Psychometric Properties of the Photograph Series of Daily Activities-Short Electronic Version (PHODA-SeV) in Patients With Chronic Low Back Pain

Abstract

Background The Photograph Series of Daily Activities-short electronic version (PHODA-SeV) assesses perceived harmfulness of daily activities in patients with low back pain (LBP). Although there is some evidence that the PHODA-SeV is a reliable and valid tool, its psychometric properties have not been fully investigated. Objectives To investigate the test-retest reliability, measurement error, interpretability, construct validity, and internal and external responsiveness of the PHODA-SeV in patients with chronic LBP. Methods Ninety-one patients were included in the analysis for this prospective cohort study. For reliability purposes, the PHODA-SeV was administered twice, with a 1-week interval before beginning treatment. Pain, disability, and measures of pain-related fear (ie, PHODA-SeV, Fear-Avoidance Beliefs Questionnaire [FABQ], and Tampa Scale of Kinesiophobia [TSK]) were collected before and after the 8-week treatment period. Results The PHODA-SeV showed excellent reliability (intraclass correlation coefficient model 2,1 = 0.91), without evidence of ceiling and floor effects. The construct validity analysis demonstrated fair correlations (r = 0.25-0.50) of the PHODA-SeV with the FABQ, but no correlation with the TSK (r<0.25). For internal responsiveness, the PHODA-SeV showed an effect size of 0.87 and a standardized response mean of 0.92, interpreted as a large effect (greater than 0.80). For external responsiveness, the correlations between the PHODA-SeV and changes in the TSK and FABQ were considered low, and the receiver operating characteristic curve analyses revealed an area under the curve lower than the proposed threshold of 0.70. Conclusion The PHODA-SeV is a reliable tool that can detect changes over time in pain-related fear in patients with chronic LBP undergoing physical therapy treatment. This tool, however, failed to identify those patients who did or did not improve, according to other pain-related fear measures. J Orthop Sports Phys Ther 2018;48(9):719-727. Epub 23 May 2018. doi:10.2519/jospt.2018.7864.

The beliefs of healthcare students about the harmfulness of daily activities for their back: a cross-sectional study

“…A key limitation is that the psychometric properties of the specific 12-item mPHODA version used in our study have not been established. While longer versions of the PHODA survey have been shown to be reliable and valid [14,72], and the internal consistency of our version appears similar to other versions [14,73,74], the lack of established validity must be considered when interpreting these findings. There is no known value, or cut-off, which signifies optimal beliefs regarding these common daily activities on the mPHODA.…”

Lumbar range of motion in chronic low back pain is predicted by task‐specific, but not by general measures of pain‐related fear

“…lifting with a bent back) is indeed reflected in the actual movement behaviour during a similar lifting task. This could be considered as a limitation of the construct validity of the PHODA‐SeV, and therefore, it has been recommended to relate PHODA‐SeV scores with the performance on behavioural tests (Leeuw et al, ; Oliveira et al, ). Because the scores on the PHODA‐lift were indeed predictive for the lumbar ROM during a lifting task, the results of this study suggest that the PHODA‐SeV is a valid instrument for establishing a fear hierarchy and further support the use of task‐specific behavioural assessments to investigate protective movement behaviour (Holzapfel, Riecke, Rief, Schneider, & Glombiewski, ).…”

“…Therefore, the scores on the PHODA-total, TSK-total, TSK-AA and TSK-SF were considered as general measures of pain-related fear. Similar to other papers (Karayannis, Smeets, Hoorn, & Hodges, 2013;Oliveira et al, 2018), the overarching term pain-related fear will further be used for both the TSK and PHODA-SeV. However, one should bear in mind that the TSK and PHODA-SeV might not measure exactly the same construct (Lundberg, Grimby-Ekman, Verbunt, & Simmonds, 2011).…”

“…Although some patients with CLBP may present with a generalized fear of movement, others might be fearful of particular activities only, without achieving a high score on the TSK or the FABQ. As such, task-specific measures of pain-related fear could be more appropriate to assess the relationship with movement patterns (Leeuw, Goossens, Breukelen, Boersma, & Vlaeyen, 2007;Oliveira et al, 2018).…”

Treatment monitoring as a component of psychologically informed physical therapy: A case series of patients at high risk for persistent low back pain related disability

“…57 For example, the Photograph Series of Daily Activities (PHODA) has been found to reliably detect changes over time in pain-related fear of patients with chronic LBP, however not able to identify patients who are likely to improve according to other painrelated fear measures such as the FABQ and TSK. 58 A primary limitation of this case series was the small sample size of 23 high risk patients with LBP. When focusing on SBT high risk patients, a smaller sample is inevitable as three separate outpatient physical therapy cohorts in the United States have indicated the prevalence of high risk patients ranged from 20-30% of LBP episodes.…”