Confidence in the Ability to Perform Movements in Patients With Low Back Pain

Study Overview
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Brief Summary
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The goals of this observational study are: To determine the validity and reliability of the OPTIMAL-confidence scale in people with chronic low back pain. To assess the influence of confidence and fear of movement on the evolution of low back pain. The main question it aims to answer is if people with chronic low back pain present different psychoemotional variables around fear of movement and decreased confidence in their ability to perform movement that may influence their low back pain. For this purpose, a two-phase study was designed. In the first phase, the OPTIMAL-confidence scale will be validated in patients with chronic low back pain, determining its internal consistency and validity. In the second phase, a prospective study will be carried out with patients with low back pain who attend physiotherapy centres to determine how confidence and fear of movement influence the characteristics of pain and its evolution. Data will be collected at the beginning of the physiotherapy treatment, at the end of the treatment and after three months. The data will be analysed using learning machine techniques.

Detailed Description
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In the first phase of the study, a sample of patients diagnosed with chronic low back pain will bwe selected, as well as a general population of convenience. The scope of the study is the health centres of the Primary Care Management of León and El Bierzo. To calculate the optimal sample size, the criteria included in the COSMIN20 guide (Consensus-based standards for the selection of health measurement instruments) were taken into account, taking as a reference the maximum quality criterion for hypotheses testing, which states that they should be equal to or greater than 100 subjects. The second phase will consist of a prospective observational study among patients with low back pain selected by physiotherapists and interested in participating in the study. Data will be collected at three different times: at recruitment and at the end of treatment, in person, and three months after the end of treatment, by telephone. The scope of the study will be the Primary and Specialised Health Care Departments of León and El Bierzo. In both cases participants will sign an informed consent form and the physiotherapists who will collect the data will be trained by researchers. Patients will complete socio-demographic and health questions as well as validated questionnaires on confidence, self-efficacy, fear of movement, risk of chronification and disability. Participants in the second phase will complete the questionnaires not only at the beginning, but two more times. In the validation phase of optimal-confidence, the internal consistency of the scale will be analysed, as well as convergent and known-groups validity. In the second phase, the data will be analysed using machine learning techniques. In order to find out which variables are most influential in the evolution of low back pain, different variations of the following machine learning techniques will be used: Gaussian Naive Bayes, Complement Naive Bayes, K-Nearest Neighbours (KNN and decision trees. Experiments using oversampling techniques such as RandomOver and Smote will also be carried out.

Official Title
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Assessment of Confidence in the Ability to Perform Movements in Patients With Low Back Pain and Its Relationship With the Characteristics and Evolution of Pain

Conditions
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Low Back Pain

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with low back pain. Be able to read and understand Spanish. Acceptance and signature of the informed consent. Exclusion Criteria: Tumor and/or infection related to the back. Cauda equina syndrome. Vertebral compression fracture. Abdominal aneurysm. Central nervous system disorders. Confirmed diagnosis of active neoplasm. Presence of cognitive deficits that prevented participation in the study. Pregnant patients in the last year.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline Confidence at 3 months | Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) instrument, confidence scale, spanish version. Total score ranges from 0-100 points, with higher scores indicating worse outcome (lower confidence). | Recruitment, physiotherapy discharge (week 3) and 3 months later. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline Kinesiophobia at 3 months. | Tampa scale of kinesiophobia (TSK-11), spanish version. Total score ranges from 11-44 points, with higher scores indicating worse outcome (greater fear). | Recruitment, physiotherapy discharge (week 3) and 3 months later. | 
| Change from Baseline Disability at 3 months. | Oswestry disability index (ODI), spanish version. Total score ranges from 0-100 points, with higher scores indicating worse outcome (greater disability). | Recruitment, physiotherapy discharge (week 3) and 3 months later. | 
| Change from Baseline Risk at 3 months. | STart Back screening tool (SBST-9), spanish version. Total score ranges from 0-9 points, with higher scores indicating worse outcome (greater risk). | Recruitment, physiotherapy discharge (week 3) and 3 months later. | 
| Change from Baseline Intensity of pain at 3 months. | Numerical Pain Rating Scale (NPRS). Total score ranges from 0-10 points, with higher scores indicating worse outcome (higher pain). | Recruitment, physiotherapy discharge (week 3) and 3 months later. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Low Back Ache, Lumbago, Self Efficacy, Kinesiophobia, Machine Learning