Beliefs; general population; healthcare professionals; low back pain; measurement properties; validation studies
Abstract :
[en] [en] 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. [en] The Dutch Back Pain Attitudes Questionnaire (Back-PAQ) exhibits strong measurement properties, supporting its application in both clinical practice and research contexts.The Dutch translation of the Back-PAQ demonstrates good to excellent reliability and construct validity, making it suitable for health-care practitioners to assess recovery-impeding beliefs about back pain within the general population.The factor structure of the 10-item version of the Back-PAQ 10 has been further analysed using a Confirmatory Factor Analysis, facilitating a practical comparison of its sub-score outcomes in a clinical setting.
Disciplines :
Orthopedics, rehabilitation & sports medicine
Author, co-author :
Vanderstraeten, R; Faculty of Medicine and Health Sciences (MOVANT), University of Antwerp, Antwerp, Belgium
Fourré, A; Faculty of Medicine and Health Sciences (MOVANT), University of Antwerp, Antwerp, Belgium ; Department of Neurosciences, Université de Mons, Mons, Belgium
Demoulin, Christophe ; Université de Liège - ULiège > Département des Sciences de l'activité physique et de la réadaptation > Kinésithérapie spécifique et réadaptation motrice ; Faculty of Motricity Sciences, UCLouvain, Louvain-la-Neuve, Belgium
Westerweel, A; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
Meuleman, E M; Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Anthierens, S; Faculty of Medicine and Health Sciences, Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
Michielsen, J; Faculty of Medicine and Health Sciences (MOVANT), University of Antwerp, Antwerp, Belgium ; Antwerp Surgical Training, Anatomy and Research Centre, University Hospital of Antwerp, Antwerp, Belgium
Darlow, B; Department of Primary Health Care and General Practice, University of Otago, Wellington, Wellington, New Zealand
Roussel, Nathalie ; Université de Liège - ULiège > Département des Sciences de l'activité physique et de la réadaptation ; Faculty of Medicine and Health Sciences (MOVANT), University of Antwerp, Antwerp, Belgium
Hutting, N; Research Group Occupation and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
Language :
English
Title :
Dutch translation, cross-cultural adaptation, validation, and reliability of the Back Pain Attitudes Questionnaire (Back-PAQ).
Dieleman JL, Cao J, Chapin A, et al.US health care spending by payer and health condition, 1996–2016. JAMA. 2020;323(9):863–884. doi: 10.1001/jama.2020.0734.
Andersson GB., Epidemiological features of chronic low-back pain. Lancet. 1999;354(9178):581–585. doi: 10.1016/S0140-6736(99)01312-4.
Meucci RD, Fassa AG, Faria NM., Prevalence of chronic low back pain: systematic review. Rev Saude Publica. 2015;49:1. doi: 10.1590/S0034-8910.2015049005874.
Bernstein IA, Malik Q, Carville S, et al.Low back pain and sciatica: summary of NICE guidance. BMJ. 2017;356:i6748. doi: 10.1136/bmj.i6748.
Almeida M, Saragiotto B, Richards B, et al.Primary care management of non-specific low back pain: key messages from recent clinical guidelines. Med J Aust. 2018;208(6):272–275. doi: 10.5694/mja17.01152.
van Wambeke P, Desomer A, Jonckheer P, et al.The Belgian national guideline on low back pain and radicular pain: key roles for rehabilitation, assessment of rehabilitation potential and the PRM specialist. Eur J Phys Rehabil Med. 2020;56(2):220–227. doi: 10.23736/S1973-9087.19.05983-5.
Marin TJ, Van Eerd D, Irvin E, et al.Multidisciplinary biopsychosocial rehabilitation for subacute low back pain. Cochrane Database Syst Rev. 2017;6(6):CD002193.
Jonckheer P, Desomer A, Depreitere B., Low back pain and radicular pain: development of a clinical pathway; Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE). 2017. KCE Reports 295. D/2017/10.273/87.
Koes BW, van Tulder MW, Thomas S., Diagnosis and treatment of low back pain. BMJ. 2006;332(7555):1430–1434. doi: 10.1136/bmj.332.7555.1430.
Airaksinen O, Brox JI, Cedraschi C, et al.Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl. 2):S192–S300. doi: 10.1007/s00586-006-1072-1.
Maher C, Underwood M, Buchbinder R., Non-specific low back pain. Lancet. 2017;389(10070):736–747. doi: 10.1016/S0140-6736(16)30970-9.
Poitras S, Durand M-J, Côté A-M, et al.Guidelines on low back pain disability: interprofessional comparison of use between general practitioners, occupational therapists, and physiotherapists. Spine. 2012;37(14):1252–1259. doi: 10.1097/BRS.0b013e31824b6adf.
van Tulder M, Becker A, Bekkering T, et al.Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15(Suppl. 2):S169–S191. doi: 10.1007/s00586-006-1071-2.
Morton L, de Bruin M, Krajewska M, et al.Beliefs about back pain and pain management behaviours, and their associations in the general population: a systematic review. Eur J Pain. 2019;23(1):15–30. doi: 10.1002/ejp.1285.
Hartvigsen J, Hancock MJ, Kongsted A, et al.What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356–2367. doi: 10.1016/S0140-6736(18)30480-X.
Foster NE, Bishop A, Thomas E, et al.Illness perceptions of low back pain patients in primary care: what are they, do they change and are they associated with outcome?Pain. 2008;136(1–2):177–187. doi: 10.1016/j.pain.2007.12.007.
Wertli MM, Rasmussen-Barr E, Held U, et al.Fear-avoidance beliefs—a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J. 2014;14(11):2658–2678. doi: 10.1016/j.spinee.2014.02.033.
Wertli MM, Eugster R, Held U, et al.Catastrophizing—a prognostic factor for outcome in patients with low back pain: a systematic review. Spine J. 2014;14(11):2639–2657. doi: 10.1016/j.spinee.2014.03.003.
Darlow B, Fullen BM, Dean S, 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 Pain. 2012;16(1):3–17. doi: 10.1016/j.ejpain.2011.06.006.
Parsons S, Harding G, Breen A, et al.The influence of patients’ and primary care practitioners’ beliefs and expectations about chronic musculoskeletal pain on the process of care: a systematic review of qualitative studies. Clin J Pain. 2007;23(1):91–98. doi: 10.1097/01.ajp.0000210947.34676.34.
Clareus B, Renstrom EA., Patients’ return-to-work expectancy relates to their beliefs about their physician’s opinion regarding return to work volition and ability. J Pain Res. 2019;12:353–362.
Roussel NA, Neels H, Kuppens K, et al.History taking by physiotherapists with low back pain patients: are illness perceptions addressed properly?Disabil Rehabil. 2016;38(13):1268–1279. doi: 10.3109/09638288.2015.1077530.
Shaw WS, Pransky G, Winters T, et al.Does the presence of psychosocial "yellow flags" alter patient-provider communication for work-related, acute low back pain?J Occup Environ Med. 2009;51(9):1032–1040. doi: 10.1097/JOM.0b013e3181b2f539.
Vanderstraeten R, Fourré A, Demeure I, et al.How do physiotherapists explain influencing factors to chronic low back pain? A qualitative study using a fictive case of chronic non-specific low back pain. Int J Environ Res Public Health. 2023;20(10):5828. doi: 10.3390/ijerph20105828.
Fourré A, Vanderstraeten R, Ris L, et al.Management of low back pain: do physiotherapists know the evidence-based guidelines?Int J Environ Res Public Health. 2023;20(9):5611. doi: 10.3390/ijerph20095611.
Demoulin C, Gabriel L, Nève de Mévergnies O, et al.Several low back pain-related misbeliefs are still around in 2020: a cross-sectional survey in Belgium. Physiother Res Int. 2022;27(1):e1927. doi: 10.1002/pri.1927.
Darlow B, Perry M, Mathieson F, et al.The development and exploratory analysis of the Back Pain Attitudes Questionnaire (Back-PAQ). BMJ Open. 2014;4(5):e005251. doi: 10.1136/bmjopen-2014-005251.
Pierobon AP, Policastro PO, Solino S, et al.Spanish translation, cross-cultural adaptation and validation of the Argentine version of the Back Pain Attitudes Questionnaire. Musculoskelet Sci Pract. 2020;46:102125.
Demoulin C, Halleux V, Darlow B, et al.Traduction en français du « Back Pain Attitudes Questionnaire » et étude de ses qualités métrologiques. Kinésithérapie, la Revue. 2017;17(184):22–23. doi: 10.1016/j.kine.2017.02.015.
Numanovic P, Darlow B, Larsson ME., The Swedish version of the Back Pain Attitudes Questionnaire–translation, cross-cultural adaptation and validation. Musculoskelet Sci Pract. 2024;72:102984. doi: 10.1016/j.msksp.2024.102984.
Kanaan SFKH, Almhdawi KA, Darlow B, et al.Arabic version of the Back Pain Attitudes Questionnaire: translation, cross-cultural adaptation, and psychometric properties. J Back Musculoskelet Rehabil. 2021;34(1):59–67. doi: 10.3233/BMR-191758.
Krug RC, Caneiro JP, Ribeiro DC, et al.Back Pain Attitudes Questionnaire: cross-cultural adaptation to Brazilian-Portuguese and measurement properties. Braz J Phys Ther. 2021;25(3):271–280. doi: 10.1016/j.bjpt.2020.07.001.
Nicolaysen MSL, Palson TS., The Danish version of the Back Pain Attitudes Questionnaire–translation and cross-cultural adaptation. Musculoskelet Sci Pract. 2021;52:102348.
Tay HA, Özgül B, Darlow B, et al.Cross-cultural translation, validity, and reliability of the Turkish version of the Back Pain Attitudes Questionnaire. Musculoskelet Sci Pract. 2022;57:102472. doi: 10.1016/j.msksp.2021.102472.
Villalba FJ, Policastro PO, Soliño S, et al.Standard measurement error and minimal detectable change of the Back-PAQ ArgSpan Questionnaire: secondary analysis. Musculoskelet Sci Pract. 2021;51:102315. doi: 10.1016/j.msksp.2020.102315.
Moran RW, Rushworth WM, Mason J., 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 Pract. 2017;32:44–50. doi: 10.1016/j.msksp.2017.08.008.
Beaton DE, Bombardier C, Guillemin F, et al.Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186–3191. doi: 10.1097/00007632-200012150-00014.
Mokkink LB, Terwee CB, Patrick DL, et al.The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63(7):737–745. doi: 10.1016/j.jclinepi.2010.02.006.
Dillman D, Smyth J, Christian L., Internet, phone, mail and mixed-mode surveys. The tailored design method. Hoboken (NJ): Wiley; 2014.
Eysenbach G., Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004;6(3):e34. doi: 10.2196/jmir.6.3.e34.
Krägeloh C, Medvedev ON, Dean S, et al.Rasch analysis of the Back Pain Attitudes Questionnaire (Back-PAQ). Disabil Rehabil. 2022;44(13):3228–3235. doi: 10.1080/09638288.2020.1861484.
Waddell G, Newton M, Henderson I, et al.A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52(2):157–168. doi: 10.1016/0304-3959(93)90127-B.
Linton SJ, Buer N, Vlaeyen J, et al.Are fear-avoidance beliefs related to the inception of an episode of back pain? A prospective study. Psychol Health. 2000;14(6):1051–1059. doi: 10.1080/08870440008407366.
Terwee CB, Bot SDM, de Boer MR, et al.Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34–42. doi: 10.1016/j.jclinepi.2006.03.012.
Revelle W., Psych: procedures for psychological, psychometric, and personality research. R Package Version 1912. Evanston: Northwestern University; 2019.
Nunnally JBL., Psychometric theory. New York: McGraw-Hill Higher, Inc.; 1994.
Gamer M, Lemon J, Fellows I, et al.irr: various coefficients of interrater reliability and agreement. Version 0.84.1. Windhoek, Namibia: CRAN; 2019.
Koo TK, Li MY., A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155–163. doi: 10.1016/j.jcm.2016.02.012.
Andresen EM., Criteria for assessing the tools of disability outcomes research. Arch Phys Med Rehabil. 2000;81(12 Suppl. 2):S15–S20. doi: 10.1053/apmr.2000.20619.
de Vet HC, Terwee CB, Knol DL, et al.When to use agreement versus reliability measures. J Clin Epidemiol. 2006;59(10):1033–1039. doi: 10.1016/j.jclinepi.2005.10.015.
Weir JP., Quantifying test–retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res. 2005;19(1):231–240. doi: 10.1519/15184.1.
Cohen J., Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers; 1988.
Hinkle DEWW, Jurs SG., Applied statistics for the behavioral sciences. Boston (MA): Houghton Mifflin; 2003.
Rosseel Y., lavaan: an R package for structural equation modeling. J Stat Soft. 2012;48(2):1–36. doi: 10.18637/jss.v048.i02.
Hu LT, Bentler PM., Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Eq Model. 1999;6(1):1–55. doi: 10.1080/10705519909540118.
Browne MW, Cudeck R., Alternative ways of assessing model fit. Sociol Methods Res. 1992;21(2):230–258. doi: 10.1177/0049124192021002005.
Hair JF, Jr., Anderson RE, Tatham RL., Multivariate data analysis with readings. United States: Macmillan Publishing Co., Inc.; 1986.
Fornell C, Larcker DF., Evaluating structural equation models with unobservable variables and measurement error. J Market Res. 1981;18(1):39–50. doi: 10.1177/002224378101800104.
Christe G, Nzamba J, Desarzens L, et al.Physiotherapists’ attitudes and beliefs about low back pain influence their clinical decisions and advice. Musculoskelet Sci Pract. 2021;53:102382. doi: 10.1016/j.msksp.2021.102382.
Grøn S, Jensen RK, Jensen TS, et al.Back beliefs in patients with low back pain: a primary care cohort study. BMC Musculoskelet Disord. 2019;20(1):578. doi: 10.1186/s12891-019-2925-1.
Tan BK, Smith AJ, O’Sullivan PB, et al.Low back pain beliefs are associated to age, location of work, education and pain-related disability in Chinese healthcare professionals working in China: a cross sectional survey. BMC Musculoskelet Disord. 2014;15:255.