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Adaptação cultural e contributo para a validação da Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) para a população de fisioterapeutas portugueses
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Advisor(s)
Abstract(s)
Introdução: Vários estudos têm encontrado evidência para a relação entre as crenças e
atitudes dos profissionais de saúde, a sua abordagem de tratamento, referida como
orientada segundo o modelo biomédico ou modelo biopsicossocial (Bishop, 2008;
Mutsaers, 2012), e os resultados obtidos. É sugerido que, no tratamento da dor lombar
crónica, os profissionais que orientam o seu raciocínio e prática segundo o modelo
biomédico, tendem a obter piores resultados quando comparados com os obtidos pelos
profissionais que orientam o seu raciocínio e prática segundo uma abordagem
biopsicossocial. Esta área de estudo tem salientado a importância de desenhar
instrumentos capazes de identificar a orientação preferencial dos profissionais de saúde
no tratamento da dor crónica de natureza músculo-esquelética, entre os quais se
encontra a “Pain Attitudes and Beliefs Scale for Physiotherapists” (PABS-PT).
Objetivo: Adaptar culturalmente a PABS-PT para a população de fisioterapeutas
portugueses que intervêm em utentes com dor (lombar) crónica, e contribuir para a sua
validação
Metodologia: A versão original (língua inglesa) do PABS-PT foi adaptada para a
língua e cultura portuguesas, através das etapas definidas nas normas orientadoras
estabelecidas para este processo (Beaton et al., 2002; MAPI Institute, 2001). A
avaliação das propriedades psicométricas da versão portuguesa foi realizada com
recurso a uma amostra de 202 fisioterapeutas e estudantes finalistas do curso de
licenciatura em Fisioterapia. Inicialmente foi realizada a análise fatorial exploratória da
escala através do método das componentes principais. Posteriormente avaliou-se a
consistência interna das componentes obtidas com recurso ao alpha de Cronbach (α).
Para analisar a validade de constructo foram correlacionadas as componentes obtidas
com a versão portuguesa da “Health Care Providers’ Pain and Impairment Relationship
Scale” (HC-PAIRS), recorrendo ao cálculo do coeficiente de Spearman.
Resultados: O processo de adaptação cultural não revelou dificuldades importantes
sendo considerado que a versão portuguesa da PABS-PT é de fácil compreensão e
preenchimento, e os seus itens adequados para avaliar as crenças e atitudes dos
fisioterapeutas portugueses relativas à intervenção na dor crónica músculo-esquelética.
Os resultados revelaram uma estrutura fatorial de duas componentes, identificadas com
as componentes da escala original que explicam 30,96% da variância total. A
consistência interna encontrada é boa, para a componente biomédica (α de Cronbach =
0,826), mas muito fraca para a componente biopsicossocial (α de Cronbach= 0,589).
Relativamente à validade convergente e discriminativa, foi encontrada uma associação
estatisticamente significativa e positiva, entre as componentes 1 (biomédica) da versão
portuguesa da PABS e a HC-PAIRS (Rs = 0,481,p≤ 0,005), e negativa, fraca e
significativa entre a pontuação total da componente 2 (biopsicossocial) e a HC-PAIRS
(Rs = -0,038, p=0,612).
Conclusão: A versão portuguesa do PABS-PT é de fácil compreensão e aparenta ser um
instrumento válido para a medição da orientação preferencial dos fisioterapeutas,
relativamente às suas atitudes e crenças na avaliação e tratamento de utentes com dor
crónica de natureza músculo-esquelética. No entanto, a componente biopsicossocial
requer uma análise mais aprofundada para que possa, com rigor, ser utilizada na
definição de uma orientação preferencialmente biopsicossocial.
Abstract: Introduction: Previous studies have found a relation between the beliefs and attitudes of health professionals, their treatment approach, which can follows a biomedical or a biopsychosocial orientation (Bishop, 2008; Mutsaers, 2012), and the outcomes obtained. Therefore, is suggested that the professionals who tend to approach chronic low back pain patients according to the biomedical model have worse outcomes than professionals who use a biopsychosocial approach in there clinical reasoning. This research field has highlighted the importance of developing measures capable of identifying the preferred orientation of health professionals in the treatment of chronic pain of musculoskeletal nature, including the “Pain Attitudes and Beliefs Scale for Physiotherapists” (PABS-PT). Objective: To cross culturally adapt and validate the PABS-PT for the Portuguese population of physiotherapists. Methodology: The original version (English version) of the PABS-PT was adapted to the Portuguese language and culture, through the guidelines established for these processes (Beaton et al., 2002; MAPI Institute, 2001). The psychometric evaluation of the Portuguese version was carried out on a sample of 202 physiotherapist and final year students of the physiotherapy course. Initially, an exploratory factorial analysis was performed through the method of the main components. Then, the internal consistence of the main components was evaluated using the Cronbach’s alpha (α). The convergent construct validity was analysed through the correlation between the obtained components of PABS-PT and the Health Care Provider’s Pain and Impairment Relationship Scale (HC-PAIRS), using the Spearmen correlation coefficient. Results: No major difficulties were found during the cultural adaptation process of PABS-PT to Portugal, which means that the Portuguese version is easy to understand and fulfill, and items are appropriated to evaluate the beliefs and attitudes of the Portuguese physiotherapists who treat chronic pain of musculoskeletal origins. The results revealed a factorial structure of two components, as the original scale, explaining 30,96% of the total variance. Internal consistence results were good, for the biomedical component (Cronbach’s α = 0,826), but very weak for the biopsychosocial component (Cronbach’s α = 0,589). Relatively to convergent and discriminative validity, a statistically significant association was found, between the components 1 (biomedical) of the Portuguese version of PABS-PT and the HC-PAIRS (Rs= 0,481, p≤ 0,005) and negative, weak and significant between the total score of component 2 (biopsychosocial) and the HC-PAIRS (Rs = -0,038, p=0,612). Conclusion: The Portuguese Version of PABS-PT is easy to understand and seems to be a valid instrument to measure the attitudes and beliefs of physiotherapists in the management of patients with chronic low back pain. However, the biopsychosocial component requires a further deep analysis to examine a preferable biopsychosocial orientation.
Abstract: Introduction: Previous studies have found a relation between the beliefs and attitudes of health professionals, their treatment approach, which can follows a biomedical or a biopsychosocial orientation (Bishop, 2008; Mutsaers, 2012), and the outcomes obtained. Therefore, is suggested that the professionals who tend to approach chronic low back pain patients according to the biomedical model have worse outcomes than professionals who use a biopsychosocial approach in there clinical reasoning. This research field has highlighted the importance of developing measures capable of identifying the preferred orientation of health professionals in the treatment of chronic pain of musculoskeletal nature, including the “Pain Attitudes and Beliefs Scale for Physiotherapists” (PABS-PT). Objective: To cross culturally adapt and validate the PABS-PT for the Portuguese population of physiotherapists. Methodology: The original version (English version) of the PABS-PT was adapted to the Portuguese language and culture, through the guidelines established for these processes (Beaton et al., 2002; MAPI Institute, 2001). The psychometric evaluation of the Portuguese version was carried out on a sample of 202 physiotherapist and final year students of the physiotherapy course. Initially, an exploratory factorial analysis was performed through the method of the main components. Then, the internal consistence of the main components was evaluated using the Cronbach’s alpha (α). The convergent construct validity was analysed through the correlation between the obtained components of PABS-PT and the Health Care Provider’s Pain and Impairment Relationship Scale (HC-PAIRS), using the Spearmen correlation coefficient. Results: No major difficulties were found during the cultural adaptation process of PABS-PT to Portugal, which means that the Portuguese version is easy to understand and fulfill, and items are appropriated to evaluate the beliefs and attitudes of the Portuguese physiotherapists who treat chronic pain of musculoskeletal origins. The results revealed a factorial structure of two components, as the original scale, explaining 30,96% of the total variance. Internal consistence results were good, for the biomedical component (Cronbach’s α = 0,826), but very weak for the biopsychosocial component (Cronbach’s α = 0,589). Relatively to convergent and discriminative validity, a statistically significant association was found, between the components 1 (biomedical) of the Portuguese version of PABS-PT and the HC-PAIRS (Rs= 0,481, p≤ 0,005) and negative, weak and significant between the total score of component 2 (biopsychosocial) and the HC-PAIRS (Rs = -0,038, p=0,612). Conclusion: The Portuguese Version of PABS-PT is easy to understand and seems to be a valid instrument to measure the attitudes and beliefs of physiotherapists in the management of patients with chronic low back pain. However, the biopsychosocial component requires a further deep analysis to examine a preferable biopsychosocial orientation.
Description
Relatório do Projecto de Investigação apresentado para cumprimento dos requisitos
necessários à obtenção do grau de Mestre em Fisioterapia, área de especialização em
Fisioterapia em Condições Músculo-Esquléticas.
Keywords
Dor lombar crónica Fisioterapeutas Crenças Atitudes PABS-PT Chronic low back pain Physiotherapists Beliefs Attitudes
Citation
Publisher
Instituto Politécnico de Setúbal. Escola Superior de Saúde