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Model validation and structural equation modeling: a reply to Ward and Thorn.

Andrew J Cook·Kevin E Vowles·Peter A Brawer
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Avoidance LearningFearHumansModels, PsychologicalReproducibility of ResultsCommentLetter

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Andrew J Cook, Kevin E Vowles, Peter A Brawer. 2006-07-20. Model validation and structural equation modeling: a reply to Ward and Thorn.. https://doi.org/10.1016/j.pain.2006.06.023

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Causal relations drive young children's induction, naming, and categorization.

A number of recent models and experiments have suggested that evidence of early category-based induction is an artifact of perceptual cues provided by experimenters. We tested these accounts against the prediction that different relations (causal versus non-causal) determine the types of perceptual similarity by which children generalize. Young children were asked to label, to infer novel properties, and to project future appearances of a novel animal that varied in two opposite respects: (1) how much it looked like another animal whose name and properties were known, and (2) how much its parents looked like parents of another animal whose name and properties were known. When exemplar origins were known, children generalized to exemplars with similar origins rather than with similar appearances; when origins were unknown, children generalized to exemplars with similar appearances. Results indicate even young children possess the cognitive control to choose the similarities that best predict accurate generalizations.

Avoidance Learning↗
PubMed2006

Psychometric characteristics of the Spanish version of the FAB questionnaire.

STUDY DESIGN: Validation of a translated, culturally adapted questionnaire. OBJECTIVES: To translate and culturally adapt the Spanish version of the Fear Avoidance Beliefs Questionnaire (FABQ), and to validate its use in Spanish-speaking patients with low back pain (LBP). SUMMARY OF BACKGROUND DATA: The FABQ is a reliable evaluation instrument for fear avoidance beliefs, which includes two subscales (FAB-Work and FAB-Phys). No validated Spanish version was available. METHODS: Translation/retranslation of the English version of the FABQ was done blindly and independently by a multidisciplinary team. The study was done in 12 primary care centers and 9 hospital outpatient clinics from seven regions in Spain, with 209 acute, subacute, and chronic patients who visited their physician for LBP: 53 in the pilot phase and 156 in the validation phase. Subjects were given the FABQ, two VAS for LBP and referred pain, and the Roland-Morris and SF-12 Questionnaires on their first visit and 14 days later. In the pilot phase, on day 1 test-retest reliability was estimated by giving a second FABQ in which the name and order of the items had been changed. RESULTS: Time necessary to complete the FABQ was [median, P25, P75] 10 minutes (5,15). FABQ values were not normally distributed. Comprehensibility: No request for aid in interpretation was made during the validation phase and no item was left unanswered by >or= 10% of patients. Reliability: Scores [median, P25, P75] of the two FABQ were: 72.00 (47.25, 82.00) and 72.00 (49.50, 83.75), with an intraclass correlation coefficient of 0.9668 (95% confidence interval, 0.9421,0.9823). Mean of kappa values for all items was 0.743. Internal Consistency: Cronbach's alpha was 0.9337. VALIDITY: Values of FAB and FAB-Work were >37% higher for patients on sick leave. For FAB-Phys differences were below 8%. FABQ, FAB-Work and FAB-Phys strongly correlated with disability on days 1 and 15. CONCLUSIONS: The Spanish version of the FABQ has good comprehensibility, internal consistency, and reliability. It cannot be analyzed parametrically, but only nonparametrically. The total FABQ is at least as valid as its subscales and simpler to score, making it more suitable for routine clinical use.

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PubMed2006

Fear avoidance and prognosis in back pain: a systematic review and synthesis of current evidence.

OBJECTIVE: Fear of pain, which is hypothesized to result in avoidance behavior, has been described as an obstacle to recovery in populations of patients with low back pain. However, the evidence to support the link between high levels of fear at early stages of pain and poor prognosis has yet to be systematically assessed. We undertook this review to explore current evidence and to propose further development of theoretical models. METHODS: We performed a systematic literature review of all prospective inception cohorts of patients with acute low back pain that measured fear of pain (often described as fear avoidance) at baseline. RESULTS: We reviewed 9 studies reported between 2001 and 2006. Several of these had acceptable/good methodology. Three studies, of which at least 1 had excellent methodology, showed no link between measures of fear at baseline and poor prognosis in the short term (3 months) or the long term (12 months). Three studies with acceptable methodology showed weak evidence for such a link, but the effect sizes were small. The only study with acceptable methodology to find a clear link suggested that fear of movement was linked to long-term pain. CONCLUSION: Despite the prevalent focus on fear of pain at early stages of back pain, there is little evidence to link such fear states with poor prognosis. There is some evidence to suggest that fear may play a role when pain has become persistent. There is a growing consensus that distress/depression plays an important role at early stages, and clinicians should focus on these factors.

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