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European Journal of Physical and Rehabilitation Medicine 2021 May 27

DOI: 10.23736/S1973-9087.21.06729-0


language: English

Responsiveness and minimal important change of the Pain Catastrophizing Scale in people with chronic low back pain undergoing multidisciplinary rehabilitation

Marco MONTICONE 1, 2 , Igor PORTOGHESE 1, Barbara ROCCA 3, Andrea GIORDANO 4, Marcello CAMPAGNA 1, Franco FRANCHIGNONI 3

1 Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; 2 Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy; 3 Physical Medicine and Rehabilitation Unit, Institute of Lissone, ICS Maugeri, IRCCS, Lissone, Monza Brianz, Italy; 4 Bioengineering Unit, Institute of Veruno, ICS Maugeri, IRCCS, Veruno, Novara, Italy


BACKGROUND: The Pain Catastrophizing Scale (PCS), a widely used tool to assess catastrophizing related to spinal disorders, shows valid psychometric properties in general but the minimal important change (MIC) is still not determined.
DESIGN: Prospective observational study.
AIM: To assess responsiveness and MIC of the PCS in individuals with chronic low back pain (LBP) undergoing multidisciplinary rehabilitation.
SETTING: Outpatient rehabilitation hospital.
POPULATION: Two hundred and five patients with chronic LBP.
METHODS: Before and after an 8-week multidisciplinary rehabilitation program, 205 patients completed the Italian version of the PCS (PCS-I). We calculated the PCS-I responsiveness by distribution-based methods [effect size, ES; standardised response mean, SRM; minimum detectable change, MDC] and anchor-based methods [receiver operating characteristic (ROC) curves]. After the program, participants completed a 7-point global perceived effect scale (GPE), based on which they were classified as “improved” vs. “stable”. ROC curves computed the best cut-off level (taken as the MIC) between the two groups. ROC analysis was also performed on subgroups according to patients’ baseline PCS scores.
RESULT: ES, SRM and MDC were 0.71, 0.67 and 7.73, respectively. ROC analysis yielded an MIC of 8 points (95% confidence interval [CI]: 6-10; area under the curve [AUC]: 0.88). ROC analysis of the PCS subgroups confirmed an MIC of 8 points (95%CI: 6-10) for no/low catastrophizers (score <30, n=159; AUC: 0.90) and indicated an MIC of 11 points (95%CI: 8-14) for catastrophizers (score >30, n=33; AUC: 0.84).
CONCLUSIONS: The PCS-I showed good ability to detect patient-perceived clinical changes in chronic LBP post-rehabilitation. The MIC values we determined provide a benchmark for assessing individual improvement in this clinical context.
CLINICAL REHABILITATION IMPACT: The present study calculated - in a sample of people with chronic LBP - the responsiveness and MIC of the PCS. These values increase confidence in interpreting score changes, enhancing their meaningfulness for both research and clinical contexts.

KEY WORDS: Low back pain; Catastrophization; Pain; Rehabilitation; Exercise; Psychometrics

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