Assessing attitudes and beliefs regarding low back pain is an integral component of a person-centered biopsychosocial approach to care.
Objectives
This study aimed to translate and cross-culturally adapt the Back Pain Attitudes Questionnaire (Back-PAQ) and to evaluate the psychometric properties of both the full 34-item version and its shortened versions.
Methods
Following recommended guidelines, cross-cultural adaptation process included forward and back translation, expert committee review, and pretesting using Three-Step Test-Interview. The psychometric properties evaluation involved physiotherapists and members of the general public, both with and without low back pain. Factor structure was analyzed using Principal Component Analysis, internal consistency was assessed using Cronbach's α, and test-retest reliability was measured using the Intraclass Correlation Coefficient (ICC).
Results
The Back-PAQ was translated and culturally adapted to Czech (Back-PAQ-CZ). Five hundred and thirty-nine participants (299 physiotherapists; 240 members of general public) were included for the analysis. No meaningful factor structure was found for the 34-item Back-PAQ-CZ. However, a meaningful factor structure and acceptable Internal Consistency were found for the 10-item and 8-item versions. The test-retest reliability was excellent (ICC2,1 = 0.94), good (ICC2,1 = 0.87) and moderate to good (ICC2,1 = 0.76) for the 34-, 10- and 8-item version, respectively.
Conclusions
The Back-PAQ-CZ and its shortened versions should only be used with an awareness of identified limitations.
HartvigsenJHancockMJKongstedA, et al.What low back pain is and why we need to pay attention. Lancet2018; 391: 2356–2367.
2.
O’SullivanPBCaneiroJPO’KeeffeM, et al.Cognitive functional therapy: an integrated behavioral approach for the targeted management of disabling low back pain. Phys Ther2018; 98: 408–423.
3.
AlamamDMLeaverAAlsobayelHI, et al.Low back pain-related disability is associated with pain-related beliefs across divergent non-English-speaking populations: Systematic Review and Meta-Analysis. Pain Med2021; 22: 2974–2989.
4.
ChristeGCrombezGEddS, et al.Relationship between psychological factors and spinal motor behaviour in low back pain: a systematic review and meta-analysis. Pain2021; 162: 672–686.
5.
ImaiRImaokaMNakaoH, et al.Task-specific fear rather than general kinesiophobia assessment is associated with kinematic differences in chronic low back pain during lumbar flexion: a preliminary investigation. PAIN Rep2022; 7: 1025.
6.
WernliKSmithACollF, et al.From protection to non-protection: a mixed methods study investigating movement, posture and recovery from disabling low back pain. Eur J Pain2022; 26: 2097–2119.
7.
DarlowB. Beliefs about back pain: the confluence of client, clinician and community. Int J Osteopathic Med2016; 20: 53–61.
8.
DarlowBFullenBMDeanS, et al.The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review. Eur J Pain2012; 16: 3–17.
9.
DarlowBDowellABaxterGD, et al.The enduring impact of what clinicians say to people with low back pain. Ann Fam Med2013; 11: 527–534.
10.
GardnerTRefshaugeKSmithL, et al.Physiotherapists’ beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies. J Physiother2017; 63: 132–143.
11.
FritzJMClelandJABrennanGP. Does adherence to the guideline recommendation for active treatments improve the quality of care for patients with acute low back pain delivered by physical therapists?Med Care2007; 45: 973–980.
12.
RuttenGMDegenSHendriksEJ, et al.Adherence to clinical practice guidelines for low back pain in physical therapy: do patients benefit?Phys Ther2010; 90: 1111–1122.
13.
WertliMMRasmussen-BarrEHeldU, et al.Fear-avoidance beliefs-a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J2014; 14: 2658–2678.
14.
WertliMMRasmussen-BarrEWeiserS, et al.The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J2014; 14: 816–836.e4.
15.
DarlowBPerryMMathiesonF, et al.The development and exploratory analysis of the Back Pain Attitudes Questionnaire (Back-PAQ). BMJ Open2014; 4: e005251.
16.
PierobonAPolicastroPOSoliñoS, et al.Spanish translation, cross-cultural adaptation and validation of the Argentine version of the Back Pain Attitudes Questionnaire. Musculoskelet Sci Pract2020; 46: 102125.
17.
KrägelohCMedvedevONDeanS, et al.Rasch analysis of the Back Pain Attitudes Questionnaire (Back-PAQ). Disabil Rehabil2022; 44: 3228–3235.
18.
PierobonADarlowB. Back Pain Attitudes Questionnaire (Back-PAQ) [Internet]. In: KrägelohCUAlyamiMMedvedevON (eds) International handbook of behavioral health assessment. Cham: Springer International Publishing, 2023[cited 2024 Dec 1], pp.1–14. DOI: https://doi.org/10.1007/978-3-030-89738-3_12-1.
19.
KanaanSFKhraiseHAlmhdawiKA, et al.Arabic version of the Back Pain Attitudes Questionnaire: translation, cross-cultural adaptation, and psychometric properties. J Back Musculoskelet Rehabil2021; 34: 59–67.
20.
KrugRCCaneiroJPRibeiroDC, et al.Back pain attitudes questionnaire: cross-cultural adaptation to Brazilian-Portuguese and measurement properties. Braz J Phys Ther2021; 25: 271–280.
21.
NicolaysenSMBoye LarsenDSkuli PalssonT. The Danish version for the Back Pain Attitudes Questionnaire - translation and cross-cultural adaptation. Musculoskeletal Science and Practice2021; 52: 102348.
22.
DemoulinCBrasseurPRousselN, et al.Cross-cultural translation, validity, and reliability of the French version of the neurophysiology of pain questionnaire. Physiother Theory Pract2017; 33: 880–887.
23.
NumanovicPDarlowBLarssonMEH. The Swedish version of the back pain attitudes questionnaire - translation, cross-cultural adaptation and validation. Musculoskeletal Sci Pract2024; 72: 102984.
24.
TayHAÖzgülBDarlowB, et al.Cross-cultural translation, validity, and reliability of the Turkish version of the Back Pain Attitudes Questionnaire. Musculoskeletal Sci Pract2022; 57: 102472.
25.
BeatonDEBombardierCGuilleminF, et al.Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976)2000; 25: 3186–3191.
26.
GagnierJJLaiJMokkinkLB, et al.COSMIN Reporting guideline for studies on measurement properties of patient-reported outcome measures. Qual Life Res2021; 30: 2197–2218.
27.
HakTvan der VeerKJansenH. The Three-Step Test-Interview (TSTI): an observation-based method for pretesting self-completion questionnaires. Surv Res Methods2008; 2: 143–150.
28.
de VetHCWTerweeCBMokkinkLB, et al.Measurement in medicine: a practical guide [Internet]. Cambridge: Cambridge University Press, 2011[cited 2024 Aug 11]. DOI: https://doi.org/10.1017/CBO9780511996214.
29.
NavarroDFoxcroftD. Learning statistics with jamovi: A tutorial for beginners in statistical analysis [Internet]. Cambridge, UK: Open Book Publishers, cited 2024Nov 26. DOI: https://doi.org/10.1017/CBO9780511996214.
30.
PallantJ. SPSS Survival Manual : A step by step guide to data analysis using IBM SPSS [Internet]. London: Routledge, 2020[cited 2024 Aug 11]. DOI: https://doi.org/10.4324/9781003117452.
31.
TerweeCBBotSDMde BoerMR, et al.Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol2007; 60: 34–42.
32.
KooTKLiMY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropractic Med2016; 15: 155–163.
33.
MokkinkLBTerweeCBPatrickDL, et al.The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res2010; 19: 539–549.
34.
QinSNelsonLMcLeodL, et al.Assessing test–retest reliability of patient-reported outcome measures using intraclass correlation coefficients: recommendations for selecting and documenting the analytical formula. Qual Life Res2019; 28: 1029–1033.
35.
FrankeTPCde VetHCWHuisstedeBMA. Minimally important change and smallest detectable change of the OSTRC questionnaire in half- and full-marathon runners. Scand J Med Sci Sports2021; 31: 1048–1058.
36.
MoranRWRushworthWMMasonJ. Investigation of four self-report instruments (FABT, TSK-HC, Back-PAQ, HC-PAIRS) to measure healthcare practitioners’ attitudes and beliefs toward low back pain: reliability, convergent validity and survey of New Zealand osteopaths and manipulative physiotherapists. Musculoskelet Sci Pract2017; 32: 44–50.
37.
AkogluH. User’s guide to correlation coefficients. Turk J Emerg Med2018; 18: 91–93.
38.
FeyCFHuTDeliosA. The measurement and communication of effect sizes in management research. Manage Organ Rev2023; 19: 176–197.
39.
AndradeC. Types of analysis: planned (prespecified) vs post hoc, primary vs secondary, hypothesis-driven vs exploratory, subgroup and sensitivity, and others. Indian J Psychol Med2023; 45: 640–641.
De BaetsLMeuldersAVan DammeS, et al.Understanding discrepancies in a person’s fear of movement and avoidance behavior: a guide for musculoskeletal rehabilitation clinicians who support people with chronic musculoskeletal pain. J Orthop Sports Phys Ther2023; 53: 307–316.
