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

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.

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

Physical Therapy ◽

10.2522/ptj.20130217 ◽

2014 ◽

Vol 94 (1) ◽

pp. 91-100 ◽

Cited By ~ 29

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.

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

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-03985-4 ◽

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.

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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 ◽

10.1371/journal.pone.0249370 ◽

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.

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Evaluation of the EQ-5D-3L and 5L versions in low back pain patients

Health and Quality of Life Outcomes ◽

10.1186/s12955-021-01792-y ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

A. M. Garratt ◽

H. Furunes ◽

C. Hellum ◽

T. Solberg ◽

J. I. Brox ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Missing Data ◽

Measurement Properties ◽

Low Back ◽

Improve Measurement ◽

Multicenter Randomized Controlled Trial ◽

Patient Reported ◽

Ceiling Effects

Abstract Background The EuroQol EQ-5D is one of the most widely researched and applied patient-reported outcome measures worldwide. The original EQ-5D-3L and more recent EQ-5D-5L include three and five response categories respectively. Evidence from healthy and sick populations shows that the additional two response categories improve measurement properties but there has not been a concurrent comparison of the two versions in patients with low back pain (LBP). Methods LBP patients taking part in a multicenter randomized controlled trial of lumbar total disc replacement and conservative treatment completed the EQ-5D-3L and 5L in an eight-year follow-up questionnaire. The 3L and 5L were assessed for aspects of data quality including missing data, floor and ceiling effects, response consistency, and based on a priori hypotheses, associations with the Oswestry Disability Index (ODI), Pain-Visual Analogue Scales and Hopkins Symptom Checklist (HSCL-25). Results At the eight-year follow-up, 151 (87%) patients were available and 146 completed both the 3L and 5L. Levels of missing data were the same for the two versions. Compared to the EQ-5D-5L, the 3L had significantly higher floor (pain discomfort) and ceiling effects (mobility, self-care, pain/discomfort, anxiety/depression). For these patients the EQ-5D-5L described 73 health states compared to 28 for the 3L. Shannon’s indices showed the 5L outperformed the 3L in tests of classification efficiency. Correlations with the ODI, Pain-VAS and HSCL-25 were largely as hypothesized, the 5L having slightly higher correlations than the 3L. Conclusion The EQ-5D assesses important aspect of health in LBP patients and the 5L improves upon the 3L in this respect. The EQ-5D-5L is recommended in preference to the 3L version, however, further testing in other back pain populations together with additional measurement properties, including responsiveness to change, is recommended. Trial registration: retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT01704677.

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

Scandinavian Journal of Pain ◽

10.1515/sjpain-2021-0014 ◽

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.

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Development of the Italian Version of the Pain Vigilance and Awareness Questionnaire in Subjects with Chronic Low Back Pain: Cross-cultural Adaptation, Confirmatory Factor Analysis, Reliability and Validity

International Journal of Behavioral Medicine ◽

10.1007/s12529-015-9507-x ◽

2015 ◽

Vol 23 (2) ◽

pp. 214-223 ◽

Cited By ~ 3

Author(s):

Marco Monticone ◽

Emilia Ambrosini ◽

Barbara Rocca ◽

Tiziana Nava ◽

Erica Terragni ◽

...

Keyword(s):

Factor Analysis ◽

Low Back Pain ◽

Back Pain ◽

Cultural Adaptation ◽

Reliability And Validity ◽

Cross Cultural ◽

Low Back ◽

Italian Version ◽

Cross Cultural Adaptation ◽

Confirmatory Factor

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Factors associating with disability of non-specific low back pain in different subgroups: A hierarchical linear regression analysis

Scientific Reports ◽

10.1038/s41598-021-97569-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Takahiro Miki ◽

Daisuke Higuchi ◽

Tsuneo Takebayashi ◽

Mina Samukawa

Keyword(s):

Regression Analysis ◽

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Psychosocial Factors ◽

Self Efficacy ◽

Explanatory Power ◽

Low Back ◽

Acute Group ◽

Pain Catastrophising

AbstractThis study aimed to explore factors associating with disability, which means physical impairment affecting a person’s mobility, capacity, stamina, or agility, of non-specific low back pain (NSLBP) of the acute and non-acute groups. Two hundred thirty-five patients with NSLBP of less than 8 weeks’ duration as acute groups (n = 124) and more than 8 weeks’ duration as non-acute group (n = 111) were recruited. It was collected data on pain intensity, disability and psychosocial factors, including pain catastrophising, fear of movement and pain self-efficacy. Disability was measured Roland Morris Disability Questionnaire. A hierarchical multiple regression analysis was performed to analyse factors associating with disability of the acute and non-acute groups. The Result was that explanatory power increased with each additional variable of the order of demographic characteristics, pain intensity and psychosocial factors for both groups. Pain intensity, pain catastrophising and pain self-efficacy had significant explanatory power, with pain self-efficacy having the most significant association on the acute group. Only pain self-efficacy having the most significant association on disability of the non-acute group. In conclusion, the factors associating with disability differed depending on the duration of the disease, and pain self-efficacy might be one of the factors associating with disability of patients with NSLBP.

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