BackgroundLow back pain (LBP) is the number one cause of disability globally. LBP is a symptom associated with biological, psychological and social factors, and serious causes for pain are very rare. Unhelpful beliefs about LBP and inappropriate imaging are common. Practitioners report pressure from patients to provide inappropriate imaging. A recently developed patient education and management booklet, ‘Understanding low back pain’, was designed to target previously identified barriers for reducing inappropriate imaging. The booklet includes evidence-based information on LBP and supports communication between patients and practitioners. Our aim was to 1) describe the translation process into Finnish and 2) study patients’ and practitioners’ attitudes to the booklet and to evaluate if it improved patients’ understanding of LBP and practitioners’ ability to follow imaging guidelines.MethodsWe translated the booklet from English to Finnish. Preliminary evaluation of the booklet was obtained from LBP patients (n = 136) and practitioners (n = 32) using web-based questionnaires. Open-ended questions were analysed using thematic analysis.ResultsApproximately half of the patients reported that reading the booklet helped them to understand LBP, while a third thought it encouraged them to perform physical activity and decreased LBP-related fear. Eighty percent of practitioners reported that the booklet helped them to follow imaging guidelines. In addition, practitioners reported that they found the booklet helpful and that it decreased the need for imaging.ConclusionsThe booklet seemed to be helpful in LBP management and in decreasing the need for LBP imaging according to patients and practitioners. Further research on the clinical effectiveness of the booklet in controlled study settings is needed.Trial registrationISRCTN, ISRCTN14389368, Registered 4 April 2019 - Retrospectively registered; ISRCTN11875357, Registered 22 April 2019 - Retrospectively registered.

the Short form of the Örebro Musculoskeletal pain Screening Questionnaire (ÖMpSQ-short) and the Start Back tool (SBt) have been developed to screen for risk factors for future low back pain (LBp)related disability and work loss respectively. The aim of this study was to investigate the accordance of the two questionnaires and to evaluate the accumulation of risk factors in the risk groups of both screening tools in a large population-based sample. The study population consisted of 3079 participants of the Northern Finland Birth Cohort 1966 who had reported LBP over the previous 12 months and had SBT and ÖMPSQ-short data. We evaluated the association of depressive and anxiety symptoms (Hopkins symptom check list-25, Generalized anxiety disorder 7 questionnaire, and Beck's Depression Inventory 21), psychological features (Fear-Avoidance Beliefs Questionnaire), lifestyle characteristics (BMI, smoking, alcohol abuse, physical inactivity) and social factors (education level) with the SBT and ÖMPSQ-short risk groups. The high-risk groups of both questionnaires were associated (p < 0.001) with depressive and anxiety symptoms and fear-avoidance beliefs. In addition, adverse lifestyle factors accumulated in the higher risk groups, especially from the ÖMPSQ-short. Agreement between the two questionnaires was moderate for men and fair for women. Low back pain (LBP) is the most disabling health condition worldwide 1. No cost-effective or widely available preventive LBP interventions have yet been developed 2. Predictors of persistent LBP-related disability include symptom-related factors such as previous LBP episodes, pain intensity and the presence of leg pain; lifestyle factors such as overweight/obesity, smoking and physical inactivity; psychological factors such as depression, catastrophizing and fear-avoidance beliefs; and social factors such as education, physical workload and work satisfaction 3. To improve the effectiveness of healthcare, care processes need to take these factors into account individually and systematically 2. Early identification of patients who are at the highest risk of developing a prolonged or persistent pain problem is important 2. The short form of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-short) and the STarT Back Tool (SBT) have been developed for the easy and systematic identification of predictive psychosocial and symptom-related factors 4-6. The SBT was developed to identify subgroups of patients with non-specific LBP in order to determine which kind of treatment would benefit each patient. Cutoff scores divide patients into low-, medium-and high-risk