Photographs of activities of daily living – cervical spine

Assessing fear in patients with cervical pain: Development and validation of the Pictorial Fear of Activity Scale-Cervical (PFActS-C).
Turk DC, Robinson JP, Sherman JJ, Burwinkle T, Swanson K.

Ever since the PHODA or photographs of activities of daily living was developed, I’ve used pictures to help establish exactly what movements and contexts people are worried about. Pictures say so much more than a set of words!

So it’s great to see that Turk and colleagues have got together to develop a cervical spine version.

This study examines the reliability and development of ‘a set of photographs depicting movements in which four factors that determine biomechanical demands on the neck are systematically varied – Direction of Movement, Arm Position, Weight Bearing, and Extremity of Movement.’

Although the initial findings are quite interesting the authors acknowledge that further work needs to be carried out. I am curious to see whether there are differences between what is reported by people using photographs compared with their ‘real’ performance as assessed in their own home, perhaps by occupational therapists. I’m also curious to see whether, as I’ve found with the PHODA, there are problems transferring the photographs across different countries. Despite the PHODA being reasonably culturally neutral, there are differences in the type of building, items being carried, equipment, surfaces and so on, and these have been commented on by patients. Similarly, I would expect that a set of photographs developed in North America may also reflect cultural bias, and not be quite as useful in a Southern Hemisphere setting.

The process of developing this instrument is also really fascinating, and I wonder whether there are many areas of pain research where photographers and therapists work together!!

Let me know if you have used photographs to assess anxiety and avoidance – I’m interested to see how far this type of assessment and therapy has spread, and whether it has gained popularity amongst people like occupational therapists and physiotherapists, who work to help people generalise their skill and improve function.

TURK, D., ROBINSON, J., SHERMAN, J., BURWINKLE, T., SWANSON, K. (2008). Assessing fear in patients with cervical pain: Development and validation of the Pictorial Fear of Activity Scale-Cervical (PFActS-C). Pain DOI: 10.1016/j.pain.2008.03.001