Back pain attitudes questionnaire: Cross-cultural adaptation to brazilian-portuguese and measurement properties

The Czech version of the back pain attitudes questionnaire: Cross-cultural adaptation and measurement properties analysis

BackgroundAssessing attitudes and beliefs regarding low back pain is an integral component of a person-centered biopsychosocial approach to care.ObjectivesThis 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.MethodsFollowing 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).ResultsThe 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.ConclusionsThe Back-PAQ-CZ and its shortened versions should only be used with an awareness of identified limitations.

Dutch translation, cross-cultural adaptation, validation, and reliability of the Back Pain Attitudes Questionnaire (Back-PAQ)

PURPOSE

To translate and cross-culturally adapt the Back Pain Attitudes Questionnaire (Back-PAQ) to Dutch for the Belgian and Dutch populations, and to investigate its measurement properties in the general population and physiotherapists.

METHODS

The adaptation followed established guidelines. Content validity, internal consistency, test-retest reliability (intraclass correlation coefficient), floor and ceiling effects, minimal detectable change (MDC), construct validity, and structural validity were assessed in physiotherapists and the general population. The modified Fear-Avoidance Beliefs Questionnaire (mFABQ) investigated the Back-PAQ's convergent validity, and Confirmatory Factor Analysis evaluated structural validity. Discriminant validity was assessed between physiotherapists and the general population.

RESULTS

Two hundred and sixty participants (mean age: 29 ± 13.3) completed the initial survey and 147 completed the test-retest survey. All Back-PAQ versions (34-item, 20-item, and 10-item) demonstrated good internal consistency, good to excellent test-retest reliability. Moderate correlations with the mFABQ (p < 0.001) and adequate discriminant validity between physiotherapists and the general population supported robust construct validity. The Back-PAQ 10 exhibited a good model fit and enables meaningful sub-score comparisons.

CONCLUSIONS

This collaboration produced a validated Dutch Back-PAQ suitable for use in both the Netherlands and Belgium. All versions demonstrated robust measurement properties, supporting their use in clinical and research settings assessing unhelpful beliefs in back pain management.

Comparing the impact of interactive versus traditional e-learning on physiotherapists' knowledge, attitudes, and clinical decision-making in low back pain management: a randomized controlled trial

INTRODUCTION

Despite the recommendations to use a bio-psycho-social framework, many physiotherapists still manage their patients mainly from a biomedical point of view. The purpose of this study is to analyze the impact of two different e-learning interventions on knowledge, attitudes, and clinical decision-making of physiotherapists managing low back pain (LBP) to increase guideline-consistent care.

METHODS

Physiotherapists were allocated (1/1) either to an experimental or a traditional e-learning intervention. Baseline and post-intervention assessment included the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), Back Pain Attitudes Questionnaire (Back-PAQ), Neurophysiology of Pain Questionnaire (NPQ), and a clinical vignette. Participants had 2 weeks to complete the post-intervention assessment. Statistics were processed using ANCOVA and Fisher's t-tests.

RESULTS

Four hundred nineteen physiotherapists were included in the analysis. Mean scores of HC-PAIRS, Back-PAQ, and NPQ significantly improved post-intervention in both groups. There was a significant effect of the intervention type (experimental versus traditional) on the scores of HC-PAIRS (p < .001; η2p = .243) and Back-PAQ (p < .001; η2p = .135) but not on NPQ scores. Return to work, recommendations assessed with the clinical vignette were significantly more guideline-consistent in the experimental group (p < .001) post-intervention.

CONCLUSION

An interactive e-learning intervention which includes concrete clinical examples and focused on patient's reassurance, self-management, and importance of screening psycho-social factors had more impact than a traditional e-learning intervention to enhance physiotherapists' knowledge, attitudes, and clinical decision-making regarding LBP.

An e-learning program improves low back pain beliefs of physiotherapists: a randomised trial

QUESTION

How effective is an e-learning program based on international clinical guidelines in promoting beliefs more aligned with the current evidence for the management of low back pain among physiotherapists?

DESIGN

Randomised controlled trial with concealed allocation and intention-to-treat analysis.

PARTICIPANTS

106 physiotherapists who treat patients with low back pain.

INTERVENTIONS

The experimental group received access to an e-learning program, based on recommendations of clinical practice guidelines for the management of low back pain, over a 6-week period. The program consisted of six units, totalling 15 hours, and was offered in a self-instructional and self-paced format. The control group was instructed to continue their activities as usual.

OUTCOME MEASURES

The primary outcome was beliefs about low back pain measured using the Modified Back Beliefs Questionnaire (MBBQ, -50 worst to 50 best). Secondary outcomes included the Back Pain Attitudes Questionnaire (Back-PAQ, -20 worst to 20 best) and agreement with two statements (1: X-rays or scans are necessary to get the best medical care for low back pain; 2: Everyone with low back pain should have spine imaging). Participants were evaluated at baseline and 6 weeks.

RESULTS

Out of 53 participants allocated to the e-learning program, two completed only the first unit and one did not complete any units, resulting in an overall adherence rate of 94%. Compared with control, the e-learning program improved the MBBQ (MD 8 points, 95% CI 5 to 10) and the Back-PAQ score (MD 3.1 points, 95% CI 1.8 to 4.3). For the imaging beliefs statements, the e-learning program was able to increase the proportion of participants with beliefs aligned with the current evidence (statement 1: RD 38%, 95% CI 21 to 52; statement 2: RD 17%, 95% CI 7 to 29) compared with the control group.

CONCLUSION

The e-learning program based on recommendations of clinical practice guidelines for the management of low back pain improved physiotherapists' beliefs about the management of low back pain.

REGISTRATION

NCT05661968.

An Exploration of Low Back Beliefs of Male Pre-Professional and Professional Dancers

BACKGROUND

Globally, male dancers are affected by low back pain (LBP) up to 2.5 times more than female dancers. While female dancers' beliefs around LBP and dance-specific low back movements exist, no research has explored male dancers' beliefs. This study aimed to (1) examine the low back beliefs of Australian male professional and pre-professional dancers, and (2) determine if beliefs toward common low back movements and lifting differed when current LBP or history of disabling LBP (DLBP) were considered.

METHODS

40 male dancers (mean age [SD] 26.9 years [7.9]) from a range of dance backgrounds (all participating in ballet) were recruited to complete a cross-sectional survey comprising a beliefs questionnaire considering dance-specific movement and lifting tasks, the Back Pain Attitudes Questionnaire (Back-PAQ) and the Athletic Fear Avoidance Questionnaire (AFAQ). Primary analysis included initial descriptives, a repeated measures ANOVA for movement-specific beliefs and visual thematic analysis for written responses within the belief's questionnaire. Secondary subgroup analysis included independent T-tests for those with/without current LBP and those with/without a history of DLBP.

RESULTS

Fourteen dancers reported current LBP and 30 reported a history of DLBP. Dancers held generally negative beliefs toward the low back (Back-PAQ mean 123.1 ± 9.7) with neither subgroup demonstrating significant between-group difference (P < .05). Dance-specific flexion movements were seen as safer than extension movements (P < .05), and more extended-spine lifting was seen as safer than more flexed-spine lifting (P < .05). Dancers experiencing current LBP held less positive beliefs surrounding some dance-specific movements.

CONCLUSIONS

Dancers hold negative general beliefs toward the low back irrespective of current or historical DLBP, however their beliefs surrounding dance-specific movements were relatively positive. Dancers' beliefs surrounding some movements were affected by the presence of current LBP, in particular an arabesque and a fish dive.

Translation, cross-cultural adaptation and clinimetric properties of the Brazilian Portuguese version of the Brace Questionnaire

PURPOSE

To perform a cross-cultural adaptation and validation of the Brazilian-Portuguese versions of the Brace Questionnaire in adolescent idiopathic scoliosis.

METHODS

A forward-backward translation process was employed to produce a Brazilian Portuguese version of the Brace Questionnaire, followed by comprehensive cross-cultural adaptation stages. The measurements of internal consistency and test-retest reliability were assessed by Cronbach's a and intraclass correlation coefficient (ICC), respectively. The Pearson's correlation coefficient was used to analyze the concurrent validity by comparison with the Scoliosis Research Society-22r questionnaire.

RESULTS

A total of 84 scoliosis patients (age 13.4 ± 2.0 years, thoracic Cobb angle 33.3° ± 13.8°, and lumbar Cobb angle 29.8° ± 14.3°) were included. The Brace Questionnaire showed excellent internal consistency (Cronbach α = 0.93) and moderate reliability (ICC = 0.86). The correlations between the Brace Questionnaire and Scoliosis Research Society-22 were r = 0.66; p = 0.011. In addition, it was found that the Brazilian version of the Brace Questionnaire does not have ceiling and floor effects.

CONCLUSIONS

The Brazilian-Portuguese adaptation of the brace questionnaire shows excellent reliability and can be a valid tool for psychometric assessment in adolescent idiopathic scoliosis.

Questionnaires assessing knowledge and beliefs about musculoskeletal conditions are potentially suitable for use, but further research is needed: a systematic review

OBJECTIVES

To evaluate the measurement properties of Patient-reported outcome measures (PROMs) for knowledge and/or beliefs about musculoskeletal conditions.

STUDY DESIGN AND SETTING

A systematic review was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. This review was prospectively registered on PROSPERO - ID: CRD42022303111. Electronic databases, reference lists, forward citation tracking, and contact with experts were used to identify studies. Eligible studies were reports developing or assessing a measurement property of a PROM measuring musculoskeletal condition specific-knowledge and/or beliefs. We assessed the methodological quality and measurement properties of included studies. A modified Grading of Recommendations Assessment Development and Evaluation approach was used to rate the quality of evidence for each PROM.

RESULTS

The literature search was performed from inception to 11th September 2023. Sixty records were included, reporting 290 individual studies, and provided information on 25 PROMs. Five PROMs presented sufficient structural validity, three presented sufficient cross-cultural validity, ten presented sufficient reliability, three presented sufficient criterion validity, six presented sufficient hypothesis-testing, and four presented sufficient responsiveness. No PROM presented sufficient evidence for content validity, internal consistency, and measurement error. Based on the available evidence, no PROM was classified as suitable for use according to the COSMIN recommendations. Twenty-four PROMs are potentially suitable for use, and one PROM is not recommended for use.

CONCLUSION

No PROM designed to assess knowledge and/or beliefs about musculoskeletal conditions meets the COSMIN criteria of suitable for use. Most PROMs identified in this systematic review were considered as potentially suitable for use and need further high-quality research to assess their measurement properties.

Management of Low Back Pain: Do Physiotherapists Know the Evidence-Based Guidelines?

BACKGROUND

Clinical practice guidelines promote bio-psychosocial management of patients suffering from low back pain (LBP). The objective of this study was to examine the current knowledge, attitudes and beliefs of physiotherapists about a guideline-adherent approach to LBP and to assess the ability of physiotherapists to recognise signs of a specific LBP in a clinical vignette.

METHODS

Physiotherapists were recruited to participate in an online study. They were asked to indicate whether they were familiar with evidence-based guidelines and then to fill in the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), Back Pain Attitudes Questionnaire (Back-PAQ), Neurophysiology of Pain Questionnaire (NPQ), as well as questions related to two clinical vignettes.

RESULTS

In total, 527 physiotherapists participated in this study. Only 38% reported being familiar with guidelines for the management of LBP. Sixty-three percent of the physiotherapists gave guideline-inconsistent recommendations regarding work. Only half of the physiotherapists recognised the signs of a specific LBP.

CONCLUSIONS

The high proportion of physiotherapists unfamiliar with guidelines and demonstrating attitudes and beliefs not in line with evidence-based management of LBP is concerning. It is crucial to develop efficient strategies to enhance knowledge of guidelines among physiotherapists and increase their implementation in clinical practice.

Back Pain: Pathophysiology, Diagnosis, and Treatment

Although back pain is one of the most common medical conditions [...]

An investigation of implicit bias about bending and lifting

OBJECTIVES

Previous studies in a high-income country have demonstrated that people with and without low back pain (LBP) have an implicit bias that bending and lifting with a flexed lumbar spine is dangerous. These studies present two key limitations: use of a single group per study; people who recovered from back pain were not studied. Our aims were to evaluate: implicit biases between back posture and safety related to bending and lifting in people who are pain-free, have a history of LBP or have current LBP in a middle-income country, and to explore correlations between implicit and explicit measures within groups.

METHODS

Exploratory cross-sectional study including 174 participants (63 pain-free, 57 with history of LBP and 54 with current LBP). Implicit biases between back posture and safety related to bending and lifting were assessed with the Implicit Association Test (IAT). Participants completed paper-based (Bending Safety Belief [BSB]) and online questionnaires (Tampa Scale of Kinesiophobia; Back Pain Attitudes Questionnaire).

RESULTS

Participants displayed significant implicit bias between images of round-back bending and lifting and words representing "danger" (IATD-SCORE: Pain-free group: 0.56 (IQR=0.31-0.91; 95% CI [0.47, 0.68]); history of LBP group: 0.57 (IQR=0.34-0.84; 95% CI [0.47, 0.67]); current LBP group: 0.56 (IQR=0.24-0.80; 95% CI [0.39, 0.64])). Explicit measures revealed participants hold unhelpful beliefs about the back, perceiving round-back bending and lifting as dangerous (BSBthermometer: Pain-free group: 8 (IQR=7-10; 95% CI [7.5, 8.5]); history of LBP group: 8 (IQR=7-10; 95% CI [7.5, 9.0]); current LBP group: 8.5 (IQR=6.75-10; [7.5, 9.0])). There was no correlation between implicit and explicit measures within the groups.

CONCLUSIONS

In a middle-income country, people with and without LBP, and those who recovered from LBP have an implicit bias that round-back bending and lifting is dangerous.

Misconceptions of physical therapists and medical doctors regarding the impact of lifting a light load on low back pain

BACKGROUND

A common misconception about low back pain (LBP) is that the spine is weak and that lumbar flexion should be avoided. Because the beliefs of health-care professionals (HCPs) influence patients, it is important to understand the attitudes of health care professionals towards LBP and lifting.

OBJECTIVES

To assess and compare the perceptions of different categories of HCPs regarding the safety of specific movement strategies used to lift a light load, and their beliefs regarding back pain. The secondary aim was to determine whether certain factors influenced the beliefs of HCPs.

METHODS

Data were collected via an electronic survey. Student and qualified physical therapists (PTs), medical students, and general practitioner (GP) trainees were included. The questionnaire included eight photographs, depicting eight different strategies to lift a light load. Respondents were requested to select the strategy(s) they considered as "unsafe" to use for asymptomatic people with a previous history of LBP and people with chronic LBP. Beliefs and attitudes towards LBP were evaluated using the Back Pain Attitudes Questionnaire (Back-PAQ).

RESULTS

Questionnaires from 1005 participants were included. Seventy percent of qualified PTs considered none of the strategies as harmful (versus 32% of PT students, 9% of GP trainees and 1% of medical students). Qualified PTs had higher Back-PAQ scores (mean ± SD: 13.6 ± 5.5) than PT students (8.7 ± 5.7), GP trainees (5.9 ± 5.9) and medical students (4.1 ± 5.2), indicating less misconceptions regarding LBP. Having LBP negatively influenced beliefs while taking a pain education course positively influenced beliefs.

CONCLUSION

Misconceptions regarding LBP and the harmfulness of lifting a light load with a rounded back remain common among HCPs, particularly medical doctors.

The Danish version for the Back Pain Attitudes Questionnaire - Translation and cross-cultural adaptation

BACKGROUND

Beliefs and attitudes about back pain are relevant factors in relation to developing back pain. A Danish version of the Back Pain Attitudes Questionnaire (Back-PAQ) could be a way of assuring a more systematic examination of attitudes about back pain within patients with back pain, laypeople and healthcare professionals in Denmark.

OBJECTIVES

The aim of this study was to develop a Danish version of the Back-PAQ and assess its psychometric properties.

STUDY DESIGN

Study of diagnostic accuracy/assessment scale.

METHOD

The adaptation was performed in several steps following the dual-panel method. The psychometric analyses included testing the reliability and validity.

RESULTS

Thirty-seven individuals participated in the translation process, and the main findings were that the translated version was considered to reflect the original version and that it was considered relevant to address beliefs related to back pain. Five hundred and thirteen patients were included in principal component analysis and sixty were included in the test-retest analysis. The analysis on the 10-item version revealed a structure that was similar to the original questionnaire and explained 82% of the variance in the dataset. The test-retest analysis showed an ICC of 0.80 (95% CI 0.67-0.88) and SDC ranged from 0.78 to 2.35 with a mean of 1.61.

CONCLUSION

The Back-PAQ was successfully translated and cross-culturally adapted into Danish. Its psychometrics properties showed that the Danish version of the questionnaire is valid and reliable for assessment of beliefs and attitudes regarding back pain, and may prove useful in both clinical settings and research in Denmark.

Standard measurement error and minimal detectable change of the Back-PAQ ArgSpan questionnaire: Secondary analysis

BACKGROUND

Negative attitudes and beliefs about back pain in patients with low back pain (LBP) are associated with high levels of pain and negatively influence clinical outcome. The Back Pain Attitudes Questionnaire (Back-PAQ) was developed to assess back beliefs of patients and healthcare professionals. The minimal detectable change (MDC) is defined as the smallest amount of change that can be detected not due to inherent variation or "noise" in the measure. The MDC values at 68%, 90% and 95% confidence levels of the Back-PAQ ArgSpan are unknown.

OBJECTIVE

to calculate standard error measurement (SEM) and MDC to confirm the feasibility of Back-PAQ ArgSpan as a reliable outcome measure in clinical and research settings.

STUDY DESIGN

a secondary analysis was carried out using a subgroup of data from the cross-cultural adaptation and validation of the Argentine version of the Back PAQ.

METHOD

SEM was calculated (SD × √1 - ICC) and MDC as (SEM × z-value × √2). MDC was calculated as percentage as well.

RESULTS

the SEM was 5.16 points. The MDC₆₈, MDC₉₀ and MDC₉₅ of the Back-PAQ were 7.30, 12 and 14.3 points, respectively. The percentages of MDC₆₈, MDC₉₀ and MDC₉₅ of the Back-PAQ were 6.7%, 11.0% and 13.1%, respectively.

CONCLUSION

The present study demonstrated that the Back-PAQ ArgSpan is a reliable and interpretable measurement tool. When assessing a patient, a change in the score in the Back-PAQ ArgSpan over 15 points shows a true change at 95% confidence level.

Rasch analysis of the Back Pain Attitudes Questionnaire (Back-PAQ)

CONTEXT

As psychosocial factors have been recognised as significant predictors of the recovery trajectory from chronic back pain, the 34-item Back Pain Attitudes Questionnaire (Back-PAQ) was developed based on themes obtained from patient interviews, but previous psychometric analyses with a general population sample revealed uncertainty around the factor structure of the instrument.

OBJECTIVES

To provide more detailed information about the psychometric properties of the Back-PAQ when used with participants from the general population and also to test the internal validity of the tool for use with General Practitioners (GPs).

METHODS

After applying partial-credit Rasch analysis with a sample of participants from the general population (n = 600), a replication analysis was conducted with a sample of GPs (n = 184). This approach permitted examination of sample-specific personal factors for differential item functioning. Subtests were used to differentiate between local dependency due to underlying dimensionality from local dependency due to method effects.

RESULTS

A unidimensional fit to the Rasch model was achieved after 14 misfitting items had been deleted. The final 20-item solution also fit with a sample of 184 GPs. In both cases, the Back-PAQ-20 demonstrated good reliability (PSI ≥ 0.80), with no evidence of differential item functioning by personal factors.

CONCLUSION

The ordinal-to-interval conversion algorithms presented here further enhance the precision of the scale and permit analysis of Back-PAQ-20 scores using parametric statistics. The present study provided evidence for valid and reliable assessment of the back pain recovery beliefs of both users as well as providers of health services.IMPLICATIONS FOR REHABILITATIONPsychosocial factors have been recognised as significant predictors of the recovery trajectory from chronic back pain.The 34-item Back Pain Attitudes Questionnaire (Back-PAQ) was developed based on themes obtained from patient interviews, but previous psychometric analyses with a general population sample revealed uncertainty around the factor structure of the instrument.The 20-item version of the Back Pain Attitudes Questionnaire (Back-PAQ) is shown here to have strong psychometric properties for administration with users and providers of health services.