Citation

Chen J, Caluori C, Alberton L, Zhang J, Shashoua D, Calva V, Gauthier N, Edger-Lacoursière Z, de Oliveira A, Marois-Pagé E, Nedelec B. J. Burn Care Res. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, American Burn Association, Publisher Lippincott Williams and Wilkins)

DOI

10.1093/jbcr/irad025

PMID

36812056

Abstract

According to the Fear-Avoidance (FA) Model, FA beliefs can lead to disability due to avoidance of activities expected to result in pain or further injury. Extensive research on the relationship of FA, pain, catastrophizing, and disability has been generated with patients suffering from chronic neck and back pain, but little research has been conducted with burn survivors. To address this need, the Burn Survivor FA Questionnaire (BSFAQ) was developed (1) but has not been validated. Thus, the primary objective of this study was to investigate the construct validity of the BSFAQ among burn survivors. The secondary objective was to examine the relationship between FA and (i) pain intensity and (ii) catastrophizing at baseline, 3 months and 6 months post-burn, and (iii) disability among burn survivors at 6 months post-burn. A prospective mixed methods approach was used to examine the construct validity by comparing the quantitative scores of the BSFAQ to independently performed qualitative interviews of burn survivors (n=31) that explored their lived-experiences, to determine if the BSFAQ discriminated those who had, from those who did not have FA beliefs. Data for the secondary objective, scores of burn survivors (n=51) pain intensity (Numeric Rating Scale), catastrophizing (Pain Catastrophizing Scale), and disability (Burn Specific Health Scale-brief), were collected through a retrospective chart review. For the primary objective, Wilcoxon Rank Sum Test results showed a statistically significant difference (p=0.015) between the BSFAQ scores of participants who were identified from the qualitative interviews as fear-avoidant compared to those who were identified as non-fear-avoidant, with a ROC curve indicating that the BSFAQ correctly predicted FA 82.4% of the time. For the secondary objective, Spearman correlation test results showed a moderate correlation between FA and (i) pain at baseline (r=0.466, p=0.002), (ii) catastrophizing thoughts over time (r=0.557, p=0.000; r=0.470, p=0.00; r=0.559, p=0.002 respectively at each time point), and (iii) disability at 6 months post-burn (r=-0.643, p=0.000). These results support that the BSFAQ is able to discriminate which burn survivors are experiencing FA beliefs. It is also consistent with the FA model since burn survivors who express FA are more likely to report higher levels of pain early during their recovery that correlates with persistently elevated catastrophizing thoughts and ultimately results in higher self-reported disability. The BSFAQ demonstrates construct validity and is able to correctly predict fear-avoidant burn survivors; however, additional research is required to further examine the BSFAQ's clinimetric properties.

Language: en

Keywords

Rehabilitation; Disability; Burn Survivors; Catastrophizing; Fear-Avoidance; Pain