The development and exploratory analysis of the Back Pain Attitudes Questionnaire (Back-PAQ)

Abstract

ObjectivesTo develop an instrument to assess attitudes and underlying beliefs about back pain, and subsequently investigate its internal consistency and underlying structures.DesignThe instrument was developed by a multidisciplinary team of clinicians and researchers based on analysis of qualitative interviews with people experiencing acute and chronic back pain. Exploratory analysis was conducted using data from a population-based cross-sectional survey.SettingQualitative interviews with community-based participants and subsequent postal survey.ParticipantsInstrument development informed by interviews with 12 participants with acute back pain and 11 participants with chronic back pain. Data for exploratory analysis collected from New Zealand residents and citizens aged 18 years and above. 1000 participants were randomly selected from the New Zealand Electoral Roll. 602 valid responses were received.MeasuresThe 34-item Back Pain Attitudes Questionnaire (Back-PAQ) was developed. Internal consistency was evaluated by the Cronbach α coefficient. Exploratory analysis investigated the structure of the data using Principal Component Analysis.ResultsThe 34-item long form of the scale had acceptable internal consistency (α=0.70; 95% CI 0.66 to 0.73). Exploratory analysis identified five two-item principal components which accounted for 74% of the variance in the reduced data set: ‘vulnerability of the back’; ‘relationship between back pain and injury’; ‘activity participation while experiencing back pain’; ‘prognosis of back pain’ and ‘psychological influences on recovery’. Internal consistency was acceptable for the reduced 10-item scale (α=0.61; 95% CI 0.56 to 0.66) and the identified components (α between 0.50 and 0.78).ConclusionsThe 34-item long form of the scale may be appropriate for use in future cross-sectional studies. The 10-item short form may be appropriate for use as a screening tool, or an outcome assessment instrument. Further testing of the 10-item Back-PAQ's construct validity, reliability, responsiveness to change and predictive ability needs to be conducted.

Cross-sectional survey of attitudes and beliefs about back pain in New Zealand

“…The development of the Back-PAQ has been described elsewhere 23. The Back-PAQ contains 34 items scored on a five-point Likert scale, with response options ranging from ‘False’ to ‘True’.…”

“…Recent qualitative research has indicated that fear avoidance beliefs may be based on an underlying idea that the back is vulnerable to injury and needs to be protected, and that activity participation may be limited by risks perceived as associated with activity 22. The Back Pain Attitudes Questionnaire (Back-PAQ) was developed following these interviews with people experiencing acute and chronic LBP 23. It aims to assess beliefs which underlie common attitudes about back pain.…”

Physiotherapists implicitly evaluate bending and lifting with a round back as dangerous

“…The Back-PAQ was designed to assess back pain attitudes of the public, healthcare professionals, or those with back pain 24 . The Back-PAQ consists of 34 items that assesses five key components including, but not limited to 'vulnerability and 'protection' of the back 24 .…”

“…Studies assessing beliefs of clinicians typically employed explicit measures (e.g. self-reported questionnaires [24][25][26] ), which evaluate beliefs that are deliberately formed upon reflection. However, explicit measures are sensitive only to what people are aware of and are willing to disclose [27][28][29] .…”

“…Scoring boundaries range from 34-170, with higher scores indicating more unhelpful beliefs about the back. The 34-item long form of the questionnaire has been shown to have acceptable internal consistency (α=0.70; 95% CI 0.66 to 0.73), construct validity and test-retest reliability24,40 . For the purpose of this study, a subscale called 'danger scale' (BackPAQ Danger ) was formed by 14 items from the questionnaire (questions 1-12, 14 and 21), which are representative of 'vulnerability and…”