Clinimetrics: The Back Beliefs Questionnaire

Nurses’ beliefs about back pain, their coping strategies and participant activation for self-management

Background

Back pain affects nurses’ physical, social and emotional well-being, as they encounter difficulties in executing their social and occupational duties.

Objectives

Our study investigated the impact of a cross-cultural back pain campaign on nurses’ beliefs about back pain; activating the participants to self-manage; coping strategies; sick leave claimed; and frequency of doctor visits.

Method

A single sample pre- and post-test design was used. The intervention was a 12-week educational campaign based on evidence-based back pain messages. Primary outcomes were measured by their beliefs about back pain and their activation to self-manage. Analyses were conducted using SPSS version 27.0 software, and significant differences from before and after the campaign were analysed using the Chi-square test at a 0.05 significance level.

Results

There were no significant differences in the age, gender and work hours of the nurses who participated before and after the campaign, except for their professional work settings (< 0.05). All secondary outcomes improved significantly after the campaign, and outcomes on beliefs about back pain showed significantly positive changes in six of the 14 items, while all questions pertaining to patient activation improved significantly.

Conclusion

The 12-week back pain campaign, based on contextualised, evidence-based back pain messages for Zambian nurses, motivated the participants to self-manage their back pain. However, not all beliefs about back pain changed positively after the campaign.

Clinical implications

The findings of this back pain education campaign show promise as a strategy to improve knowledge, behaviours and beliefs about back pain in African settings.

Beliefs about back pain and associations with clinical outcomes: a primary care cohort study

OBJECTIVE

To investigate associations between beliefs about low back pain (LBP) at baseline and pain intensity and disability at 2-week, 13-week and 52-week follow-up.

DESIGN

Observational cohort study.

SETTING

Primary care private chiropractic clinics in Denmark.

PARTICIPANTS

A total of 2734 adults consulting a chiropractor for a new episode of LBP, with follow-up data available from 71%, 61% and 52% of the participants at 2, 13 and 52 weeks, respectively.

OUTCOME MEASURES

Beliefs about LBP were measured by the Back Belief Questionnaire (BBQ) before consulting the chiropractor. Pain (Numerical Rating Scale 0-10) and disability (the Roland-Morris Disability Questionnaire) were measured at baseline and after 2, 13 and 52 weeks. Associations were explored using longitudinal linear mixed models estimating interactions between BBQ and time, and by estimating associations between single items of BBQ and 13-week outcomes.

RESULTS

More positive beliefs about LBP were weakly associated with a reduction in pain at 2 weeks (β interaction BBQ#Time=-0.02 (95% CI -0.04 to -0.001)), at 13 weeks (-0.03 (95% CI -0.05 to -0.01)) and at 52 weeks of follow-up (-0.03 (95% CI -0.05 to -0.01); p=0.003). For disability, the association was uncertain (p=0.7). The item 'Back trouble means periods of pain for the rest of one's life' had the strongest association with both reduction in pain (-0.29, 95% CI -0.4 to -0.19, p<0.001) and disability (-2.42, 95% CI -3.52 to -1.33, p<0.001) at 13-week follow-up.

CONCLUSION

Positive beliefs regarding LBP, measured by the BBQ, were associated with a reduction in pain intensity at both short-term and long-term follow-up. However, the association was weak, and the clinical relevance is therefore questionable. No clear association was demonstrated between beliefs and disability. This study did not show promise that back beliefs as measured by the BBQ were helpful for predicting or explaining the course of LBP in this setting.

Development and measurement properties of the AxEL (attitude toward education and advice for low-back-pain) questionnaire

Introduction

Clinician time and resources may be underutilised if the treatment they offer does not match patient expectations and attitudes. We developed a questionnaire (AxEL-Q) to guide clinicians toward elements of first-line care that are pertinent to their patients with low back pain.

Methods

We used guidance from the COSMIN consortium to develop the questionnaire and evaluated it in a sample of people with low back pain of any duration. Participants were recruited from the community, were over 18 years and fluent in English. Statements that represented first-line care were identified. Semantic scales were used to measure attitude towards these statements. These items were combined to develop the questionnaire draft. Construct validity was evaluated with exploratory factor analysis and hypotheses testing, comparing to the Back Beliefs Questionnaire and modified Pain Self-Efficacy Questionnaire. Reliability was evaluated and floor and ceiling effects calculated.

Results

We recruited 345 participants, and had complete data for analysis for 313 participants. The questionnaire draft was reduced to a 3-Factor questionnaire through exploratory factor analysis. Factor 1 comprised 9 items and evaluated Attitude toward staying active, Factor 2 comprised 4 items and evaluated Attitude toward low back pain being rarely caused by a serious health problem, Factor 3 comprised 4 items and evaluated Attitude toward not needing to know the cause of back pain to manage it effectively. There was a strong inverse association between each factor and the Back Beliefs Questionnaire and a moderate positive association with the modified Pain Self-Efficacy Questionnaire. Each independent factor demonstrated acceptable internal consistency; Cronbach α Factor 1 = 0.92, Factor 2 = 0.91, Factor 3 = 0.90 and adequate interclass correlation coefficients; Factor 1 = 0.71, Factor 2 = 0.73, Factor 3 = 0.79.

Conclusion

This study demonstrates acceptable construct validity and reliability of the AxEL-Q, providing clinicians with an insight into the likelihood of patients following first-line care at the outset.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-021-01908-4.

Investigating the Mechanisms of Graded Sensorimotor Precision Training in Adults With Chronic Nonspecific Low Back Pain: Protocol for a Causal Mediation Analysis of the RESOLVE Trial

Background

Chronic low back pain (CLBP) is a global health problem associated with an increasing burden on individuals, health care systems, and society. Common treatments for people with CLBP produce, on average, small short-term improvements in pain and function compared with minimal care. The RESOLVE trial randomly allocated 276 people with CLBP to a new complex treatment strategy, pain education integrated with graded sensorimotor precision training (RESOLVE), or a sham control. The RESOLVE treatment was developed within a theoretical framework to target possible treatment mechanisms associated with CLBP development and persistence.

Objective

This protocol describes the planned evaluation of these proposed treatment mechanisms. Improved understanding of the mechanisms underpinning the RESOLVE treatment may guide its refinement and implementation.

Methods

We will use causal mediation analysis to evaluate the proposed treatment mechanisms, including pain self-efficacy, back beliefs, pain catastrophizing, kinesiophobia, back perception, tactile acuity, and movement coordination. The primary outcomes are pain intensity and function at 18 weeks following allocation. Data were collected blind to allocation and hypotheses at baseline (mediators, outcomes, confounders), end of treatment (mediators), and at 18 weeks following allocation (outcomes). We will test the robustness of our findings by conducting planned sensitivity analyses.

Results

Ethical approval was granted by the University of New South Wales Human Research Ethics Committee (HC15357). A total of 276 participants have been recruited from primary care practices and the community in Sydney, Australia.

Conclusions

The RESOLVE treatment constitutes a new paradigm for CLBP management with potentially wide-reaching implications. This mechanistic evaluation will provide evidence for the hypothesized treatment mechanisms and help explain why the treatment strategy did or did not have an effect on patient-reported outcomes. These results will help guide the treatment refinement and implementation.

Trial Registration

Australian and New Zealand Clinical Trials Registry ACTRN12615000610538; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368619&isReview=true

International Registered Report Identifier (IRRID)

DERR1-10.2196/26053

Exercise Is Medicine, But Perhaps Not for Preventing Low Back Pain: A Randomized Trial of Exercise and Education to Prevent Low Back Pain Recurrence

OBJECTIVE

To assess whether an exercise and education program was more effective than an education booklet for preventing recurrence of low back pain (LBP).

DESIGN

Randomized controlled trial.

METHODS

Participants aged 18 years or older who had recovered from an episode of LBP within the previous week were recruited from primary care practices and the community. Participants were randomized to receive either 12 weeks of exercise and education (8 supervised exercise sessions and 3 one-on-one sessions) or a control (education booklet). The primary outcome was time to recurrence of LBP during the 1-year follow-up. Times to recurrence of LBP leading to activity limitation, care seeking, and work absence were secondary outcomes. Data were analyzed with Cox regression using intention-to-treat principles.

RESULTS

We planned to include 160 participants but included 111 (exercise and education, n = 57; educational booklet, n = 54). At the end of the study period, data completeness was 84.2%. Thirty-six (63%) participants in the exercise and education group and 31 (57%) participants in the control group had a recurrence of LBP. There was no statistically significant difference in time to recurrence of pain between groups (hazard ratio = 1.09; 95% confidence interval: 0.7, 1.8). There was no statistically significant effect for any of the secondary outcomes.

CONCLUSION

Among people recently recovered from LBP, exercise and education may not meaningfully reduce risk of recurrence compared to providing an educational booklet. J Orthop Sports Phys Ther 2021;51(4):188-195. doi:10.2519/jospt.2021.10187.

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.

TOPS - a randomized controlled trial of exercise and education to prevent recurrence of low back pain: statistical analysis plan

BACKGROUND

This a priori statistical analysis plan describes the methods of analysis for the Trial Of Prevention Strategies for low back pain (TOPS).

OBJECTIVES

TOPS aimed to investigate the effectiveness and cost-effectiveness of exercise and education classes compared with a minimal intervention control in preventing recurrence of low back pain (LBP) in people who have recently recovered from an episode of LBP.

METHODS

TOPS is a superiority, pragmatic, parallel-group randomized controlled trial with allocation concealment, blinded outcome assessors, and intention-to-treat analysis. Participants were randomized to a physical therapist-led exercise and education program for 12 weeks or minimal intervention. The primary outcome was days to recurrence of an episode of LBP. The three key secondary outcomes were days to recurrence of an episode of LBP resulting in (1) activity limitation, (2) care seeking for LBP; and (3) work absence of at least 1 day. Differences in survival curves for the primary (days to recurrence) and secondary outcome (days to LBP with activity limitation, days to care seeking due to LBP, and days to work absence due to LBP) will be compared using Cox regression. Hazard ratios (HRs) and median survival times with 95% confidence intervals (CI) will be calculated. The number of adverse events, including serious adverse events will be reported and the proportion of adverse events between groups will be compared using a Chi-squared test.

DISCUSSION

This paper will provide a detailed description of the planned analyses for the TOPS trial.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12615000939594).