scholarly journals Cross-cultural translation, adaptation, and validation of the Amharic version pain self-efficacy questionnaire in people with low back pain in Ethiopia

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mulugeta Bayisa Chala ◽  
Catherine Donnelly ◽  
Yemataw Wondie ◽  
Setareh Ghahari ◽  
Jordan Miller
Keyword(s):  
Factor Analysis ◽  
Low Back Pain ◽  
Back Pain ◽  
Psychometric Properties ◽  
Internal Consistency ◽  
Self Efficacy ◽  
Bodily Pain ◽  
Low Back ◽  
Sf 36 ◽  
Pain Subscale

Abstract Background The Pain Self-Efficacy Questionnaire (PSEQ) is a valid and reliable instrument that evaluates pain self-efficacy beliefs in people with pain conditions. However, it has not been validated and used in Ethiopia. We conducted this study to translate, adapt, and test the psychometric properties of the PSEQ in the Amharic language and Ethiopian context for its use with people experiencing low back pain (LBP). Methods The PSEQ was translated into Amharic and then back-translated into English. An expert review committee created a final Amharic version of the tool (PSEQ-Am), followed by pilot testing and cognitive debriefing with a sample of 20 people with LBP. The psychometric properties of the final version of PSEQ-Am were assessed in a sample of 240 people with LBP recruited from three rehabilitation centers in Ethiopia. Cronbach’s alpha and Intra-class correlation coefficient were calculated to describe the reliability and internal consistency of the tool. The SF-36-Am bodily pain subscale was used to assess convergent validity. Confirmatory Factor Analysis (CFA) and Exploratory Factor Analysis (EFA) were performed to determine the dimensionality of the instrument. Results PSEQ-Am demonstrated excellent test-retest reliability (ICC = 0.93) and internal consistency (Cronbach’s alpha = 0.91). As hypothesized, the tool demonstrated a significant moderate correlation with the Bodily Pain subscale of the SF-36-Am (Rho = 0.51, p < 0.01). EFA analysis shows that the Amharic version of PSEQ is a dominant one factor and secondary two factor structure. Conclusion This study shows that PSEQ-Am is a reliable and valid tool that can be used in both clinical practice and research in the Ethiopian low back pain population.

scholarly journals The Hausa Back Beliefs Questionnaire: Translation, cross-cultural adaptation and psychometric assessment in mixed urban and rural Nigerian populations with chronic low back pain

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249370
Author(s):  
Aminu Alhassan Ibrahim ◽  
Mukadas Oyeniran Akindele ◽  
Sokunbi Oluwaleke Ganiyu ◽  
Bashir Kaka ◽  
Bashir Bello
Keyword(s):  
Factor Analysis ◽  
Low Back Pain ◽  
Back Pain ◽  
Construct Validity ◽  
Psychometric Properties ◽  
Internal Consistency ◽  
Attitudes And Beliefs ◽  
Low Back ◽  
Negative Attitudes ◽  
Test Retest Reliability

Introduction Negative attitudes and beliefs about low back pain (LBP) can lead to reduced function and activity and consequently disability. One self-report measure that can be used to assess these negative attitudes and beliefs and to determine their predictive nature is the Back Beliefs Questionnaire (BBQ). This study aimed to translate and cross-culturally adapt the BBQ into Hausa and assess its psychometric properties in mixed urban and rural Nigerian populations with chronic LBP. Methods The BBQ was translated and cross-culturally adapted into Hausa (Hausa-BBQ) according to established guidelines. To assess psychometric properties, a consecutive sample of 200 patients with chronic LBP recruited from urban and rural clinics of Nigeria completed the questionnaire along with measures of fear-avoidance beliefs, pain catastrophizing, functional disability, physical and mental health, and pain. One hundred of the 200 patients completed the questionnaire twice at an interval of 7–14 days to assess test-retest reliability. Internal construct validity was assessed using exploratory factor analysis, and external construct validity was assessed by examining convergent, divergent, and known-groups validity. Reliability was assessed by calculating internal consistency (Cronbach’s α), intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change at 95% confidence interval (MDC95), and limits of agreement using Bland-Altman plots. Reliability (ICC, SEM and MDC95) was also assessed separately for rural and urban subgroups. Results The factor analysis revealed a four-factor solution explaining 58.9% of the total variance with the first factor explaining 27.1%. The nine scoring items loaded on the first factor hence supporting a unidimensional scale. The convergent and divergent validity were supported as 85% (6:7) of the predefined hypotheses were confirmed. Known-groups comparison showed that the questionnaire discriminated well for those who differed in education (p < 0.05), but not in age (p > 0.05). The internal consistency and ICC (α = 0.79; ICC = 0.91) were adequate, with minimal SEM and MDC95 (1.9 and 5.2, respectively). The limits of agreements were –5.11 to 5.71. The ICC, SEM and MDC95 for the urban and rural subgroups were comparable to those obtained for the overall population. Conclusions The Hausa-BBQ was successfully adapted and psychometrically sound in terms of internal and external construct validity, internal consistency, and test-retest reliability in mixed urban and rural Hausa-speaking populations with chronic LBP. The questionnaire can be used to detect and categorize specific attitudes and beliefs about back pain in Hausa culture to prevent or reduce potential disability due to LBP.

Reliability and smallest detectable change of the Danish version of the Pain Self-Efficacy Questionnaire in patients with chronic low back pain

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Camilla Vejlgaard ◽  
Thomas Maribo ◽  
Johan Riisgaard Laursen ◽  
Anne Mette Schmidt
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Psychometric Properties ◽  
Self Efficacy ◽  
Inpatient Rehabilitation ◽  
Low Back ◽  
Detectable Change ◽  
Good Reliability ◽  
Danish Version ◽  
Smallest Detectable Change

Abstract Objectives Low back pain (LBP) is the leading cause of disability and a global public health concern. Studies indicate that pain self-efficacy is associated with the development of disability in chronic LBP (CLBP) patients. The Pain Self-Efficacy Questionnaire (PSEQ) is a commonly used questionnaire to assess pain self-efficacy in patients with CLBP. It is essential to examine the psychometric properties of the PSEQ in the population in which it is to be used. Thus, the aim of this study is to evaluate the reliability and smallest detectable change of the Danish version of the Pain Self-Efficacy Questionnaire (PSEQ-DK) in patients with CLBP before implementing it as an outcome measure in an inpatient rehabilitation context. Methods This observational study including 92 patients with CLBP was conducted in a multidisciplinary rehabilitation facility in Denmark. The psychometric properties statistically tested included reliability, smallest detectable change and floor and ceiling effect of the PSEQ-DK. Results The reliability analysis included 92 patients and revealed an weighted kappa of 0.82 (95% Cl 0.75; 0.88) and Intraclass correlation coefficient of 0.83 (95% CI 0.75; 0.88), which corresponds to a good reliability. The smallest detectable change was 12.67. Conclusions The present study demonstrated that the PSEQ-DK had a good reliability in patients with CLBP in an inpatient rehabilitation context. The current results expand our knowledge of the reliability and smallest detectable change of the PSEQ-DK. In order to implement PSEQ-DK in a rehabilitation context for evaluative purposes future studies should focus on examining responsiveness and interpretability.

scholarly journals Rasch Analysis Supports the Use of the Pain Self-Efficacy Questionnaire

2014 ◽  
Vol 94 (1) ◽  
pp. 91-100 ◽  
Author(s):  
Flavia Di Pietro ◽  
Mark J. Catley ◽  
James H. McAuley ◽  
Luke Parkitny ◽  
Christopher G. Maher ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Intensity ◽  
Internal Consistency ◽  
Self Efficacy ◽  
Rasch Analysis ◽  
Item Bias ◽  
Measurement Properties ◽  
Low Back ◽  
Pain Duration

Background The Pain Self-Efficacy Questionnaire (PSEQ) is used by physical therapists in clinical practice and in research. However, current understanding of the PSEQ's measurement properties is incomplete, and investigators cannot be confident that it provides unbiased information on patient self-efficacy. Objective The aims of this study were: (1) to investigate the scale properties of the PSEQ using Rasch analysis and (2) to determine whether age, sex, pain intensity, pain duration, and pain-related disability bias function of the PSEQ. Design This was a retrospective study; data were obtained from 3 existing studies. Methods Data were combined from more than 600 patients with low back pain of varying duration. Rasch analysis was used to evaluate targeting, category ordering, unidimensionality, person fit, internal consistency, and item bias. Results There was evidence of adequate category ordering, unidimensionality, and internal consistency of the PSEQ. Importantly, there was no evidence of item bias. Limitations The PSEQ did not adequately target the sample; instead, it targeted people with lower self-efficacy than this population. Item 7 was hardest for participants to endorse, showing excessive positive misfit to the Rasch model. Response strings of misfitting persons revealed older participants and those reporting high levels of disability. Conclusions The individual items of the PSEQ can be validly summed to provide a score of self-efficacy that is robust to age, sex, pain intensity, pain duration, and disability. Although item 7 is the most problematic, it may provide important clinical information and requires further investigation before its exclusion. Although the PSEQ is commonly used with people with low back pain, of whom the sample in this study was representative, the results suggest it targets patients with lower self-efficacy than that observed in the current sample.

scholarly journals Development of the Hausa Version of the Pain Catastrophizing Scale: Translation, Cross-Cultural Adaptation and Psychometric Evaluation in Mixed Urban and Rural Patients with Chronic Low Back Pain

2020 ◽  
Author(s):  
Aminu A. Ibrahim ◽  
Mukadas O. Akindele ◽  
Bashir Kaka ◽  
Naziru B. Mukhtar
Keyword(s):  
Factor Analysis ◽  
Low Back Pain ◽  
Back Pain ◽  
Internal Consistency ◽  
Concurrent Validity ◽  
Pain Catastrophizing ◽  
Low Back ◽  
Pain Catastrophizing Scale ◽  
Factorial Structure ◽  
Rural Patients

Abstract Background: Catastrophizing has been recognized as an important contributor to chronicity in individuals with chronic pain syndromes including low back pain (LBP). The Pain Catastrophizing Scale (PCS) is perhaps the most widely used questionnaire to evaluate the degree of pain catastrophizing. However, its use is limited in Hausa-speaking countries due to the lack of a validated translated version.Objective: To translate and cross-culturally adapt the PCS into Hausa (Hausa-PCS) and evaluate its psychometric properties in mixed urban and rural patients with chronic LBP.Methods: The original PCS was translated and cross-culturally adapted into Hausa in accordance with established guidelines. To evaluate psychometric properties, a consecutive sample of 200 patients with chronic LBP was recruited from urban and rural Nigerian hospitals. Validity was evaluated by exploring content validity (skewness and item-total correlation), factorial structure (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]), concurrent validity (Spearman’s rho) and known-groups validity. Reliability was evaluated by calculating internal consistency (Cronbach’s α), intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC) and limits of agreement with 95% confidence interval (LOA95%).Results: The Hausa-PCS demonstrated good face and content validity. Both EFA and CFA confirmed a 3-factor structure similar to the original English version. The concurrent validity was supported as 83% (5/6) of the a priori hypotheses were confirmed. Known-groups comparison showed that the questionnaire was unable to differentiate between male and female or urban and rural patients (p > 0.05). Internal consistency and ICC was adequate for the Hausa-PCS total score (α = 0.84; ICC = 0.90) and the subscale helplessness (α = 0.78; ICC = 0.89) but for the subscales rumination (α = 0.69; ICC =0.68) and magnification (α = 0.41; ICC = 0.43). The LOA95% for the Hausa-PCS total score was between –8.10 and +9.75, with SEM and MDC of 3.47 and 9.62 respectively. Conclusion: The Hausa-PCS was successfully developed and psychometrically adequate in terms of factorial structure, concurrent validity, internal consistency and test-retest reliability when applied in mixed urban and rural patients with chronic LBP. However, the internal consistency and reliability coefficients (ICC) for the individual subscales are questionable. Thus, we support the use of the total score when evaluating pain catastrophizing for clinical or research purposes.

Cross Cultural Adaptation and Validation of Hindi Version of WHOQOL-BREF in Patients With Chronic Low Back Pain

2022 ◽  
Author(s):  
Jeetinder Kaur Makkar ◽  
Ankita Goyal ◽  
Rajni Sharma ◽  
Vishal Kumar ◽  
Babita Ghai ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Low Back Pain ◽  
Back Pain ◽  
Confirmatory Factor Analysis ◽  
Chronic Low Back Pain ◽  
Pearson Correlation ◽  
Low Back ◽  
Cross Sectional ◽  
Sf 36 ◽  
Confirmatory Factor

Abstract Aim of the study was to validate Hindi version of WHOQOL-BREF in chronic low back pain patients (CLBP). In this cross-sectional study, 111 patients with CLBP were recruited. In addition to demographic information, two questionnaires Hi WHOQOL-BREF and SF-36 (Reference scale) were administered at day 0 and day 3. NRS was used for pain evaluation. Cronbach’s alpha coefficient was used for scale reliability. Construct validity was analysed using Pearson correlation coefficient. Confirmatory factor analysis was performed to determine the relationships between the eight domains of SF-36 and four domains of the WHOQOL-BREF.Cronbach’s alpha coefficients were acceptable for all domains of both Hi WHOQOL-BREF (0.869 - 0.938) and SF-36 (0.752 - 0.943) questionnaires. Pearson correlation coefficients of both instruments were partly to strongly correlate with most domains (r ≥0.40). Correlations for domains with similar constructs were stronger than those measuring varied constructs. Confirmatory factor analysis recommended approximately good relationships among the SF-36 and WHOQOL-BREF domains. Our study suggests that WHOQOL-BREF Hindi version is a reliable and valid tool for clinical and research use in CLBP.

scholarly journals Cross-cultural adaptation and psychometric validation of the Hausa version of Örebro Musculoskeletal Pain Screening Questionnaire in patients with non-specific low back pain

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Usman Abba Ahmed ◽  
Sonill S. Maharaj ◽  
Thayananthee Nadasan ◽  
Bashir Kaka
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Construct Validity ◽  
Psychometric Properties ◽  
Musculoskeletal Pain ◽  
Internal Consistency ◽  
Low Back ◽  
English Version ◽  
Screening Questionnaire ◽  
Culturally Adapted

AbstractObjectivesOrebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) is widely used in clinical practice and for research purpose to screen the risk of chronicity in patients with Non-specific low back pain (NSLBP). The questionnaire has been cross-culturally adapted into different languages, but to date, there has not been Hausa version of the questionnaire. This study is important as the Hausa language is widely spoken across sub-Saharan Africa. The study aims to cross-culturally translate the English version of the (OMPSQ) into Hausa language (OMPSQ-H) and to test its psychometric properties in Hausa patients with NSLBP.MethodsThis observational study involved the use of forward-backwards translation method for the English version of OMPSQ. Thus, 124 male and female participants with subacute NSLBP were recruited using convenient sampling techniques. The psychometric properties statistically tested included reliability, internal-consistency, ceiling and floor effects, acceptability and construct validity.ResultsThe Hausa version of OMPSQ has demonstrated good reliability (ICC=0.82) and internal consistency (Cronbach’s alpha=0.72) with good acceptability as all questions were answered in 5 min. Responsiveness was adequate as OMPSQ-H retest scores demonstrated good correlation with the global rating of change scale scores (r=0.67, p=0.01). Construct validity was evaluated using principal component analysis and it reveals six components structure for the OMPSQ-H.ConclusionsThe OMPSQ-H was successfully translated and cross-culturally adapted with no problem of comprehension. Moreover, it has shown adequate psychometric properties in terms of internal consistency, reliability, responsiveness and constructs validity. Consequently, the OMPSQ-H can be considered as a valid tool for identifying and screening both psychosocial risk factors and risk of chronicity of NSLBP in Hausa population.

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

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Edel T. O’Hagan ◽  
Ian W. Skinner ◽  
Matthew D. Jones ◽  
Emma L. Karran ◽  
Adrian C. Traeger ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Low Back Pain ◽  
Back Pain ◽  
Construct Validity ◽  
Exploratory Factor Analysis ◽  
Self Efficacy ◽  
Measurement Properties ◽  
Inverse Association ◽  
Low Back ◽  
First Line

Abstract Introduction Clinician time and resources may be underutilised if the treatment they offer does not match patient expectations and attitudes. We developed a questionnaire (AxEL-Q) to guide clinicians toward elements of first-line care that are pertinent to their patients with low back pain. Methods We used guidance from the COSMIN consortium to develop the questionnaire and evaluated it in a sample of people with low back pain of any duration. Participants were recruited from the community, were over 18 years and fluent in English. Statements that represented first-line care were identified. Semantic scales were used to measure attitude towards these statements. These items were combined to develop the questionnaire draft. Construct validity was evaluated with exploratory factor analysis and hypotheses testing, comparing to the Back Beliefs Questionnaire and modified Pain Self-Efficacy Questionnaire. Reliability was evaluated and floor and ceiling effects calculated. Results We recruited 345 participants, and had complete data for analysis for 313 participants. The questionnaire draft was reduced to a 3-Factor questionnaire through exploratory factor analysis. Factor 1 comprised 9 items and evaluated Attitude toward staying active, Factor 2 comprised 4 items and evaluated Attitude toward low back pain being rarely caused by a serious health problem, Factor 3 comprised 4 items and evaluated Attitude toward not needing to know the cause of back pain to manage it effectively. There was a strong inverse association between each factor and the Back Beliefs Questionnaire and a moderate positive association with the modified Pain Self-Efficacy Questionnaire. Each independent factor demonstrated acceptable internal consistency; Cronbach α Factor 1 = 0.92, Factor 2 = 0.91, Factor 3 = 0.90 and adequate interclass correlation coefficients; Factor 1 = 0.71, Factor 2 = 0.73, Factor 3 = 0.79. Conclusion This study demonstrates acceptable construct validity and reliability of the AxEL-Q, providing clinicians with an insight into the likelihood of patients following first-line care at the outset.

scholarly journals Development of the Hausa version of the Pain Catastrophizing Scale: Translation, cross-cultural adaptation and psychometric evaluation in mixed urban and rural patients with chronic low back pain

2020 ◽  
Author(s):  
Aminu A. Ibrahim ◽  
Mukadas O. Akindele ◽  
Bashir Kaka ◽  
Naziru B. Mukhtar
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Psychometric Properties ◽  
Internal Consistency ◽  
Content Validity ◽  
Pain Catastrophizing ◽  
Low Back ◽  
Pain Catastrophizing Scale ◽  
Factorial Structure ◽  
Rural Patients

Abstract Background: Catastrophizing has been recognized as an important contributor to chronicity in individuals with chronic pain syndromes including low back pain (LBP). The Pain Catastrophizing Scale (PCS) is perhaps the most widely used questionnaire to evaluate the degree of pain catastrophizing. However, its use is limited in Hausa-speaking countries due to the lack of a validated translated version.Objective: To translate and cross-culturally adapt the PCS into Hausa (Hausa-PCS) and evaluate its psychometric properties in mixed urban and rural patients with chronic LBP.Methods: The original PCS was translated and cross-culturally adapted into Hausa in accordance with established guidelines. To evaluate its psychometric properties, a consecutive sample of 200 patients with chronic LBP was recruited from urban and rural Nigerian hospitals. Validity was evaluated by exploring content validity, factorial structure (confirmatory factor analysis [CFA]), construct validity (Spearman’s rho) and known-groups validity. Reliability was evaluated by calculating internal consistency (Cronbach’s α), intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC) and limits of agreement with 95% confidence interval (LOA95%).Results: The Hausa-PCS was comprehensible with good content validity. The CFA confirmed a 3-factor structure similar to the original English version. The concurrent validity was supported as 83% (5/6) of the a priori hypotheses were confirmed. Known-groups comparison showed that the questionnaire was unable to differentiate between male and female or urban and rural patients (p > 0.05). Internal consistency and ICC were adequate for the Hausa-PCS total score (α = 0.84; ICC = 0.90) and the subscale helplessness (α = 0.78; ICC = 0.89) but for the subscales rumination (α = 0.69; ICC = 0.68) and magnification (α = 0.41; ICC = 0.43). The LOA95% for the Hausa-PCS total score was between –8.10 and +9.75, with SEM and MDC of 3.47 and 9.62 respectively. Conclusion: The Hausa-PCS was successfully developed and psychometrically adequate in terms of factorial structure, construct validity, internal consistency and test-retest reliability when applied in mixed urban and rural patients with chronic LBP. However, the internal consistency and reliability coefficients (ICC) for the individual subscales are questionable. Thus, we support the use of the total score when evaluating pain catastrophizing for clinical or research purposes.

scholarly journals The psychometric properties of the Roland Morris disability questionnaire for patients with chronic mechanical low back pain

2007 ◽  
Vol 63 (2) ◽  
Author(s):  
H. Buchanan
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Psychometric Properties ◽  
Functional Status ◽  
Spinal Fusion ◽  
Internal Consistency ◽  
Low Back ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Disability Questionnaire

Purpose: Functional status measures are currently not widelyused in South Africa to facilitate clinical decision-making or document treatment outcomes for patients with low back pain (LBP). This study investigated the internal consistency and clinical utility of a back-specific functional status measure, the Roland Morris Disability Questionnaire (RMDQ), and determined its ability to confirm the need for spinal fusion surgery. Method: Aretrospective, descriptive design was used with 42 patients with chronic mechanical low back pain who consulted a private Orthopaedic surgeon in Cape Town over a one year  period. All patients completed the RMDQ prior to their consultation. On completion of the medical examination, a rating for surgery was determined for each patient. The completed questionnaires were analysed using Statistical Package for the Social Sciences (SPSS). Results: The mean RMDQ score was 8.6 (N=42; median=9.0; range=2-21). Cronbach’s alpha showed a high internal consistency between items (.92). A categorical principal component analysis (CATPCA) identified two distinct dimensions in the RMDQ. Item reduction improved the internal consistency and thus the construct validity of the RMDQ. There was a low correlation between the surgeon’s rating for surgery and RMDQ scores (r=.40; P<.01). Conclusion: The RMDQ shows some good psychometric properties but some adjustments could improve it. The RMDQ cannot be used to predict the need for spinal fusion surgery.

Willingness to Try Acupuncture Again: Reports from Patients on Their Treatment Reactions in a Low Back Pain Trial

2010 ◽  
Vol 28 (4) ◽  
pp. 185-188 ◽  
Author(s):  
A K Hopton ◽  
K J Thomas ◽  
H MacPherson
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Back Pain ◽  
Controlled Trial ◽  
Bodily Pain ◽  
Specific Treatment ◽  
Low Back ◽  
Sf 36 ◽  
Seeking Help ◽  
Randomised Controlled

Background Reactions to treatment are common following acupuncture. Understanding how these reactions are interpreted by patients is largely unexplored. Objective To examine patients’ ratings of the severity and bothersomeness of a range of common treatment reactions, and to assess their impact on willingness to try acupuncture again. Methods Self-reported ratings of the frequency, severity and bothersomeness of treatment reactions from 133 patients in the acupuncture arm of a pragmatic randomised controlled trial of acupuncture for chronic back pain are described and analysed. Results A total of 133 acupuncture patients reported at 3 months reactions that they had experienced at any time during a course of up to 10 acupuncture treatment sessions. They received a total of 1150 treatments, an average of 8.6 sessions per patient. All patients reported treatment reactions, most commonly relaxation (84%, n = 112), which was significantly associated with willingness to try acupuncture again, (χ2 = 7.860, df = 1, p = 0.005). Only 16% (n=21) were unwilling to experience a specific treatment reaction again, and 9% (n = 12) were unwilling to try acupuncture again. The most ‘bothersome’ reaction was a temporary worsening of symptoms (29%, n=38), though this was not associated with an unwillingness to try acupuncture again (χ2 = 0.382, df = 1, p>0.536). Those unwilling to try acupuncture again reported significantly less reduction in their pain at 3 months (mean (SE) SF-36 bodily pain score at 3 months 30.453 (3.598) vs 19.30 (1.128); p=0.003). Conclusion Among this group of patients seeking help for low back pain, the experience of treatment reactions was universal. There was no evidence that the bothersomeness of treatment reactions was associated with patient's willingness to try acupuncture again. The benefit of pain reduction over the course of treatment appeared to outweigh self-rated bothersome reactions to treatment.

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