across most language groups and geographic regions; few studies reported ethnicity or religion. DISCUSSION: LBP-related disability was associated with pain-related beliefs, with consistency demonstrated for each pain belief construct across divergent non-English-speaking populations. Further research examining cultural factors, such as ethnicity or religion, and with a more diverse population is warranted.

Psychosocial Predictors of Pain and Disability Outcomes in People with Chronic Low Back Pain Treated Conservatively by Guideline-Based Intervention: A Systematic Review.

OBJECTIVE: Previous evidence has recommended conservative interventions as the best treatment in individuals with chronic low back pain (CLBP). However, the influence of psychosocial factors on the treatment outcomes is unclear. Therefore, this systematic review aimed to address the psychosocial factors that influence changes in pain and disability in patients with CLBP after a guideline-based conservative intervention. METHODS: Four electronic databases were systematically searched from inception until September 2020 for prospective studies examining the relationship between psychosocial factors and the outcomes of pain and disability after conservative intervention. All included studies were selected, extracted, and critically evaluated by two independent reviewers. RESULTS: In total, 15 studies were included in this systematic review. The results support the link between the baseline fear of movement, depression, self-efficacy, and catastrophizing with future functional disability outcomes after conservative interventions. However, these factors were less likely to predict changes in pain intensity outcomes after conservative interventions. Self-efficacy seems to mediate between some of the baseline psychosocial factors (eg, fear) and future pain and disability. CONCLUSION: Fear of movement, self-efficacy, catastrophizing and depression were consistently reported to predict disability outcomes irrespective of the type of conservative intervention. This highlights the importance of addressing these factors in conservative management of CLBP.

Attitudes and Beliefs of Primary Care Physicians Working in Saudi Arabia Regarding the Management of Low Back Pain: A Cross-Sectional Study.

INTRODUCTION: Healthcare professionals' beliefs and attitudes towards low back pain management play a significant role during treatment. This is a crucial aspect of primary care physicians working as a first point of contact for people seeking healthcare for low back pain. AIM: To identify the beliefs and behaviors of frontline healthcare professionals (primary care physicians) working in the Riyadh region with regard to low back pain management. METHODS: A cross-sectional design was implemented, in which the Pain Attitude and Beliefs Scale (PABS) questionnaire was used along with a low back pain clinical vignette with some questions. The PABS assesses healthcare provider orientations toward low back pain with two subscales: biomedical and behavioral. In total, 400 primary care physicians working in the Riyadh region of Saudi Arabia were invited to participate. RESULTS: The responding primary care physicians (n = 72, response rate = 18%) provided an average score on the behavioral subscale (mean = 31.5±7.1) that was lower than that on the biomedical subscale (36.5±7.8) of the PABS. The lower scores in the biomedical subscale are associated with the using of clinical guidelines for low back pain management (χ 2 (1) = 4.7, p = 0.03). Moreover, providing guideline-based advices regarding activity and work was more likely to come from those scoring above the mean in the behavioral subscale. CONCLUSION: The results of this study show that Saudi Arabian primary care physicians manage their patients within a biomedical framework; there is some compliance to the current low back pain clinical guidelines among these physicians, with under/post-graduate education being needed for these professionals to adopt a more biopsychosocial framework during low back pain management.

Knowledge, Awareness, and Perceptions of the Diagnosis and Management of Fibromyalgia Among Physical Therapists in Saudi Arabia: A Cross-Sectional Survey.

AIM: To explore awareness of the diagnostic criteria and management of fibromyalgia (FM) among physical therapists practicing in Saudi Arabia. METHODS: A cross-sectional survey was distributed electronically among musculoskeletal physical therapists. It was designed based on the research literature relevant to FM and reviewed by two rheumatologists for accuracy and comprehension. The survey included two sections: participants' demographic information and questions related to FM. The data were described using absolute and relative frequencies. RESULTS: A total of 234 physical therapists accepted the invitation to participate in the study, and 52 were excluded for not satisfying the inclusion criteria or not completing the survey. Responses were received from March to May 2020; only 118 (65%) respondents completed the FM section. The average age of the participants was 31.2 (SD=6.9) years, and 36% were females. Eighty percent reported seeing fewer than five patients with FM in the past year; 51% acquired FM-related knowledge through self-learning; half reported having little to no confidence in their FM assessments and management; and less than 20% were familiar with common diagnostic criteria and management guidelines for FM. CONCLUSION: Participating physical therapists showed little awareness of or confidence in the assessment and management of patients with FM; moreover, their awareness was not supported by their adherence to recent FM guidelines. Despite the common practice of referring patients with FM for physical therapy, there are many misconceptions about FM. This study highlights the need for educational programs to provide up-to-date evidence in undergraduate and postgraduate education.

Multidimensional prognostic factors for chronic low back pain-related disability: a longitudinal study in a Saudi population.

BACKGROUND CONTEXT: Chronic low back pain (CLBP) is a major health problem. Identifying prognostic factors is essential for identifying people at risk of developing CLBP-related disability. PURPOSE: To examine associations between CLBP-related disability at 12-month follow-up and individual, psychosocial and physical factors at baseline, as well as treatment-related factors between baseline and 12-month follow-up among a Saudi population. Additionally, associations between pain intensity and general perceived efficacy (GPE) at 12 months were examined with the aforementioned factors. DESIGN: A prospective cohort study. PARTICIPANTS: One hundred Saudi participants over 18 years with a history of LBP greater than 3 months' duration. MAIN OUTCOME MEASUREMENTS: The primary outcome variable was CLBP-related disability measured by the Arabic Oswestry disability index. Secondary outcome measures were pain intensity over the prior week measured by the VAS and the participant's global perceptions of recovery (general perceived efficacy [GPE]) at 12 months. METHODS: At baseline (n=115), participants completed questionnaires covering demographics, disability, pain intensity, back beliefs, fear avoidance, psychological distress, and physical activity. They performed standardized physical performance tests, including assessment of pain behaviors using a pain behavior scale. After 12 months, participants (n=100) completed questionnaires on disability, pain intensity, GPE and provided treatment-related information during the previous year. Predictors of disability, pain, and GPE were explored using univariate and multivariate regression analyses. RESULTS: The prognostic model for moderate-severe CLBP-related disability at 12 months explained 53.0% of the variance. Higher pain intensity, higher fear-avoidance work, and older age predicted higher disability. Having no additional somatic symptoms predicted lower disability. Pain intensity at 12-month follow-up was explained by higher disability at baseline, while not being in paid employment appeared protective (25.7% of variance explained). As univariate associations were weak between predictor variables and GPE, multivariate analysis was not conducted. CONCLUSION: The study results supported the multifactorial nature of CLBP and reported an important prognostic model in the Saudi population.

Pain Behaviour Scale (PaBS): An Exploratory Study of Reliability and Construct Validity in a Chronic Low Back Pain Population.

Objectives: To examine the interrater and intrarater reliability and construct validity of the Pain Behaviour Scale during standard physical performance tests in people with chronic low back pain and to confirm the test-retest reliability of the physical performance tests in this population. The Pain Behaviour Scale (PaBS) is an observational scale that was recently designed to uniquely measure both the presence and severity of observed pain behaviours. Methods: Twenty-two participants with chronic low back pain were observed during performance of five physical performance tests by two raters. Pain behaviours were assessed using the Pain Behaviour Scale. The Visual Analogue Scale and Modified Oswestry Disability Index were used to measure pain and disability, respectively. Descriptive statistics were used to report demographic features of participants. Reliability was analyzed using ICCs. Rater agreement was analyzed using the weighted Cohen's kappa. Correlations between PaBS, self-reported measures, and physical performance tests were calculated using Pearson's product-moment correlations. Results: The PaBS demonstrated excellent interrater (ICC2,1 = 1.0, 95% CI: 0.9 to 1.0) and intrarater (ICC3,1 = 0.9, 95% CI: 0.8 to 1.0) reliability. Component physical performance tests (i.e., time and distance) demonstrated good test-retest (0.6-1.0) reliability. Perfect agreement in the reporting of pain behaviours was found (95-100%). Correlations between pain behaviour severity and pain intensity (r = 0.6) and disability (r = 0.6) were moderate. Moderate correlations were found between pain behaviours and physical performance tests in sit to stand (r = 0.5), trunk flexion (r = 0.4), timed up and go (r = 0.4), and 50-foot walk (r = 0.4). Conclusion: The Pain Behaviour Scale is a valid and reliable tool for measuring the presence and severity of pain behaviour, and the physical performance tests are reliable tests.

Pain Intensity and Fear Avoidance Explain Disability Related to Chronic Low Back Pain in a Saudi Arabian Population.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: The aim of this study was to describe multi-dimensional profiles for people with chronic low back pain (CLBP) and to examine the associations between CLBP-related disability and individual, psychosocial and physical factors in a Saudi population. SUMMARY OF BACKGROUND DATA: CLBP-related disability is a multidimensional phenomenon. There is growing interest in exploring factors associated with CLBP-related disability in Saudi Arabia but research is limited in comparison to other countries. METHODS: Participants completed questionnaires covering demographics, pain intensity, back beliefs, fear avoidance, psychological distress, and physical activity. Oswestry Disability Index (ODI) was used to measure disability. Participants also performed a standardized sequence of physical performance tests and a Pain Behavior Scale was used to evaluate pain behaviors during performance of these tests. The relationships between disability and all variables were explored using univariate and multivariate regression analyses. RESULTS: One hundred and fifteen participants were included, 63% of whom were female. Participants demonstrated moderate disability (mean [SD]: 26.6 [13.5]). The mean (SD) back beliefs score was 28.6 (7.3). Mean depression, anxiety, and stress (DASS 21) scores indicated mild distress; however, 26% to 39% scored in the moderate to severe range for at least one subscale. In univariate analyses, pain intensity and fear avoidance beliefs (physical activity and work) were moderately associated with disability (r = 0.56, 0.49, 0.52, respectively, P < 0.001), with all other factors demonstrating weak association. Multivariate regression revealed that pain intensity, fear avoidance beliefs, psychological distress, and participants' age were all found to be associated with disability, accounting for 52.9% (adjusted R = 0.529) of variability. CONCLUSION: This study provides a unique insight into the clinical profile of people with CLBP in a Saudi Arabian population. Pain and psychosocial factors were significantly associated with disability. This study supports the contention that CLBP-related disability is a multifactorial biopsychosocial condition across different cultures. LEVEL OF EVIDENCE: 3.