J H Suni1, T Virkkunen2, P Husu1, K Tokola1, J Parkkari1, M Kankaanpää3. 1. UKK Institute Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland. 2. Pirkanmaa Hospital District, Physical and Rehabilitation Medicine Outpatient Clinic, Teiskontie 35, 33520, Tampere, Finland. 3. Pirkanmaa Hospital District, Physical and Rehabilitation Medicine Outpatient Clinic, Teiskontie 35, 33520, Tampere, Finland. markku.kankaanpaa@pshp.fi.
Abstract
BACKGROUND: Health-care workers have an increased risk for chronic low back pain (LBP) leading to reduced workability. Depression, a highly prevalent, costly and disabling condition, is commonly seen in patients with sub-acute LBP. This study investigated the psychometric properties and construct-validity of a modified 9-item Patient Health Questionnaire (PHQ-9-mFIN) in female health-care workers with sub-acute LBP. METHODS: Reliability (internal consistency, test-retest repeatability) was assessed using standard methods. Construct validity of the PHQ-9-mFIN was assessed as level of depressive symptoms (PHQ-9-mFIN: 0-4 none, 5-9 mild, ≥10 at least moderate) against the RAND 36 Health Survey, a valid measure of health-related quality of life (HRQoL). Additionally, the strength of the association between the levels of PHQ-9-mFIN and selected biopsychosocial factors was determined. RESULTS: The internal consistency of the PHQ-9-mFIN was high (Cronbach's α = 0.82) and the test-retest repeatability scores (n = 64) were moderate: Pearson's correlation was 0.73 and Intraclass Correlation Coefficient (ICC) 0.73 (95% CI: 0.58 to 0.82). Construct validity (Spearman correlation) against the Physical and Mental component items and their summary scales of the RAND 36 were much higher for the Mental (range, - 0.40 to - 0.67 and - 0.64) than for the Physical (range, - 0.08 to - 0.43 and - 0.22). There was a clear stepwise association (p < 0.001) between the levels of depressive symptoms and General health (physical component, range, 59.1 to 78.8). The associations with all items of the Mental components were strong and graded (p < 0.001). All participants had low scores for Bodily pain, regardless of the level of depressive symptoms. There was a strong association (p ≤ 0.003) between the levels of PHQ-9-mFIN and multisite pain, lumbar exertion and recovery after workdays, neuromuscular fitness in modified push-ups, workability, and fear of pain related to work. CONCLUSIONS: The PHQ-9-mFIN showed adequate reliability and excellent construct validity among female health-care workers with recurrent LBP and physically strenuous work. TRIAL REGISTRATION: NCT01465698 .
BACKGROUND: Health-care workers have an increased risk for chronic low back pain (LBP) leading to reduced workability. Depression, a highly prevalent, costly and disabling condition, is commonly seen in patients with sub-acute LBP. This study investigated the psychometric properties and construct-validity of a modified 9-item Patient Health Questionnaire (PHQ-9-mFIN) in female health-care workers with sub-acute LBP. METHODS: Reliability (internal consistency, test-retest repeatability) was assessed using standard methods. Construct validity of the PHQ-9-mFIN was assessed as level of depressive symptoms (PHQ-9-mFIN: 0-4 none, 5-9 mild, ≥10 at least moderate) against the RAND 36 Health Survey, a valid measure of health-related quality of life (HRQoL). Additionally, the strength of the association between the levels of PHQ-9-mFIN and selected biopsychosocial factors was determined. RESULTS: The internal consistency of the PHQ-9-mFIN was high (Cronbach's α = 0.82) and the test-retest repeatability scores (n = 64) were moderate: Pearson's correlation was 0.73 and Intraclass Correlation Coefficient (ICC) 0.73 (95% CI: 0.58 to 0.82). Construct validity (Spearman correlation) against the Physical and Mental component items and their summary scales of the RAND 36 were much higher for the Mental (range, - 0.40 to - 0.67 and - 0.64) than for the Physical (range, - 0.08 to - 0.43 and - 0.22). There was a clear stepwise association (p < 0.001) between the levels of depressive symptoms and General health (physical component, range, 59.1 to 78.8). The associations with all items of the Mental components were strong and graded (p < 0.001). All participants had low scores for Bodily pain, regardless of the level of depressive symptoms. There was a strong association (p ≤ 0.003) between the levels of PHQ-9-mFIN and multisite pain, lumbar exertion and recovery after workdays, neuromuscular fitness in modified push-ups, workability, and fear of pain related to work. CONCLUSIONS: The PHQ-9-mFIN showed adequate reliability and excellent construct validity among female health-care workers with recurrent LBP and physically strenuous work. TRIAL REGISTRATION: NCT01465698 .
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