A further note on freeman's measure of association

This note extends and elaborates Hubert's attempt to provide an interpretation of Freeman's measure of association,. The measure is used in a a contingency table when observations are ordered on one variable and unordered on the other. No attempt is made explore the distribution of.     

Long-term, non-specific spinal pain: reliable and valid subgroups of patients

The aim of this study was to identify reliable and valid subgroups of spinal pain patients, using data from the Swedish version of the Multidimensional Pain Inventory (MPI-S). A second aim was to test the generalisability of the three patient profiles described in earlier studies on the MPI ("adaptive coper", "dysfunctional" and "interpersonally distressed" patients). The study base consisted of two samples of individuals suffering from long-term, non-specific spinal pain and the results were validated across these samples. Cluster analysis was used to detect distinct groups of patients and the validity of these subgroups was evaluated on variables not used to generate the cluster solution. One subgroup was characterised by lower pain severity, lower interference with everyday activities, lower affective distress and higher life control than the other two subgroups. This patient profile was similar to the MPI adaptive coper patients. A second subgroup resembled the dysfunctional patient profile, thus displaying a worse adjustment to chronic pain than the AC patients. The third patient group reported significantly lower levels of social support from "significant others" than the other subgroups. This patient profile was similar to that of the interpersonally distressed patient group. Taken together, the results support the reliability, validity and generalisability of three subgroups of chronic pain patients derived from the MPI-S.     

Both early and late changes in psychological variables relate to treatment outcome for musculoskeletal pain patients at risk for disability

We know little about why some people get better after psychological treatments for pain disability, whereas other people do not. In order to understand differences in treatment response, we need to explore processes of change during treatment. It has been suggested that people with pain complaints who change early in treatment have better outcomes. Therefore, we aimed to investigate whether changes in psychological variables at different time points are related to outcome, and whether early or late changes are better predictors of outcome. We used the fear avoidance model as a theoretical framework. We followed 64 patients weekly over 6–7 weeks and then determined outcome. Our findings indicate that people who decrease in catastrophizing and function early in treatment as well as in depressive symptoms, worry, fear avoidance beliefs and function late in treatment have better outcomes. Early decreases in function, and late decreases in depressive symptoms and worry uniquely predict improvements in disability. While early and late changes covaried concurrently, there were no significant sequential relationships between early and late changes. Changes in the proposed process variables in the fear avoidance model, early as well as late in treatment, thus add valuable information to the explanation of outcome.     

Correspondence of back pain patients' self-reports of sick leave and Swedish National Insurance Authority register

While self-reports of sick absenteeism days are often practical for research, it is not clear how accurate these reports are. 192 Swedish participants recorded the number of days they had been off work for all illnesses, as well as for back pain specifically, for each month during the past 6 mo. These data were then compared to records from the National Insurance Authority in Sweden. The similarity between the data sets was very high, with the correspondence for those reporting 0 to 30 days off being 98%. For those with more than 30 days of self-reported sick leave, the correspondence was 81%, but the reason for the discrepancy may have been a lack of clarity in the question. It is concluded that self-reports correspond well with recorded data and that their use in research is justified.     

Are fear-avoidance beliefs related to the inception of an episode of back pain? A prospective study

Abstract

Fear-avoidance beliefs and catastrophizing have been implicated in chronic pain and theoretical models have been developed that feature these factor in the transition from acute to chronic pain. However, little has been done to determine whether these factors occur in the general population or whether they arc associated with the inception of an episode of neck or back pain. The aim of this study was to evaluate prospectively the effects of fear-avoidance beliefs and catastrophizing on the development of an episode of self-reported pain and associated physical functioning. To achieve this, we selected a sample of 415 people from the general population who reported no spinal pain during the past year. At the pretest a battery of questionnaires was administered to assess beliefs about pain and activity and it featured the Pain Catastrophizing Scale and a modified version of the Fear-Avoidance Beliefs Questionnaire. One year later outcome was evaluated by self-reports of the occurrence of a pain episode as well as a self-administered physical function test. The results showed that scores on both fear-avoidme and cabstrophizing were quite low. During the one year follow-up, 19% of the sample suffered an episode of back pain. Those with scores above the median on fear-avoidance beliefs at the pretest had twice the risk of suffering an episode of back pain and a 1.7 times higher risk of lowered physical function at the follow-up. Catastrophizing was somewhat less salient, increasing the risk of pain or lowered function by 1.5. but with confidence intervals falling below unity. These data indicate that fear-avoidance beliefs may be involved at a very early pint in the development of pain and associated activity problems in people with back pain. Theoretically. our results support the idea that fear-avoidance beliefs may develop in an interaction with the experience of pain. Clinically, the results suggest that catastrophizing and particularly fear-avoidance beliefs are important in the development of a pain problem and might be of use in screening procedures.     

Skeptical Conclusions

For a putative knower S and a proposition P, two types of skepticism can be distinguished, depending on the conclusions they draw: outer skepticism, which concludes that S does not know that P, and inner skepticism, which concludes that S does not know whether P. This paper begins by showing that outer skepticism has undesirable consequences because that S does not know that P presupposes P, and inner skepticism does not have this undesirable consequence since that S does not know whether P does not presuppose P. We indicate that the two types of skepticism aim to different loci of doubts: while outer skepticism doubts whether we can gain an epistemic warrant for the actuality, inner skepticism doubts whether we can gain epistemic identification of the actuality. It is further indicated that responses to skepticism from externalist theories, as well as from fallibilist internalist theories, can only respond to outer skepticism but not to inner skepticism.     

A Qualitative Study of Recovering and Nonrecovering Substance Abuse Counselors' Belief Systems

This study investigated recovering and nonrecovering substance abuse counselors' beliefs about the etiology and treatment of substance abuse disorders. Qualitative methods were used to investigate these variables. Analysis of the data revealed several key findings with implications for future research.