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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

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Abstract

Background: Healthcare practitioner beliefs influence advice and management provided to patients with back pain. Several instruments measuring practitioner beliefs have been developed but psychometric properties for some have not been investigated. Aims: To investigate internal consistency, test-retest reliability and convergent validity of the Fear Avoidance Beliefs Tool (FABT), the Tampa Scale of Kinesiophobia for Health Care Providers (TSK-HC), the Back Pain Attitudes Questionnaire (Back-PAQ), and the Health Care Pain and Impairment Relationship Scale (HC-PAIRS). A secondary aim was to explore beliefs of New Zealand osteopaths and physiotherapists regarding low back pain. Method: FABT, TSK-HC, Back-PAQ, and HC-PAIRS were administered twice, 14 days apart. Results: Data from 91 osteopaths and 35 physiotherapists were analysed. The FABT, TSK-HC and Back-PAQ each demonstrated excellent internal consistency, (Cronbach's α = 0.92, 0.91, and 0.91 respectively), and excellent test-retest reliability (lower limit of 95% CI for intraclass correlation coefficient >0.75). Correlations between instruments (Pearson's r = 0.51 to 0.77, p < 0.001) demonstrated good convergent validity. There was a medium to large effect (Cohen's d > 0.47) for mean differences in scores, for all instruments, between professions. Conclusions: This study found excellent internal consistency, test-retest reliability and good convergent validity for the FABT, TSK-HC, and Back-PAQ. Previously reported internal consistency, test-retest and convergent validity of the HC-PAIRS were confirmed, and test-retest reliability was excellent. There were significant scoring differences on each instrument between professions, and while both groups demonstrated fear avoidant beliefs, physiotherapist respondent scores indicated that as a group, they held fewer fear-avoidant beliefs than osteopath respondents.

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... Psychometric properties of the 34-item Back-PAQ were furtherly assessed in a sample of New Zealand osteopaths and manipulative physiotherapists (Moran et al., 2017). The convergent validity was evaluated against the Fear Avoidance Beliefs Tool (FABT), the TSK for Health Care Providers (TSK-HC) and the HC-PAIRS with moderate correlations observed: r ¼ 0.51, r ¼ À0.58 and r ¼ À0.62, respectively. ...
... HCP). The standard error of measurement (SEM) was 3.94 and the minimum detectable change (MDC) was 1.69 (Moran et al., 2017). ...
... The Back-PAQ has been also used in research to compare the beliefs of different of HCP groups (physiotherapists, physiotherapy students, manual handling advisors, osteopaths, and medical doctors) and explore whether these influence their advice to patients and/or their lifting/bending techniques (Christe et al., 2021b;Davis et al., 2022;Nolan et al., 2018Nolan et al., , 2019Rialet-Micoulau et al., 2022;Smith & Thomson, 2020). Moran et al. found that the beliefs of osteopaths were significantly more negative than those of physiotherapists (Moran et al., 2017). Nolan et al. (2018) found that manual handling advisors and physiotherapists who perceive a straight back lifting posture as safer had significantly greater 34-item Back-PAQ scores than those who perceived a rounded back lifting posture was safer (61.7 vs. 81.9). ...
... A high score on the HC-PAIRS reflects a belief in a strong relationship between pain and impairment [17]. The good psychometric properties of this questionnaire have been established in graduated HCPs, including physiotherapists [17,26,27]. ...
... Concerning the HC-PAIRS, recent studies using the 13-item version in physiotherapists in the USA [42] and New Zealand [27] found lower scores (i.e., median of 31 compared to 42 in our study), suggesting a more bio-psychosocial orientation of participants in these countries. Higher scores on the HC-PAIRS are not only associated with a more biomedical treatment orientation, but this can also negatively influence health attitudes and behaviour of the patients [43]. ...
... These beliefs related to the need of protection reflect guideline-inconsistent beliefs related to the biomedical model. In other countries, some studies presented lower (worse) scores for the Back-PAQ in physiotherapists [27,48]. These results highlight the urgent need to develop interventions aiming to enhance beliefs of physiotherapists as they can influence the prognosis of the patient [49]. ...
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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.
... Reasons for indeterminate evidence for structural validity included a lack of information provided about the analysis, or only exploratory factor analysis/ principal components analysis conducted. There was a high level of evidence for sufficient internal consistency for the 3*I-P-J [49], HC-PAIRS-15 [80,82,83,90,91,95], HC-PAIRS-13 [103,105] and HC-PAIRS-12 [107]. For the MCRS, there was a low level of evidence for sufficient structural validity and internal consistency [117]. ...
... There was a high level of evidence for sufficient reliability of the HC-PAIRS-12 [107], and a moderate level of evidence for sufficient reliability of the HC-PAIRS-15 [81,83,91,95]. There was a low level of evidence for sufficient reliability of the MCRS [117]. ...
... The only instruments measuring measurement error were the HC-PAIRS-15 [83,95] and the HC-PAIRS-12 [107], for which there was indeterminate evidence. This is because we were not able to judge whether the Smallest Detectable Change (SDC) or Limits of Agreement (LoA) were smaller than the Minimal Important Change (MIC). ...
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Objective: Patients with persistent somatic symptoms (PSS) experience stigmatising attitudes and behaviours by healthcare professionals. While previous research has focussed on individual manifestations of PSS related stigma, less is known about sound ways to measure stigmatisation by healthcare professionals towards patients with PSS. This review aims to assess the quality of questionnaire measurement instruments and make recommendations about their use. Methods: A systematic review using six databases (PubMed, Embase, CINAHL, PsycINFO, Open Grey and EThOS). The search strategy combined three search strings related to healthcare professionals, PSS and stigma. Additional publications were identified by searching bibliographies. Three authors independently extracted the data. Data analysis and synthesis followed COSMIN methodology for reviews of outcome measurement instruments. Results: We identified 90 publications that met the inclusion criteria using 62 questionnaire measurement instruments. Stereotypes were explored in 92% of instruments, prejudices in 52% of instruments, and discrimination in 19% of instruments. The development process of the instruments was not rated higher than doubtful. Construct validity, structural validity, internal consistency and reliability were the most commonly investigated measurement properties. Evidence around content validity was inconsistent or indeterminate. Conclusion: No instrument provided acceptable evidence on all measurement properties. Many instruments were developed for use within a single publication, with little evidence of their development or establishment of content validity. This is problematic because stigma instruments should reflect the challenges that healthcare professionals face when working with patients with PSS. They should also reflect the experiences that patients with PSS have widely reported during clinical encounters.
... The Back-PAQ has 34 question items, each scored using a 5-point Likert scale, with scores for each item being combined to provide an overall score. Eleven items (1,2,3,15,16,17,27,28,29,30,31) are reverse-scored compared with the other items. Overall scores range from 34 to 170 with a higher score representing more unhelpful beliefs regarding LBP [23]. ...
... Within the general population suffering from LBP a mean score of 113.2 ± 10.6 has been reported [25], and the internal consistency and validity of the Back-PAQ reported as Cronbach's alpha = 0.70 [23] and Pearson's r = 0.51-0.77, respectively [30]. ...
... In contrast, one study reported a strong correlation magnitude between Back-PAQ and the Tampa Scale of Kinesiophobia in a cohort of healthcare practitioners and the general public [35]. However, another study reported a moderate correlation between Back-PAQ and the Fear Avoidance Beliefs Questionnaire in a cohort of healthcare practitioners [30]. The divergent change to beliefs and fear suggest that other variables could moderate their relationship. ...
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The purpose of this study was to understand how weightlifting/powerlifting (WL/PL) influences low back pain (LBP) beliefs and pain-related fear, and the potential influence of training, individual, and injury characteristics on these psychological features. Responses to the Photographic Series of Daily Activities-Short Electronic Version (PHODA-SeV) and the Back Pain and Attitudes Questionnaire (Back-PAQ) were collected from 67 participants who train on WL/PL. Relevant statistics were conducted to (1) compare questionnaire scores to previously published values from the general population, (2) compare male versus female WL/PL participants, (3) estimate the correlation between PHODA-SeV and Back-PAQ, and (4) identify the most important associative factors of both scores. Only the Back-PAQ was significantly lower than the published score of 113 (p < 0.001). Male participants had a significantly lower PHODA-SeV score compared to female participants (p = 0.008), but no difference was observed for the Back-PAQ. Back-PAQ and PHODA-SeV scores were moderately correlated with each other (r = 0.54). One of the most important association factors was back squat weight for both PHODA-SeV (p < 0.001) and Back-PAQ (p = 0.006). Future studies are required to investigate whether frequent WL/PL training improves pain-related fear and beliefs and reduces the risk of LBP occurrence.
... In addition, patients' beliefs and expectations affected the treatment given and clinical decisions were based on the therapists' perceived 'passivity of the patient' (Gardner et al., 2017). The ability to identify HCPs beliefs that may contribute to suboptimal clinical outcomes is seen as an essential prerequisite when striving to improve the quality of patient care (Moran et al., 2017). So far, the only internationally known questionnaire translated into Finnish for evaluating attitudes and beliefs of HCPs about LBP is 'Attitudes to Back Pain Scale for musculoskeletal practitioners' (ABS-mp) (Valjakka et al., 2013). ...
... The Tampa Scale of Kinesiophobia (TSK) is used to measure fear of movement or (re)injury in patients (Miller et al., 1991;Vlaeyen et al., 1995). TSK was first adapted to HCPs in Dutch by Houben et al. (2004) and its English version (TSK-HC) has been validated by Moran et al. (2017). TSK has been validated in a Finnish population (TSK-FIN) and it has demonstrated substantial intertest reliability, good test-retest reliability, good internal consistency, and acceptable limits of agreement (Koho et al., 2014(Koho et al., , 2015. ...
... Construct validity of HC-PAIRS-FI (answers to the first round) was assessed by hypothesis testing based on the following assumptions: 1) at least a moderate correlation between HC-PAIRS-FI and TSK-HC-FI (answers of PTs and PT-students as a combined group) because both scales measure similar constructs (Houben et al., 2004;Moran et al., 2017); 2) a significant difference in HC-PAIRS-FI scores of PTs according to the amount of self-reported pain education; 3) a significant difference in HC-PAIRS-FI scores of PT-students according to the completion vs. not completion of a musculoskeletal course; 4) a significant difference in HC-PAIRS-FI scores of PT-students according to receiving vs. not receiving lessons in chronic pain and; 5) a significant difference in the HC-PAIRS-FI scores of PTs compared to the scores of PT-students. Pearson's (r) correlation coefficient was used to calculate the association between HC-PAIRS-FI and TSK-HC-FI. ...
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Background: Health care providers’ beliefs influence the outcomes of low back pain patients care. Objectives: The aim of this study was to translate and cross-culturally adapt the Health Care Providers’ Pain and Impairment Relationship Scale into Finnish (HC-PAIRS-FI) and to evaluate its psychometric properties and factor structure in a sample of Finnish physiotherapists and physiotherapy students. Methods: The translation was performed using established guidelines. Participants answered an online survey consisting of HC-PAIRS-FI and the Finnish Tampa Scale of Kinesiophobia adapted for health care providers (TSK–HC–FI). Internal consistency was assessed using Cronbach's alpha. Intraclass correlation coefficient (ICC) was used to determine test-retest reliability. A second round of analysis, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was performed as the fit indices of the initial CFA were not satisfactory. Results: A sample of 202 physiotherapists and 97 physiotherapy students completed the survey. The second round of analysis EFA and CFA, conducted on a randomly split subsample, revealed and confirmed a three-factor, 11-item HC-PAIRS-FI scale with satisfactory model fit indices. Cronbach's alpha 0.79 and ICC = 0.82 (p < 0.001) indicate good internal consistency and test-retest reliability. The standard error of measurement was 2.12. HC-PAIRS-FI scores correlated moderately with TSK–HC–FI (r = 0.69, p < 0.001). Conclusions: The 11 items HC-PAIRS-FI appears to be a valid and reliable questionnaire to evaluate Finnish physiotherapists' and physiotherapy students’ attitudes and beliefs about the relationship between chronic low back pain and impairment. Future studies are required to validate this scale for other health care providers.
... This instrument has similar properties to the original version. 23,24 The inclusion of the developer (BD) of the questionnaire in the process of cross-cultural adaptation added strength to our methods. The very weak correlation between the scores on the Back-PAQ-Br and HADS 43 confirmed our hypothesis that the Back-PAQ does not measure anxiety and depression. ...
... 57---59 Internal consistency for the Back-PAQ-Br was excellent (Cronbach's alpha = 0.92). This is similar to the estimates reported by Moran et al. 23 (Cronbach's alpha = 0.91) and higher than the estimates reported by Darlow et al. 24 (Cronbach's alpha = 070), Demoulin et al. 25 (Cronbach's alpha = 0.63), and Pierobon et al. 26 (Cronbach's alpha = 0.76). Differences in these estimates may relate to sample characteristics. ...
... The study by Demoulin et al. 25 only included people with back pain. 25 The study by Pierobon et al. 26 included people with and without back pain, while Moran et al. 23 20 To the best of our knowledge, the only previous study that tested the convergent validity of the Back-PAQ against the TSK was Moran et al., 23 which reported a coefficient r = -0.58. There was a very weak correlation between Back-PAQ-Br and HADS (depression and Anxiety). ...
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Background The Back Pain Attitudes Questionnaire (Back-PAQ) was developed to evaluate attitudes and beliefs of the general public, people with back pain, and healthcare professionals about the spine. Objectives To translate and cross-culturally adapt the Back-PAQ (34-item and 10-item versions) into Brazilian-Portuguese (Back-PAQ-Br) and test its measurement properties in a Brazilian sample. Methods The cross-cultural adaptation and testing of the measurement properties followed the recommendations of international guidelines. Members of the general public, people with back pain, and healthcare professionals, for a total of 139 individuals, took part in the assessment of internal consistency, construct validity, and ceiling and floor effects. The Hospital Anxiety and Depression Scale (HADS) and the Brazilian-Portuguese version of the Tampa Scale of Kinesiophobia (TSK) were used to evaluate construct validity. Test-retest reproducibility was determined on 77 participants. Retest was performed a minimum of 1 week and a maximum of 2 weeks from the original test. Results There was very high agreement between translators (88.2%). The Back-PAQ-Br showed excellent internal consistency (Cronbach’s alpha 0.92) and excellent reproducibility (ICC 0.94; SEM 5.14 points on a 136 point scale), with a smallest detectable change (90% confidence level) of 11.93 points. There was strong correlation between Back-PAQ-Br and TSK (r = -0.72) and very weak correlation between Back-PAQ-Br and HADS (r = -0.23 for both depression and anxiety domains). No ceiling/floor effects were observed. Conclusion The translation process and cross-cultural adaptation had very high agreement between translators. The Back-PAQ-Br has excellent measurement properties that are similar to the properties of the original version.
... Similar to the Argentine Spanish (Pierobon et al., 2020) and Turkish versions (Tay et al., 2022) that also found higher Cronbach's alpha estimates, the majority of participants in the current study were recruited in a non-probabilistic manner. A high Cronbach's alpha was also found by Moran et al. (2017) who solely recruited HCPs. It is feasible that HCPs would have a more consistent understanding of the concepts being measured, though this was not assessed in the current study. ...
... (Pierobon and Darlow, 2023). The estimate was, however, slightly higher than what was found by Scott Nicolaysen et al. (2021) (ICC = 0.80, 95% CI 0.67 to 0.88) and Moran et al. (2017) (ICC = 0.84, 95% CI 0.76 to 0.89). Although the protocol permitted a retest interval of two weeks, participants in the current study generally answered the retest-survey after three days (median (IQR) 3.0 (3.0) days). ...
Article
Background Psychosocial factors influence low back pain (LBP) and guidelines recommend assessing unhelpful beliefs. The Back Pain Attitudes Questionnaire (Back-PAQ) is an instrument developed to assess LBP attitudes and beliefs. There is currently no Swedish translation of Back-PAQ. Objectives To translate and culturally adapt the Back-PAQ into Swedish (Back-PAQ-S) and to test its measurement properties. Design Study of diagnostic accuracy/assessment scale. Methods The cultural adaptation followed established guidelines and 120 individuals with and without nonspecific LBP (NSLBP) were recruited for the assessment of Back-PAQ-S's internal consistency, test-retest reliability, standard error of measurement (SEM) and smallest detectable change (SDC). Construct validity was assessed by testing hypotheses regarding Back-PAQ-S's relationship to the Back Beliefs Questionnaire (BBQ) and Tampa Scale of Kinesiophobia (TSK). Results The Back-PAQ was translated and culturally adapted to Swedish. Expert panelists and informants thought items were relevant, comprehensive, and understandable. Back-PAQ-S of all lengths (34, 20 and 10-items) showed good internal consistency (Cronbach's α 0.95, 0.91 and 0.82) and excellent test-retest reliability (Intraclass correlation coefficient (ICC) 0.97, 0.96 and 0.95). The SEM was found to be 4.28, 3.13 and 1.66, and the SDC to be 11.85, 8.68 and 4.59 respectively. The Back-PAQ-S showed high positive correlations (Spearman's rho ( r s ) 0.78, 0.76 and 0.72) to the BBQ and moderate negative correlations ( r s −0.67, −0.50 and −0.69) to the TSK. Conclusion The Back-PAQ-S has good validity and excellent reliability. It is viable for clinical and research use to assess LBP attitudes and beliefs in Swedish populations with and without NSLBP.
... Les questions sont formulées de manière à ce que l'instrument puisse convenir aux personnes souffrant de rachialgie, aux personnes sans rachialgie et aux professionnels de la santé. Ce questionnaire a notamment été utilisé dans plusieurs études récentes évaluant les croyances de différents types de professionnels : kinésithérapeutes (26)(27)(28) , étudiants en kinésithérapie (29) , étudiants en ostéopathie (30) et ostéopathes (31,32) . ...
... Objective: This study explores the attitudes, beliefs, and clinical orientations of students, recent graduates, educators, and non-teaching practitioners from two French osteopathic educational institutes regarding the management of NSLBP. De plus, il s'agit également d'un défi car il n'existe aucun outil de référence pour évaluer les croyances et attitudes à l'égard de la lombalgie (32) . La version française du Back-PAQ a en outre été validée pour des patients lombalgiques francophones belges (38) . ...
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Les facteurs psychosociaux jouent un rôle essentiel dans le pronostic et la prise en charge des patients présentant une lombalgie non-spécifique (LNS). Les données scientifiques indiquent que les croyances d'un individu concernant la douleur sont associées aux attitudes et aux croyances du clinicien consulté. Cette étude a exploré les attitudes, croyances et orientations cliniques des étudiants, des nouveaux diplômés, des enseignants et praticiens non-enseignants issus de deux instituts français d'enseignement de l'ostéopathie en ce qui concerne la prise en charge de la LNS. Cette population a été étudiée au moyen d'une enquête transversale réalisée en ligne entre août et octobre 2021 comprenant un recueil des caractéristiques socio-démographiques, un questionnaire (Back-PAQ) et une vignette clinique. 798 participants ont répondu à l'enquête (556 étudiants, 47 nouveaux diplômés, 88 enseignants, 107 praticiens). Les résultats des étudiants au Back-PAQ ont montré une diminution progressive des scores (croyances plus adaptées) de la première année (113 ± 10,2) à la cinquième année (81,4 ± 12,1) (p < 0,001) avec une diminution plus importante entre les étudiants de 5ème année (81,4 ± 12,1) et les nouveaux diplômés (48,4 ± 7,5) (p < 0,001). Les orientations cliniques basées sur les questions de la vignette (score moyen : 1,7/3) étaient modérément corrélées au score du Back-PAQ (r =-0,489, p < 0,001). Ainsi, les participants ayant plus de croyances délétères étaient plus susceptibles d'encourager la limitation de l'activité physique ou professionnelle. Pour que les futurs cliniciens puissent aborder de manière adéquate les facteurs psychosociaux associés à la LNS, il semble crucial d'évaluer leurs attitudes pendant leur formation afin de mieux appréhender les croyances qui les sous-tendent.
... Professional's ability to identify their beliefs about pain is crucial, given the significant role they can play in modifying patient's biopsychosocial beliefs about pain 5 . Thus, identifying health care professional's beliefs that may contribute to suboptimal clinical outcomes is a relevant prerequisite for improving the quality of pain patient care 6 . The Pain Education Program (PEP) is a cognitive-based intervention to teach people about the biology and physiology of pain and to not emphasize the issues associated with anatomical structures, focusing on the biopsychosocial factors that contribute to pain development 7 . ...
... PEP research is dominated by randomized clinical trials and systematic reviews, all aimed at exploring its effectiveness [9][10][11][12] . Currently, questionnaires that aim to evaluate knowledge, attitudes and beliefs of health professionals are available and these are encouraged in literature for enabling the construction of health values 5,6,13,14 . In general, pain assessment is based on a fragmented conception of the human being, which separates biological aspects from subjective and behavioral aspects, leading to protocolized and mechanized practices 15 , being Pain Attitudes and Beliefs Scale for Physiotherapists (PABS) 16,17 and Neurophysiological Pain Questionnaire (NSQ) 18 considered secondary measures. ...
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BACKGROUND AND OBJECTIVES Health professionals attitudes and beliefs about musculoskeletal pain have a negative influence on patient beliefs and outcomes. However, there is no gold standard for assessing knowledge and attitudes toward pain among these professionals. Thus, the objective of the present study was to translate, adapt and validate the Knowledge and Attitudes of Pain (KNAP) questionnaire into Brazilian Portuguese (KNAP-Br), apply the questionnaire and analyze the correlation of its results with the Neurophysiological Pain Questionnaire (NPQ). METHODS After being translated, back-translated and adapted, the NKAP-Br was applied to 60 physical therapy and medicine students for validation. The correlation between the results obtained by multiplying the scores of the questions of the NKAP-Br instrument and the NPQ was evaluated. To assess reliability, another 200 students responded to the initial KNAP-Br (T1), performed the Pain Education Program (PEP) in one week and one week after T1, the participants received access to answer the KNAP-Br end (T2). RESULTS Concurrent validity was assessed by the correlation between NPQ and the final KNAP-Br score. A significant correlation was found between the NPQ result (0.3 and p-value=0.0001) and the KNAP-Br score. Intragroups, 84% improved in the KNAP-Br score after studying PEP, 43.50% improved at or above the minimal detectable difference (MDD) and at or above the minimal important difference (MID). CONCLUSION The questionnaire was translated and adapted respecting the Brazilian population cultural aspects and presented satisfactory reliability and construct validity, being considered valid for the assessment of knowledge and the interpretation of pain by health professionals. Keywords Pain; Pain measurement; Physical therapy specialty.
... Professional's ability to identify their beliefs about pain is crucial, given the significant role they can play in modifying patient's biopsychosocial beliefs about pain 5 . Thus, identifying health care professional's beliefs that may contribute to suboptimal clinical outcomes is a relevant prerequisite for improving the quality of pain patient care 6 . The Pain Education Program (PEP) is a cognitive-based intervention to teach people about the biology and physiology of pain and to not emphasize the issues associated with anatomical structures, focusing on the biopsychosocial factors that contribute to pain development 7 . ...
... PEP research is dominated by randomized clinical trials and systematic reviews, all aimed at exploring its effectiveness [9][10][11][12] . Currently, questionnaires that aim to evaluate knowledge, attitudes and beliefs of health professionals are available and these are encouraged in literature for enabling the construction of health values 5,6,13,14 . In general, pain assessment is based on a fragmented conception of the human being, which separates biological aspects from subjective and behavioral aspects, leading to protocolized and mechanized practices 15 , being Pain Attitudes and Beliefs Scale for Physiotherapists (PABS) 16,17 and Neurophysiological Pain Questionnaire (NSQ) 18 considered secondary measures. ...
... It is widely accepted as a measure of attitude towards chronic musculoskeletal pain more generally although the questions are related to back pain [30]. Moran, Rushworth and Mason (2017) [31] reported good internal consistency (α = 0.84), and convergent validity of the HC-PAIRS and good test-retest reliability (ICC -0.84). Scores in this 15 item version can range from 15 to 105, lower scores indicating a more positive attitude towards patient function in those with chronic pain. ...
... It is widely accepted as a measure of attitude towards chronic musculoskeletal pain more generally although the questions are related to back pain [30]. Moran, Rushworth and Mason (2017) [31] reported good internal consistency (α = 0.84), and convergent validity of the HC-PAIRS and good test-retest reliability (ICC -0.84). Scores in this 15 item version can range from 15 to 105, lower scores indicating a more positive attitude towards patient function in those with chronic pain. ...
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Background Healthcare professionals’ attitudes toward people with chronic pain influence their clinical practice. Objectives To investigate physiotherapy students’ attitudes and beliefs toward people with chronic pain over the course of their Scottish undergraduate program. Methods In this observational study, physiotherapy students from one university were recruited in the first year and followed up to their final year (year 1 n = 62/75, year 2 n = 68/72, year 3 n = 59/69, year 4 n = 74/74) for 4 years. The Health-Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS with scores ranging from 15 to 105) was completed annually Results A one-way ANOVA found that attitudes and beliefs improved significantly (p < .01) from the first to final year (9.2 ± 11.5 (mean±SD)). Participants showed a reduction in scores (signifying improved attitudes) annually with smaller reductions initially followed by a larger reduction in the final 2 years. Conclusions This is the first study to chart changes in the same cohort of physiotherapy students’ attitudes and beliefs toward people with chronic pain over time. Future work should explore which aspects of degree courses, if any, impact upon attitudes and beliefs toward people with chronic pain so that courses can be enhanced accordingly.
... The ability of HCPs to identify their beliefs about MSK pain is crucial given the significant role practitioners can play in achieving patients' biopsychosocial beliefs about low back pain (LBP) (Sullivan, 2011;Darlow, 2016;Lakke et al., 2015). Identifying HCPs' beliefs that may contribute to suboptimal clinical outcomes is a relevant prerequisite towards improving the quality of patient care (Moran et al., 2017). Pain Neuroscience Education (PNE) is a cognitive-based intervention to teach people about pain biology and physiology and de-emphasise the issues associated with the anatomical structures and focus on the biopsychosocial factors that contribute to the development of pain (Louw et al., 2016;Ryan et al., 2010;Nijs et al., 2014;Foster et al., 2003;Butler and Moseley, 2013). ...
... Questionnaires are available that aim to evaluate knowledge, attitudes, and beliefs among HCPs (Moran et al., 2017;Bishop et al., 2007;Darlow et al., 2014;Waddell et al., 1993;Domenech et al., 2013;Pincus et al., 2006;Houben et al., 2004). Because there is no gold standard for assessing knowledge and attitudes of pain among students (Ung et al., 2016), the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and the Neurophysiology of Pain Questionnaire (NPQ) were added as secondary measures. ...
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Background Healthcare practitioner beliefs influence patients’ beliefs and health outcomes in musculoskeletal (MSK) pain. A validated questionnaire based on modern pain neuroscience assessing Knowledge and Attitudes of Pain (KNAP) was unavailable. Objectives The aim of this study was to develop and test measurement properties of KNAP. Design Phase 1; Development of KNAP reflecting modern pain neuroscience and expert opinion. Phase 2; a cross-sectional and longitudinal study among Dutch physiotherapy students. Method In the cross-sectional study (n = 424), internal consistency, structural validity, hypotheses testing, and Rasch analysis were examined. Longitudinal designs were applied to analyse test-retest reliability (n = 156), responsiveness, and interpretability (n = 76). Results A 30-item KNAP was developed in 4 stages. Test-retest reliability: ICC (2,1) 0.80. Internal consistency: Cronbach's ?? 0.80. Smallest Detectable Difference 90%: 4.99 (4.31; 5.75). Structural validity: exploratory factor analysis showed 2 factors. Hypotheses testing: associations with the Pain Attitudes and Beliefs Scale for Physiotherapists biopsychosocial subscale r = 0.60, with biomedical subscale r = −0.58, with the Neurophysiology of Pain Questionnaire r = 0.52. Responsiveness: 93% improved on KNAP after studying pain education. Minimal Important Change: 4.84 (95%CI: 2.77; 6.91). Conclusions The KNAP has adequate measurement properties. This new questionnaire could be useful to evaluate physiotherapy students’ knowledge and attitudes of modern pain neuroscience that could help to create awareness and evaluate physiotherapy education programs, and ultimately provide better pain management.
... The HC-PAIRS questionnaire has demonstrated good to high level of internal consistency (Cronbach's alpha =0.78-0.92); it has already been used in healthcare student populations (Appendix 3) and is responsive to change [28][29][30] . The HC-PAIRS score seems to correlate with and be a good predictor of clinicians' recommendations concerning work and activity, for patients with low back pain [29] . ...
... Brief educational interventions could be used to complement undergraduate healthcare education, with the aim to enhance pain management in the long-term. Based on the strong construct validity of the questionnaires used, these improvements in HC-PAIRS and BBQ scores are likely to reflect a shift towards a more biopsychosocial approach to pain management, in line with the current guidelines [11,12,[14][15][16]30,32,33] . ...
... Measures have also been developed to assess healthcare practitioners' fear-avoidance beliefs [17] and beliefs about back pain [18]. The literature contains several examples of studies that utilise the previously mentioned measures to explore osteopaths' beliefs and attitudes towards back pain and lifting [19] and back pain in general [20][21][22][23]. Other measures have been used to evaluate osteopaths' beliefs about pain [24,25] and empathy within a patient-centred care context [26] using the Consultation and Relational Empathy (CARE) instrument [27]. ...
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Background Health professionals develop their own approach to patient care based on education, experience and philosophical stance. Literature suggests that this practice approach informs patient care, and clinical outcomes. The Osteopaths’ Therapeutic Approaches Questionnaire (Osteo-TAQ) is a novel 36-item instrument developed from qualitative grounded theory research with osteopaths in the United Kingdom. The aim of the study was to develop evidence for the structural and construct validity of the Osteo-TAQ in the Australian osteopathic profession and provide initial descriptive data about the therapeutic approaches of osteopaths in Australia. Methods A cross-sectional study design was used to collect data from registered osteopaths in Australia using the Osteo-TAQ and analysed with Exploratory Factor Analysis (EFA). The EFA utilised parallel analysis to determine the number of factors to extract and McDonald’s omega calculated as the reliability estimation statistic. Results 691 Australian osteopaths provided data for the study, representing 25% of the Australian osteopathic profession. Empirically the number of factors to extract based on the parallel analysis was seven. Two- and three-factor solutions were evaluated given the underpinning theory identifying two conceptions of practice and three interrelated therapeutic approaches. Both the two- and three-factor solutions were consistent with the underpinning theory with acceptable reliability estimations for each factor. Descriptive data suggested the most common element of the therapeutic approach of Australian osteopaths was establishing rapport, while the least common was ‘only talking’ with their patients. Conclusions This study provides evidence for the structural, content and construct validity of the Osteo-TAQ in an Australian osteopathic practitioner population. The results support both a two- and three-factor structure for the Osteo-TAQ in an Australian osteopathic population, with each factor demonstrating acceptable reliability estimations supporting the items comprising each factor as measuring a single construct. From a theoretical and empirical perspective, it can be inferred that the Osteo-TAQ tool encapsulates an osteopaths’ conception of practice (professional artistry and technical rational) and three main therapeutic approaches to patient care: Educator, Communicator and Treater. Further research is required to explore each of these therapeutic approaches to better understand how they relate to an individual osteopath’s conception of practice, and their associations with other measures of practice including clinical outcomes.
... Toutefois, la saturation des données a été atteinte avec une émergence de thèmes généraux. Le Back-PAQ, validé en français (24)(25)(26)(27) , comprend 34 items sur les représentations liées aux facteurs de risque de chronicisation. Le Back-PAQ a démontré sa validité et sa fiabilité. ...
... The inclusion of the adaptive cross-cultural process into the validation procedure enhanced the robustness of the AxEL. The Arabic AxEL version demonstrates excellent internal consistency with a Cronbach's alpha of 0.92, which compares favorably to Moran et al 23 Despite its strengths, this study acknowledges certain limitations. First, one of the translators did not have a medical background. ...
Article
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Purpose This cross-sectional study aimed to validate the Arabic version of the Attitude toward Education and Advice for Low Back Pain (AxEL) Questionnaire. Patients and Methods This study was conducted in two phases. First, the AxEL questionnaire was translated into Arabic and cross-culturally adapted. Second, the psychometric properties (such as validity) of the translated AxEL were evaluated. Results The results showed that back translators and language specialists had no trouble translating the AxEL. The translators’ agreement was very high (88.2%), and the questionnaire items were logically and clearly translated from English into Arabic. Conclusion The Arabic version of AxEL is a valid tool that can assess individuals’ beliefs and attitudes towards low back pain (LBP). It fills a significant void in cross-cultural research and can help healthcare providers understand the attitudes and beliefs influencing individuals’ management of LBP within the Arabic context.
... The HC-PAIRS internal consistency, construct validity, and discriminant validity was adequate. [41][42][43] The Physical Therapists' Attitudes and Beliefs About Exercise and Knee OA contains 23 attitude statements, 12 statements regarding the benefits of exercise for knee OA and 11 statements regarding the delivery of exercise and exercise adherence. 23 Each attitude statement is scored on a 6-point Likert scale ranging from 'totally disagree' to 6 'totally agree'. ...
Article
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Background In 2013, physical therapy students demonstrated low guideline-adherent recommendations regarding chronic low back pain (CLBP) for spinal pathology, activity, and work. Objectives To assess the differences in physical therapy students’ attitudes, beliefs, and adherence to guideline recommendations regarding CLBP and knee osteoarthritis between 2013 and 2020. Methods In 2013 and 2020, second and fourth-year physical therapy students were recruited from 6 Belgian and 2 Dutch institutions. Attitudes and beliefs regarding CLBP and knee OA were evaluated using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS), and a questionnaire regarding therapeutic exercise and knee osteoarthritis. A clinical vignette was used to measure guideline-adherent recommendations regarding spinal pathology, activity and work. Results In 2013, 927 s-year and 695 fourth-year students; in 2020, 695 s-year and 489 fourth-year students; were recruited to participate in the study. Compared to 2013, students had less biomedical and stronger biopsychosocial attitudes and beliefs regarding CLBP, more guideline-adherent recommendations for activity, and more biopsychosocial beliefs regarding the benefits of exercise for patients with knee osteoarthritis in both the second year and fourth year. Only fourth-year students in 2020 scored significantly better on HC-PAIRS and guideline-adherent recommendation relating to spinal pathology. No differences were found regarding work recommendations. Conclusions Between 2013 and 2020, physical therapy students made a positive shift towards a more biopsychosocial approach to CLBP and knee osteoarthritis management. Guideline-adherent recommendations for CLBP concerning activity improved, however, concerning work and spinal pathology, it remained low.
... The total score range from 34 to 170, with a higher score reflecting more unhelpful beliefs. The Back-PAQ has acceptable internal consistency (α = 0.70) (12), excellent test-retest reliability (ICC = 0.84) (25), and moderate convergent validity relative to the Tampa Scale of Kinesiophobia (r = −0.58) (25) when used by a cohort of healthcare practitioners. ...
Article
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Objectives The current study used a network analysis approach to explore the complexity of attitudes and beliefs held in people with and without low back pain (LBP). The study aimed to (1) quantify the adjusted associations between individual items of the Back Pain Attitudes Questionnaire (Back-PAQ), and (2) identify the items with the strongest connectivity within the network. Methods This is a secondary data analysis of a previously published survey using the Back-PAQ (n = 602). A nonparametric Spearman’s rank correlation matrix was used as input to the network analysis. We estimated an unregularised graphical Gaussian model (GGM). Edges were added or removed in a stepwise manner until the extended Bayesian information criterion (EBIC) did not improve. We assessed three measures of centrality measures of betweenness, closeness, and strength. Results The two pairwise associations with the greatest magnitude of correlation were between Q30–Q31 [0.54 (95% CI 0.44 to 0.60)] and Q15–Q16 [0.52 (95% CI 0.43 to 0.61)]. These two relationships related to the association between items exploring the influence of attentional focus and expectations (Q30–Q31), and feelings and stress (Q15–Q16). The three items with the greatest average centrality values, were Q22, Q25, and Q10. These items reflect beliefs about damaging the back, exercise, and activity avoidance, respectively. Conclusion Beliefs about back damage, exercise, and activity avoidance are factors most connected to all other beliefs within the network. These three factors may represent candidate targets that clinicians can focus their counseling efforts on to manage unhelpful attitudes and beliefs in people experiencing LBP.
... Scores range from 34 to 170, with higher scores indicating more unhelpful beliefs about the back. It has been shown to have acceptable internal consistency (α = 0.70; 95% CI 0.66 to 0.73), construct validity and test-retest reliability [35,36]. ...
Article
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Objective: The primary objective was to compare non-biomechanical factors between manual workers with and without a history of LBP related to lifting. A secondary objective was to investigate associations between the change in pain intensity during repeated lifting (termed pain ramp) and non-biomechanical factors tested in the LBP group. Methods: Manual workers currently in lifting occupations with and without a history of lifting-related LBP were recruited (21 LBP and 20 noLBP) and took part in a repeated (100) lift task. A series of non-biomechanical factors, including psychological, work-related, lifestyle, whole health and psychophysical factors, were collected. Psychophysical factors (pressure pain thresholds (PPTs) and fatigue) were also measured at different time points. Associations between pain ramp during lifting and non-biomechanical factors were investigated with linear regression. Results: The LBP group reported worse perceived sleep quality, more musculoskeletal pain sites other than LBP and greater symptoms related to gastrointestinal complaints and pseudo-neurology compared to the group with no history of LBP. The group with LBP were also slightly more worried about the lifting task and felt more fatigued at the end of the lifting task. The feeling of fatigue during lifting was positively associated with pain ramp in the LBP group. Anxiety and gastrointestinal complaints were weakly negatively associated with pain ramp during lifting. Conclusions: The group differences of poorer perceived sleep, greater non-specific health complaints, slightly more worry about the lifting task and more perceived fatigue in the LBP group highlight the complex and multi-factorial nature of LBP related to lifting. The feeling of fatigue was positively associated with pain ramp in the LBP group, suggesting a close relationship with pain and fatigue during lifting that requires further exploration.
... Psychometric properties of the HC-PAIRS are well established. Excellent internal consistency has been demonstrated Cronbach's α = 0.92 [53] as well as good test-retest reliability [ICC = 0.84] 95% confidence interval 0.78-0.89. Latimer, Maher and Refshauge (2004) [54] also observed its adequate responsiveness to change. ...
Article
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Background Persistent pain is a highly prevalent, global cause of disability. Research suggests that many healthcare professionals are not well equipped to manage pain, and this may be attributable at least in part to undergraduate education. The primary aim of this study was to quantify and compare first and final year nursing, midwifery and allied health professional (NMAHP) students’ pain related knowledge and attitudes. The secondary aim was to explore what factors influence students’ pain related knowledge and attitudes. Methods In this cross-sectional study, 1154 first and final year healthcare students, from 12 universities in five different countries completed the Revised Neurophysiology of Pain Quiz (RNPQ) [knowledge] and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS) [attitudes]. Results Physiotherapy was the only student group with statistically and clinically improved pain related knowledge [mean difference, 95% CI] (3.4, 3.0 to 3.9, p = 0.01) and attitudes (-17.2, -19.2 to 15.2, p = 0.01) between first and final year. Pain education teaching varied considerably from course to course (0 to 40 h), with greater levels of pain related knowledge and attitudes associated with higher volumes of pain specific teaching. Conclusions There was little difference in pain knowledge and attitudes between all first and final year NMAHP students other than physiotherapy. This suggests that for most NMAHP disciplines, undergraduate teaching has little or no impact on students’ understanding of pain. There is an urgent need to enhance pain education provision at the undergraduate level in NMAHPs. Trial Registration The study protocol was prospectively registered at ClinicalTrials.Gov NCT03522857 .
... Excellent internal consistency has been demonstrated (Cronbach's α = 0.92) as well as good test-retest reliability [ICC = 0.84] (95% confidence interval 0.78-0.89). It is also observed to have adequate responsiveness to change [16]. ...
Article
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Background Persistent pain is a leading cause of disability worldwide yet implementation of clinical guidelines that recommend a biopsychosocial approach remains a challenge in clinical practise. Limited pain understanding amongst clinicians may be partly responsible for this. Purpose of the study 1) Qualitatively explore the experience of receiving PSE, understanding of PSE and operationalisation of PSE-related principles in routine clinical practice. 2) Quantitatively explore pain knowledge, attitudes, and behaviours of general practitioners (GPs) and nurse practitioners (NPs) before and after pain science education (PSE). Methods An exploratory, single-site, mixed-methods study in north-east England. Fifteen NPs/GPs completed questionnaires and a case-vignette before and after a 70-min face-to-face PSE lecture. Qualitative data were thematically analysed from two focus groups after the intervention. Results Clinicians’ relatively high prior levels of knowledge, attitudes, and behaviour were similar after PSE. Qualitative themes described facilitation of self-reflection on pain management behaviours, and difficulties in operationalising PSE principles in practise including: limited patient rapport; short appointment times; patients’ passive and often oppositional biomedical treatment expectations; and clinicians’ lack of readily understandable language to communicate with patients. Conclusion The findings highlight the value of PSE perceived by these clinicians who were already favourably inclined towards biopsychosocial pain management. They sought more resources for their personal learning and for communication with patients. Even with such favourable disposition, the practicalities and environment of clinical practice impeded the operationalisation of PSE-related principles. Trial registration This study was prospectively registered at ClinicalTrials.Gov ( NCT04587596 ) in October 2020.
... However, results showed that osteopaths' attitudes and beliefs towards cLBP may be no different than those from other HCPs. 9,10 .No studies have specifically addressed the attitudes of French osteopathic educators towards cLBP patients. Their beliefs are all the more crucial as they are likely to not only have an impact on their patients 3 Results: Scores for the FABQ-HC Physical activity, the FABQ-HC Work and the NPQ were overall similar across the three groups included with respectively the following average scores: ...
Conference Paper
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Chronic back pain has been identified as one of the leading causes of disability in worldwide analysis and has remained one of the two main contributing factors to the global causes of disability for more than two decades. Practitioners’ attitudes and beliefs can trigger whether positive (placebo) or negative (nocebo) therapeutic outcomes in their patients, may influence their treatment approach and could be detrimental to the recovery of chronic low back pain (cLPB) patients when wrong messages are sent. Beliefs about the body and pain are therefore considered to form key considerations in the treatment of pain-related disabilities. Previous studies on the attitudes and beliefs of osteopaths towards cLBP have hypothesised that osteopaths would have a more biopsychosocial approach towards cLBP patients than other health care professionals (HCPs). Moreover, patients seem to report stronger person-centeredness in complementary care than with conventional care. However, results showed that osteopaths’ attitudes and beliefs towards cLBP may be no different than those from other HCPs.
... Items are also grouped in six different themes, which are 'the vulnerability of the back' (vulnerability), 'the need to protect the back' (protection), 'the correlation between pain and injury' (pain), 'the special nature of back pain' (LBP is special, with regard to the nature of pain, its impact, and its complexity), 'activity participation while experiencing back pain' (activity) and 'the prognosis of back pain' (prognosis). The Back-PAQ demonstrated high internal consistency (α = 0.91), excellent test-retest reliability (ICC 2,1 = 0.84) and good convergent validity with other instruments amongst health professionals (Moran et al., 2017). ...
Article
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Background Physiotherapists' biomedical orientation influences the implementation of evidenced-based care for low back pain (LBP) management. However, information on physiotherapists’ own beliefs about their back and LBP and the influence of these on clinical decisions and advice is lacking. Objectives To identify attitudes and beliefs about LBP among physiotherapists and to analyse the association of these beliefs with physiotherapists’ individual characteristics and clinical decisions and advice. Design Cross-sectional survey. Method Attitudes and beliefs about LBP were measured with the Back-Pain Attitudes Questionnaire (Back-PAQ) among French-speaking Swiss physiotherapists. Physiotherapists’ clinical decisions and advice were assessed with a clinical vignette to determine their association with the Back-PAQ score. Results The study included 288 physiotherapists. The mean Back-PAQ score (82.7; SD 17.2) indicated the presence of helpful beliefs in general, but unhelpful beliefs in relation to back protection and the special nature of LBP (nature of pain, impact, complexity) were frequently identified. Individual characteristics explained 17% of the Back-PAQ score. Unhelpful beliefs were associated with clinical decisions toward back protection and movement avoidance (r = - 0.47, p < 0.001). Conclusions While helpful beliefs and guidelines consistent decisions were generally identified, unhelpful beliefs about back protection and the special nature of LBP were frequently present among physiotherapists. These unhelpful beliefs were associated with less optimal clinical decisions. Educational approaches should challenge unhelpful beliefs and empower physiotherapists to provide explanations and management that increases patients’ confidence in the back. Future research should investigate the effect of educational strategies on implementation of best practice for LBP management.
... Hence scores on the total scale could range from 10 to 50, with a neutral score being represented by a score of 30; and scores on individual sub-scales could range from 2 to 10, with a neutral sub-scale score being represented by a score of 6. This measure is reliable and has demonstrated convergent validity with the Tampa Scale of Kinesiophobia and the Fear Avoidance Beliefs Questionnaire [16]. The 10-item nature of the scale allowed for employees' attitudes and beliefs to be sampled quickly to avoid disruption to the day. ...
Article
Work absence due to back pain is best predicted by beliefs and attitudes. Lots of money is spent on training in the NHS trying to prevent back pain; this study explores the effect of that training on back pain beliefs. 151 NHS employees were surveyed using the Back Pain Attitudes Questionnaire before and after manual handling training. NHS employees had mixed beliefs. Before training, staff had positive beliefs about activity participation (8.25, SD 1.78), neutral beliefs about psychological influences (6.11, SD 2.51) and prognosis (6.34, SD 2.18), negative beliefs about relationship with injury (5.26, SD 2.09) and strongly negative beliefs about vulnerability of the back (2.81, SD 1.45). Training had a small negative effect (–1.57, SD 4.06 p < 0.001) primarily through exacerbating beliefs regarding the vulnerability of the back (–0.45, SD 1.24, p < 0.001) and the relationship between pain and injury (–0.80, SD 1.83 p < 0.001). NHS employees hold many outdated views on back pain. The immediate effects of manual handling training based on the traditional paradigm of ‘protect your back’ appeared to make respondents slightly more cautious about using the spine; viewing it as easy to injure, that pain and damage may be linked, and slightly less optimistic about recovery.
... The Back-PAQ was developed based on qualitative studies conducted on subjects with LBP (Darlow et al., 2014a). It was used to evaluate back beliefs of both patients and healthcare professionals (Darlow et al., 2014b;Moran et al., 2017). The questionnaire was validated in different languages with good to excellent psychometric properties (Demoulin et al., 2017;Krug et al., 2020;Pierobon et al., 2020). ...
Article
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 minimal detectable change (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.
... good to high level of internal consistency (Cronbach's alpha ¼ 0.78-0.92), excellent test-retest reliability (intraclass correlation coefficient >0.75) [27], and has been used previously with healthcare students and professionals [4,10,19,21,28]. ...
Article
Background: Attitudes, knowledge and understanding (K&U) may predispose practitioner adherence to clinical guidelines for chronic pain. To date, there are no data exploring this in adult, mental health and paediatric nursing, or occupational therapy, podiatry and physiotherapy student healthcare professionals at the same institution. Methods: We approached 1383 students enrolled on pre-registration healthcare programmes at a Scottish University, using the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) and Pain Understanding and Confidence Questionnaire (PUnCQ). Results: Three hundred and forty-six students completed the survey (response rate 25%). There was a significant effect of degree discipline on HC-PAIRS and PUnCQ with a moderate effect size of ηp² = .212 and ηp² = .204, respectively. Postgraduate pre-registration physiotherapy students had more positive attitudes towards function with pain, M(SD) HC-PAIRS score = 49.6(8.9), 95%CI = 46.5–52.8, and greater confidence towards management of chronic pain M(SD) = 6.3, 95%CI = 5.9–6.8 compared to the other disciplines surveyed. Undergraduate physiotherapy and mental health nursing also displayed significantly more positive attitudes M(SD) = 55.2 (10.2), 95%CI 53.3–57.2 and 62.6 (7.6), 60.1–65.2, respectively. Conclusions: Physiotherapy students have more biopsychosocial-orientated attitudes, and higher confidence towards the management of people in pain than the other disciplines surveyed despite similar levels of K&U of pain.
... The original TSK was first adapted to be used with HCPs by Houben et al. [36]. An English version of the TSK-HC was later validated by Moran et al., but until today a validated Spanish version does not exist [39]. However, a Spanish version of the 11-item format, the TSK-11, is validated and considered a reliable tool for use in both acute (Cronbach's alpha 0.81) and chronic (Cronbach's alpha 0.79) patient populations [40]. ...
Article
Background Healthcare providers' attitudes and beliefs might influence patients’ attitudes and beliefs as well as their management approach. It was hypothesised that osteopaths have a more biopsychosocial mindset towards chronic low back pain (CLBP) because of their holistic reasoning. Objective The primary aim of the study was to assess the beliefs of osteopaths registered in Spain about CLBP and the presence of kinesiophobic and fear-avoidance beliefs. The secondary aim was to compare these results with previous research and cut-off values. Method Members of the Spanish Federation of Osteopaths (FOE) were invited to participate in an online cross-sectional survey based on three questionnaires: the Health Care providers Pain and Impairment Relationship Scale (HC-PAIRS), the Tampa Scale of Kinesiophobia 11-item version for healthcare providers (TSK(11)-HC) and the Fear Avoidance Beliefs Questionnaire for healthcare providers (FABQ-HC). The mean scores were calculated for each questionnaire and correlations were established to assess the strength of the associations between the different instruments. The results were compared to previous research with other HCPs and to cut-off scores when available. Results The response rate was 14.58% (n = 70). The mean score on the HC-PAIRS was 59.44 ± 12.19 [CI 95% 56.54–62.35] and there was a large variation in scores. On the TSK(11)-HC and FABQ-HC 28.6% and 25.7% of the sample respectively reached the cut-off scores. Conclusion The study suggests that the Spanish osteopaths do not have a more biopsychosocial orientation towards the management of CLBP than other HCPs. Approximately a quarter of them hold kinesiophobic and fear-avoidance beliefs that might negatively influence their treatment approach.
... 9,36,56 Two studies independently demonstrated that osteopaths significantly endorsed a more biomedical approach than did physical therapists 9 and manual therapists. 61 In our study, we therefore expected osteopaths to have higher biomedical scores than general physical therapists (hypothesis 3), physical therapist specialists (hypothesis 4), manual therapists (hypothesis 5), and psychomotor physical therapists (hypothesis 6). ...
Article
Background: The Pain Attitudes and Beliefs Scale (PABS) for Physical Therapists aims to measure clinicians' biomedical and biopsychosocial treatment orientations regarding nonspecific low back pain. Objective: The objective of this study was to assess whether the PABS can differentiate between subgroups of physical therapists hypothesized to differ in treatment orientations. Design: This study was a cross-sectional survey. Methods: The PABS was completed by 662 Norwegian physical therapists with a diversity of professional backgrounds. Twenty-four a priori hypotheses on expected differences in PABS scores were formulated. Sufficient discriminative ability was defined as a minimum of 75% confirmed hypotheses. Hypotheses on differences in scores were tested for the biomedical and biopsychosocial subscales separately as well as for combinations of the 2 subscales, representing responders with high biomedical and low biopsychosocial PABS scores and vice versa. Results: Of the 24 hypotheses, only 15 (62.5%) were confirmed. Between-group differences concerning the separate subscales were small, varying from -0.63 to 1.70 scale points, representing values up to 6.0% of the total subscale ranges. Between-group differences were larger when combined subscales were used, varying from 1.80 to 6.70 points, representing values up to 25.1% of the total subscale ranges. Despite little spread in scores, 24% of respondents demonstrated extreme attitudes. Limitations: The lack of convincing scientific evidence from previous research on differences in attitudes and beliefs between physical therapists was a limitation for the formulation of hypotheses. Conclusions: Discriminative validity of separate subscales of the PABS was not supported. Combining the 2 subscales into global treatment attitudes enabled better discrimination. Little spread in biomedical and biopsychosocial orientations explains why more than one-third of the hypotheses were not confirmed. Either Norwegian physical therapists are basically similar in their treatment orientation or the PABS is not able to detect any differences between them.
... Both of the methods of reliability estimation demonstrated issues with respect to the individual items and the generation of a total score. These findings are in contrast to other authors who have demonstrated high Cronbach's alpha values for the HC-PAIRS [36,39,40] but appears consistent with the original authors (α=0.78) [14] and others (α=0.74) ...
Article
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Background Chronic pain is a substantial burden on the Australian healthcare system with an estimated 19.2% of Australians experiencing chronic pain. Knowledge of the neurophysiology and multidimensional aspects of pain is imperative to ensure health professionals apply a biopsychosocial approach to pain. Questionnaires may be used to assess learner changes in neurophysiology knowledge and beliefs and attitudes towards pain after education interventions. The aim of this study was to evaluate changes in pain neurophysiology knowledge, beliefs and attitudes following a 12 week clinically-focused pain module in year 3 osteopathy students as measured by the Neurophysiology of Pain (NPQ) Questionnaire and Health Care Providers Pain and Impairment Relationship scale (HC-PAIRS). Methods A pre-post design was utilised. Learners completed a demographic information survey pre-module, and completed the NPQ & HC-PAIRS prior to undertaking, and after completing, a twelve week clinically-focused pain module. Results Learners (n = 55) completed the NPQ & HC-PAIRS at both time points. The median NPQ score was significantly increased with a large effect size (p < 0.001, z = − 5.71, r = 0.78) following the completion of the module. In contrast, the HC-PAIRS total score was significantly increased after the completion of the module (p < 0.01, z = − 6.95, r = 0.91) suggesting an increase in negative pain attitudes and beliefs. Results indicate that a clinically-focused pain module can increase pain neurophysiology knowledge. However the HC-PAIRS results suggest an increase in negative pain attitudes and beliefs. The HC-PAIRS questionnaire was developed for use with chronic low back pain attitudes & beliefs in practitioners, rather than pre-clinical students. Students were provided with general principles of pain management, rather than condition specific pain management. This study is the first comparing pain neurophysiology knowledge and changes in attitudes and beliefs towards pain pre-post a clinically-focused pain module using the NPQ & HC-PAIRS. Conclusions There was a significant improvement in NPQ score after the 12 week clinically-focused pain module. The HC-PAIRS result was paradoxical and may reflect issues with the module design or the measurement tool. The module duration is longer than that reported in the literature and demonstrates effectiveness in increasing pain neurophysiology knowledge. Electronic supplementary material The online version of this article (10.1186/s12998-018-0212-0) contains supplementary material, which is available to authorized users.
... The total score of the "danger scale" was used to find its correlation with other explicit and implicit scores. 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 reliability [23,46]. ...
Article
Background and aims Despite lack of support from recent in vivo studies, bending and lifting (especially with a round-back posture) are perceived as dangerous to the back. In light of this view, it has been proposed that pain-free people may hold a common implicit belief that is congruent with the idea that bending and lifting with a round-back represents danger to a person’s back, however this has not been evaluated. The aims of this study were: (1) to evaluate implicit associations between back posture and safety related to bending and lifting in pain-free people; (2) to explore correlations between the implicit measure and explicit measures of back beliefs, fear of movement and safety of bending; (3) to investigate self-reported qualitative appraisal of safe lifting. Methods Exploratory cross-sectional study including 67 pain-free participants (no pain, or average pain ≤3/10 for less than one week over the previous 12 months) (52% male), who completed an online survey containing demographic data and self-reported measures of: fear of movement (Tampa Scale for Kinesiophobia for General population – TSK-G), back beliefs (Back Pain Attitudes Questionnaire BackPAQ), and bending beliefs (Bending Safety Belief – BSB – a pictorial scale with images of a person bending/lifting with round and straight back postures). Implicit associations between back posture and safety related to bending and lifting were evaluated with the Implicit Association Test (IAT). A qualitative assessment of descriptions of safe lifting was performed. Results An implicit association between “danger” and “round-back” bending/lifting was evident in all participants (IAT D-score =0.65 (SD=0.45; 95% CI [0.54, 0.76]). Participants’ profile indicated high fear of movement, unhelpful back beliefs, and perceived danger to round-back bending and lifting (BSB Thermometer : 5.2 (SD=3.8; 95% CI [4.26, 6.13] range −10 to 10; t (67) =11.09, p <0.001). There was a moderate correlation between IAT and BSB Thermometer (r=0.38, 95% CI [0.16, 0.62]). There were weaker and non-statistically significant correlations between IAT and TSK-G (r=0.28, 95% CI [−0.02, 0.47]), and between IAT and BackPAQ Danger (r=0.21, 95% CI [−0.03, 0.45]). Qualitative assessment of safe lifting descriptions indicated that keeping a “straight back” and “squatting” when lifting were the most common themes. Conclusions Pain-free people displayed an implicit bias towards bending and lifting with a “round-back” as dangerous. Our findings support the idea that pain-free people may have a pre-existing belief about lifting, that the back is in danger when rounded. Research to evaluate the relationship between this implicit bias and lifting behaviour is indicated. Implications The findings of this study may have implications for ergonomic guidelines and public health information related to bending and lifting back postures. Additionally, clinicians may need to be aware of this common belief, as this may be reflected in how a person responds when they experience pain.
Article
Objective To examine chiropractic students’ attitudes regarding knowledge of pain neuroscience, chronic pain, and patient-centered care before and after educational interventions. Secondarily, this study aimed to compare measures of these skills between cohorts at different timepoints throughout training programs. Methods Using stratified randomization, 281 Year 3 chiropractic students at 2 institutions were allocated into 1 of 3 educational interventions and served as active-control comparison groups: pain neuroscience education, chronic pain education, or patient-centered care. Participants completed validated surveys regarding their experience with the education interventions immediately pre- and post-lecture and 12 weeks after completion. For further comparison, surveys were also completed by 160 Year 1 students and 118 Year 2 students at 1 of the institutions. Independent sample t tests and 1-way analysis of variance were used for data analysis. Results All Year 3 lecture groups showed immediate improvements (pain neuroscience education: 3.99 + 3.09/100, p = .18 [95% CI: 10.10 to −1.77]; chronic pain education: 0.42 + 0.74/7, p = .02 [95% CI: 0.72 to 0.07]; patient-centered care: 0.25 + 0.12/6, p = .05 [95% CI: 0.12–0.51]), but these were not sustained at the 12-week follow-up (pain neuroscience education: −6.25 + 4.36/100, p = .15 [95% CI: 14.93 to −2.42]; chronic pain education: 0.33 + 0.16/7, p = .19 [95% CI, 0.66 to 0.01]; patient-centered care: 0.13 + 0.13/6, p = .30 [95% CI: 0.41 to −0.13]). Compared to active controls, only the patient-centered care group showed an immediate statistically significant difference. Conclusions While this study found that immediate improvement in targeted competencies is possible with focused interventions, they were not sustained long term.
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Chronic back pain is a frequent and disabling health problem. There is evidence that ignorance and erroneous beliefs about chronic low back pain among health professionals interfere in the treatment of people who suffer from it. The Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) has been one of the most used scale to assess these misbeliefs, but no studies have been reported in Latin America. Method: We studied the factorial structure of the HC-PAIRS in health personnel and health sciences university students in two Latin American countries: Colombia (n = 930) and Chile (n = 190). Spain's data was taken of the original study of the Spanish version of the HC-PAIRS (171 Physiotherapy students). Additionally, the measurement invariance of this scale among Chile, Colombia and Spain was evaluated by calculating three nested models: configural, metric and scalar. We used a Confirmatory Factor Analysis (CFA) in both Latin American samples, with Maximum Likelihood Robust (MLR) estimation to estimate the parameters. For the final model in each sample, reliability was assessed with the Composite Reliability (CR) index, and to obtain the proportion of variance explained by the scale the Average Variance Extracted (AVE) was calculated. Results The one-factor solution shows an acceptable fit in both countries after deleting items 1, 6, and 14. For the resulting scale, the CR value is adequate, but the AVE is low. There is scalar invariance between Chile and Colombia, but not between these two countries and Spain. Conclusions HC-PAIRS is useful for detecting misconceptions about the relationship between chronic low back pain that would cause health personnel to give wrong recommendations to patients. However, it has psychometric weaknesses, and it is advisable to obtain other evidence of validity.
Article
Objectives Patients’ interactions with health care providers influence back pain–related outcomes. The Health Care Providers’ Pain and Impairment Relationship Scale (HC‐PAIRS) is an instrument that assesses providers’ attitudes and beliefs about patients with persistent back pain, with lower scores implying that persistent pain does not indicate disability or limitation of activities. This scoping review aims to explore the extent of research involving the HC‐PAIRS. Literature Survey PubMed, Embase, and PEDro databases were searched from inception to April 2022. Methods Extracted HC‐PAIRS scores were standardized to 15‐item scores and categorized by profession, student or professional status, and pre/post‐educational intervention to evaluate scores. Psychometric properties and educational interventions of the HC‐PAIRS were described. Results After screening, 51 studies representing 10,416 participants were included. Student and professional scores were investigated in 24 and 29 studies, respectively. Twenty‐one studies included educational interventions, with heterogenous follow‐up. Psychometric properties of the HC‐PAIRS were assessed in 10 studies and demonstrated acceptable reliability and validity. The overall baseline mean score among all participants was 55.34 (95% CI: 53.54–57.14) (students: 56.54 [56.54–60.87]; professionals: 51.67 [49.08–54.27]). Nurses (61.99 [55.66–68.31]) and non–health care professionals (65.30 [57.33–73.28]) had the highest overall baseline mean scores, whereas chiropractors (51.69 [33.73–69.66]), MDs/PAs (52.64 [47.27–58.00]), physical therapists (53.42 [50.67–56.17]), and exercise professionals (57.36 [49.39–65.33]) had lower scores. Conclusions The HC‐PAIRS has been used across many disciplines in both students and professionals and demonstrated acceptable reliability and validity. Professionals commonly treating back pain had lower HC‐PAIRS scores. Future research could benefit from standardization of interventions and timing of follow‐up assessments.
Article
Background Back pain (BP) is a major cause of absenteeism in National Health Service (NHS) staff in the UK. However, the back beliefs of NHS staff with BP are unknown. Objectives To explore the BP beliefs of UK NHS staff presenting with BP, and how these beliefs are constructed. Method Purposive sampling of NHS staff with BP who had self-referred to University Hospitals of Leicester NHS Trusts occupational health physiotherapy service. 30 participants completed the Back-Pain Attitudes Questionnaire. Ten participants with a range of BP beliefs also completed semi-structured interviews. Mean responses, and frequency of different responses were reported, for the questionnaire data. Interviews were analysed using thematic analysis. Results Total Back-PAQ scores (mean −9.6, SD 9.16) indicated unhelpful BP beliefs overall, though some BP beliefs such as the potential benefit of exercise were more positive. Key themes identified from the interviews were; (i) the uniquely vulnerable nature of BP, (ii) the need to protect the back through avoidance behaviours, and (iii) the importance of being active for BP. Conclusion NHS staff presenting with BP generally held negative BP beliefs, based on both questionnaire responses and the qualitative interviews. Awareness of the potential benefits of activity contrasted with the notion that ongoing protection of the back was required, and was evident in questionnaire data and interviews. Back pain beliefs were influenced by health care professional advice (both formal and informal settings), moving and handling training, family opinion and childhood experiences, offering insights into the settings where BP beliefs could be targeted.
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Background Practitioners’ fear-avoidance beliefs can influence positively or negatively therapeutic outcomes in their patients. This study reports pain knowledge and fear-avoidance beliefs of French osteopathy students and educators towards the management of chronic low back pain (cLBP). Methods An online cross-sectional survey was proposed to educators and students. It included sociodemographic characteristics and two questionnaires: the FABQ-HC to assess beliefs on the effects of physical and work activities for people with cLBP, and the NPQ to assess participants' knowledge of pain. Results Participants (N = 172) had mean FABQ-HC subscale scores of 11.02 ± 4.44 (Physical activity) and 24.37 ± 11.78 (Work). The mean NPQ total score was 11.90 ± 2.05. There were no significant score differences between students and educators (p > 0.05). Results showed that Year 4 students (N = 65) had a significantly better score (p < 0.05) at the FABQ-HC Physical Activity than Year 5 students (N = 71). Educators (N = 36) having less than 10 years of practice in osteopathy had better scores than other educators (p < 0.01) at the FABQ-HC Work. Educators and students in the study show similar scores to other French HCPs and international osteopaths on the FABQ-HC Physical activity. In contrast, they scored lower on the FABQ-HC Work. Conclusions The main finding was that educators and students belonging to the same OEI have no significantly different beliefs about cLBP and no significantly differing knowledge of pain. There is potential to improve pain education especially concerning the beliefs around cLBP concerning work activity.
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Background As the Back Pain Attitudes Questionnaire (Back-PAQ), a validated instrument, could be performed to evaluate biopsychosocial dimensions of back pain, it has not been translated and adapted for Turkish population. Objectives It was aimed to translate and cross-culturally adapt the Back-PAQ (versions of 34-item, 20-item, and 10-item) into Turkish language and analyse the validity and reliability of the Back-PAQ-Turkish version (Back-PAQ-Tr). Study design Study of diagnostic accuracy/assessment scale. Methods The translation and cross-cultural adaptation process were carried out in several steps according to international best-practice guidelines. 173 participants with back pain were recruited. Turkish version of the Tampa Scale of Kinesiophobia (TSK-Tr) and Fear Avoidance Beliefs Questionnaire (FABQ-Tr) were used to investigate the convergent validity. Results Internal consistency of the Back-PAQ-Tr, Back-PAQ-Tr-20, and Back-PAQ-Tr-10 were 0.82, 0.78 and 0.68, respectively. Test-retest reliability was excellent for Back-PAQ-Tr (ICC = 0.95) and Back-PAQ-Tr-20 (ICC = 0.95), but weak for Back-PAQ-Tr-10 (ICC = 0.50). A weak correlation was found between all versions of Back-PAQ-Tr and TSK-Tr & FABQ-Tr, except for the moderate correlation between Back-PAQ-Tr-10 and TSK-Tr (r = −0.51) & the physical activity score of FABQ-Tr (r = −0.51). Back-PAQ-Tr, Back-PAQ-Tr-20, and Back-PAQ-Tr-10 accounted for 66.2%, 60.5%, and 78.2% of the variance in the data set, respectively. Conclusion The versions of 34-item and 20-item Back-PAQ-Tr are reliable and valid questionnaire to assess Turkish populations' attitudes and beliefs regarding back pain. Since the reliability of the 10-item version was determined to be quite low, we particularly recommend the use of the versions of Back-PAQ-Tr and Back-PAQ-Tr-20.
Article
Purpose To develop the Turkish version of the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS-TR) by conducting the linguistic and cultural adaptation and to examine the psychometric properties and reliability of the adapted version. Methods A double back-translation procedure was used to translate the questionnaire. Participants received an online survey package with the HC-PAIRS-TR, the Turkish version of Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT-TR), and Turkish Version of the Tampa Scale for Kinesiophobia (TSK-TR). Cronbach's alpha coefficient and item analysis were used to evaluate internal consistency. Intraclass correlation coefficient (ICC) was used to determine the test–retest reliability. Confirmatory factor analysis (CFA) and Rasch Analysis were performed. Results The study was conducted with 153 physiotherapists practicing in Turkey. Cronbach’s alpha was 0.81. Test-retest reliability was high (ICC=0.85, p<0.001), the standard error of measurement was 4.96 (0.94% of mean), and minimal detectable change was 13.75 (26.06% of mean). HC-PAIRS-TR scores correlated significantly with scores for the biomedical factor of the PABS-PT-TR (r=0.52, p=0.00), biopsychosocial factor of PABS-PT-TR (r=0.32, p=0.00), and TSK-TR (r=0.52, p=0.00). According to CFA and Rasch Analysis, the 12 items version of HC-PAIRS-TR fits the one-factor model excellently. Conclusion The HC-PAIRS-TR appears to be a reliable and valid questionnaire to measure Turkish physiotherapists’ beliefs and attitudes about the relationship between low back pain and impairment. Future studies might be planned to validate this questionnaire for other health care providers.
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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- 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.
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Objective 1) To investigate the effects of a brief pain neuroscience education (PNE) lecture on multi-disciplinary healthcare students’ knowledge, attitudes and behaviours towards people with pain post intervention and at 6-months follow-up, 2) To explore students’ perceptions of PNE. Design Mixed-methods randomized controlled trial. Setting UK university. Participants Thirty-seven students (30♀, mean age 30years) from six healthcare disciplines. Intervention 70-minute PNE lecture (intervention group) or a 70-minute control education. Main outcome measures 1) Knowledge: The Revised Pain Neurophysiology Quiz (RPNQ); 2) Attitudes: Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS); 3) behaviours: A case vignette to assess clinical recommendations; and 4) thematic analysis of semi-structured interviews (n=12). Results The intervention group increased knowledge compared to the control, post-intervention [mean difference 3.7 (95% CI, 2.4, 5.0), P<0.001] but not at 6-months (0.1 (-1.1, 1.3), P=0.860). Greater improvements in attitudes for the intervention group were seen post-intervention [-10.4 (-16.3, -4.6), P<0.001] and at 6-months [-5.8, (-11.5, -0.2), P<0.044]. There was no difference in behaviours between groups. Thematic analysis identified increased patient empathy, partial and patchy reconceptualisation of pain and increased confidence in recommending an active management programme following PNE. Conclusion This study adds to existing knowledge by demonstrating that a 70-minute PNE lecture can have a short-term effect on knowledge and positively shift attitudes towards people with pain in the short and medium-term. It also resulted in some students’ reconceptualisation of pain, increased empathy, and confidence to recommend activity. The effect of PNE on clinical behaviours was unclear.
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Background Lower back pain is a leading cause of disability and a common condition seen by osteopaths. Evidence and advice for the safest lifting posture vary, as do healthcare practitioners' attitudes and beliefs towards back pain. Objectives The aim of this study was to understand osteopaths' beliefs about safe lifting postures in relation to their attitudes towards back pain, and to compare these findings with published data from physiotherapists and manual handling advisors. Design Cross-sectional study. Method Between October and November 2018 a cross-sectional electronic survey was used to invite a sample of UK osteopaths to select images that best represent their perception of safe lifting posture (straight or rounded back), and to complete the Back Pain Attitudes Questionnaire (Back-PAQ). Data was analysed to assess lifting posture selection and relationship to back pain attitudes. Results 46 (85.2%) out of 54 osteopaths selected straight back posture as safest, these participants had significantly more negative attitudes to back pain injury (i.e. higher Back-PAQ scores), than the 8 osteopaths who selected a rounded back posture (p = 0.007). Data from 266 physiotherapists and 132 manual handling advisors revealed an overall agreement about straight back lifting posture, and differences in Back-PAQ attitude between the professions. Conclusion Despite a lack of evidence and inconsistent recommendations, osteopaths in this study believed that straight back lifting posture is the safest. Practitioners' attitudes vary and are known to influence their patients' attitudes and recovery behaviour. Further research is recommended to identify reasons for different beliefs, and their impact on advice-giving and patient outcomes.
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Background Pain has been identified as a global health issue with substantial effects on individuals and society. Health professionals managing pain complaints must have appropriate knowledge of pain neurophysiology, and attitudes and beliefs towards pain management that align with current practice guidelines. Objectives Evaluate Australian osteopaths’ current level of knowledge of pain neurophysiology and their beliefs and attitudes towards pain, and explore associations with demographic variables. Method Australian osteopaths drawn from a nationally representative practice-based research network received the questionnaire. The questionnaire included demographic information, Neurophysiology of Pain Questionnaire (NPQ), Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and the Attitudes to Back Pain Scale in Musculoskeletal Practitioners (ABS-mp). Results Complete responses were received from 211 osteopaths (21.3% response rate). The mean total NPQ score was equivalent to 72.2% correct responses. The PABS-PT Biomedical scale mean score was 38.8 (+/-9.1, α=0.81) and the Biopsychosocial scale was 22.3 (+/-3.3, α=0.38). ABS-mp mean factor scores suggest osteopaths support psychological approaches (22.1, +/-3.3, α=0.71) but endorsed more treatment sessions for those with back pain (15.9, +/-4.7, α=0.71). Trivial correlations between measures and most demographic variables were observed. Osteopaths who undertook further studies in pain had higher mean NPQ scores, with moderate negative correlations with a lower PABS-PT Biomedical subscale score (ρ=-0.45, p<0.01). Conclusions Australian osteopaths demonstrate a range of pain neurophysiology knowledge, and beliefs and attitudes towards pain. The findings support the positive impact of professional development for improving pain knowledge in this population.
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Patient beliefs play an important role in the development of back pain and disability, as well as subsequent recovery. Community beliefs about the back and back pain which are inconsistent with current research evidence have been found in a number of developed countries. These beliefs negatively influence people's back-related behaviour in general, and these effects may be amplified when someone experiences an episode of back pain.In-depth qualitative research has helped to shed light on why people hold the beliefs which they do about the back, and how these have been influenced. Clinicians appear to have a strong influence on patients' beliefs. These data may be used by clinicians to inform exploration of unhelpful beliefs which patients hold, mitigate potential negative influences as a result of receiving health care, and subsequently influence beliefs in a positive manner.
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Changes in survey mode for conducting panel surveys may contribute significantly to survey error. This article explores the causes and consequences of such changes in survey mode. The authors describe how and why the choice of survey mode often causes changes to be made to the wording of questions, as well as the reasons that identically worded questions often produce different answers when administered through different modes. The authors provide evidence that answers may changeas a result of different visual layouts for otherwise identical questions and suggest ways to keep measurement the same despite changes in survey mode.
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