Development and Validation of the Behavioral Avoidance Test—Back Pain (BAT-Back) for Patients With Chronic Low Back Pain
Abstract
Objectives: Pain-related fear and avoidance of physical activities are central elements of the fear-avoidance model of musculoskeletal pain. Pain-related fear has typically been measured by self-report instruments. In this study, we developed and validated a Behavioral Avoidance Test (BAT) for chronic low back pain (CLBP) patients with the aim of assessing pain-related avoidance behavior by direct observation. Materials and Methods: The BAT-Back was administered to a group of CLBP patients (N=97) and pain-free controls (N=31). Furthermore, pain, pain-related fear, disability, catastrophizing, and avoidance behavior were measured using self-report instruments. Reliability was assessed with intraclass correlation coefficient and Cronbach α. Validity was assessed by examining correlation and regression analysis. Results: The intraclass correlation coefficient for the BAT-Back avoidance score was r=0.76. Internal consistency was α=0.95. CLBP patients and controls differed significantly on BAT-Back avoidance scores as well as self-report measures. BAT-Back avoidance scores were significantly correlated with scores on each of the self-report measures (r s=0.27 to 0.54). They were not significantly correlated with general anxiety and depression, age, body mass index, and pain duration. The BAT-Back avoidance score was able to capture unique variance in disability after controlling for other variables (eg, pain intensity and pain-related fear). Discussion: Results indicate that the BAT-Back is a reliable and valid measure of pain-related avoidance behavior. It may be useful for clinicians in tailoring treatments for chronic pain as well as an outcome measure for exposure treatments.
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Based on comparable studies and the pilot study, a dropout rate of 20% is expected.
“Based on comparable studies [16, 21] in this research area and the pilot study [19], a dropout rate of 20% is expected.”
From EFFects of Exposure and Cognitive behavioral Therapy for chronic BACK pain (“EFFECT-BACK”): study protocol for a randomized controlled trial (2024) · cites this paper as [21]
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- Authors
- Holzapfel, S., Riecke, J., Rief, W., Schneider, J., & Glombiewski, J. A.
- Affiliations
- Philipps University of Marburg (DE)
- MediClin Clinic for Acute Psychosomatics and Rehabilitation Center Am Hahnberg, Germany
- Corresponding author
- Holzapfel, Sebastian
- Riecke, Jenny
- Rief, Winfried
- Glombiewski, Julia A.
- Venue
- The Clinical Journal of Pain
- Published
- 2016-11
- Volume
- 32
- Issue
- 11
- Pages
- 940-947
- ISSN
- 0749-8047 (ISSN-L)
- OpenAlex
- W2235859535
- Cited by
- 21
- References
- 47
- Citations by year
- 2025: 4 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 3
- FWCI
- 2.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- chronic low back pain, fear-avoidance model, fear of pain, disability, catastrophizing, exposure therapy, outcome measure development
- MeSH terms
- Anxiety, Avoidance Learning, Depression, Disability Evaluation, Fear, Female, Humans, Male, Middle Aged, Pain Measurement, Psychometrics, Regression Analysis, Reproducibility of Results, Cognitive Behavioral Therapy, Low Back Pain, Self Report, Catastrophization, Chronic Pain
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