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of the FABQ, has been suggested as an indicator of poor treatment outcomes 
in patients with low back pain seeking care from primary care or osteopathic physicians.124 Data from 2 separate physical therapy 
intervention clinical trials indicated that the FABQ-W cutoff score (greater than 29) was a better predictor of self-reported disability at 
6 months in comparison to the FABQ-PA cutoff score (greater than 14).125 Another psychometric analysis indicated that single items 
of the FABQ-PA and FABQ-W were able to accurately identify those with elevated (above median) or not elevated (below median) total 
FABQ-PA and FABQ-W scores.143
Pain Catastrophizing Scale
ICF category Measurement of impairment of body function – content of thought (mental functions consisting of the ideas that are present in the 
thinking process and what is being conceptualized); and thought functions, specified as the tendency to elaborate physical symptoms 
for cognitive/ideational reasons
Description The Pain Catastrophizing Scale (PCS) assesses the extent of catastrophic cognitions due to low back pain.285 Pain catastrophizing has 
been broadly defined as an exaggerated negative orientation toward actual or anticipated pain experiences.285 The PCS is a 13-item 
questionnaire with a potential range of 0 to 52, with higher scores indicating higher levels of pain catastrophizing. The PCS assesses 
3 independent dimensions of pain catastrophizing: rumination (items 8-11: ruminating thoughts, worrying, inability to inhibit pain-
related thoughts), magnification (items 6, 7, 13: magnification of the unpleasantness of pain situations and expectancies for negative 
outcomes), and helplessness (items 1-5, 12: inability to deal with painful situations).285,296 Patients rate their agreement with statements 
related to thoughts and feelings when experiencing pain on a 5-point Likert scale (0 is “not at all,” 4 is “all the time”).285
(continued)
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Low Back Pain: Clinical Practice Guidelines
journal of orthopaedic & sports physical therapy | volume 42 | number 4 | april 2012 | a29
Pain Catastrophizing Scale (continued)
Measurement method Self-report
Nature of variable Continuous
Units of measurement Individual items: 5-point Likert scale
(0 is “not at all,” 4 is “all the time”)
Measurement properties Test-retest reliability at 6 (r = 0.75) and 10 weeks (r = 0.70) has been reported for the PCS.285 Cronbach alpha estimates ranging from 
.85 to .92 suggest the PCS is internally consistent,72,73,232 and similar findings have been found for items related to rumination (.85), 
magnification (.75), and helplessness (.86).232 The PCS has been found to demonstrate several different types of validity.72,73,232,285
Subgroups for Targeted Treatment Back Screening Tool
ICF category Measurement of limitation in activities and participation – completing the daily routine; purposeful sensory experiences, specified as 
repetitive perception of noninjurious sensory stimuli; and interacting according to social rules
Measurement of impairment of body function – pain in back; pain in lower limb; content of thought; and thought functions, specified 
as the tendency to elaborate physical symptoms for cognitive/ideational reasons; appropriateness of emotion (mental functions 
that produce congruence of feeling or affect with the situation, such as happiness at receiving good news); range of emotion (mental 
functions that produce the spectrum of experience of arousal of affect or feelings such as love, hate, anxiousness, sorrow, joy, fear, and 
anger); and emotional functions, specified as the tendency to elaborate physical symptoms for emotional/affective reasons
Description The Subgroups for Targeted Treatment (STarT) Back Screening Tool is a 9-item screening measure used to identify subgroups of 
patients with low back pain in primary care settings based on the presence of potentially modifiable prognostic factors that may 
be useful in matching patients with targeted interventions.159 The STarT contains items related to physical (items 2, 3, 5, 6) and 
psychosocial (items 1, 4, 7, 8, 9) factors that have been identified as strong independent predictors of persistent disabling low back 
pain.
Measurement method Potential responses for the STarT are dichotomized ("agree" or "disagree"), with the exception of an item related to "bothersomeness" 
which uses a 5-point Likert scale. Overall STarT scores (ranging from 0 to 9) are determined by summing all positive responses. 
Psychosocial subscale scores (ranging from 0 to 5) are determined by summing items related to bothersomeness, fear, catastrophizing, 
anxiety, and depression (ie, items 1, 4, 7, 8, 9). Based on overall and psychosocial subscale scoring, the STarT categorizes patients 
as "high-risk" (psychosocial subscale scores 4), in which high levels of psychosocial prognostic factors are present with or without 
physical factors present, "medium-risk" (overall score >3; psychosocial subscale score <4), in which physical and psychosocial factors 
are present but not a high level of psychosocial factors, or "low-risk" (overall score 0-3), in which few prognostic factors are present.146
Nature of variable Continuous subscale scores for function and psychosocial items and categorical subgroups
Units of measurement Individual items:
Bothersomeness item: 5-point Likert scale
Remaining items: dichotomous scale
(continued)
Örebro Musculoskeletal Pain Screening Questionnaire
ICF category Measurement of limitation in activities and participation – completing the daily routine; purposeful sensory experiences, specified as 
repetitive perception of noninjurious sensory stimuli; and interacting according to social rules
Measurement of impairment of body function – pain in back; pain in lower limb; content of thought; and thought functions, specified 
as the tendency to elaborate physical symptoms for cognitive/ideational reasons
Description The Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) (also referred to as the Acute Low Back Pain Screening 
Questionnaire) was originally developed to assist primary care practitioners in identifying psychosocial “yellow flags” and patients at 
risk for future work disability due to pain. The OMPSQ is a 25-item screening questionnaire (of which 21 are scored) that consists of 
items involving pain location (item 4), work absence due to pain (item 5), pain duration (item 6), pain intensity (items 8 and 9), control 
over pain (item 11), frequency of pain episodes (item 10), functional ability (items 20 through 24), mood (items 12 and 13), perceptions 
of work (items 7 and 16), patients' estimate of prognosis (items 14 and 15), and fear-avoidance (items 17 through 19).199 The scored 
items are summed to provide a total score potentially ranging from 0 to 210, with higher scores indicating a higher risk of poor outcome. 
Measurement method Self-report 
Nature of variable Continuous
Units of measurement Individual items rated on a 0-to-10 scale
Measurement properties The ability of the OMPSQ to predict long-term pain, disability, and sick leave has been supported in previous studies,207 including a 
systematic review of 7 publications (5 discrete data sets).163
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