Abstract
Low back pain (LBP) is a common, expensive, and disabling musculoskeletal condition. Cognitive factors like attitudes and beliefs influence the experience of musculoskeletal pain. The Back Pain Attitudes Questionnaire (Back-PAQ) was developed to assess attitudes and beliefs about back pain. During the development of the instrument, themes were identified in qualitative interviews with people who had acute and chronic LBP. These interviews aimed to explore beliefs that underlie constructs like fear-avoidance, catastrophization, and poor outcome expectation. Items representing these beliefs were drafted, included in the questionnaire, and tested in a general population sample. The Back-PAQ has been found to have acceptable to excellent internal consistency, excellent test-retest reliability, and adequate validity. Three different versions of the questionnaire are available (34-, 20-, and 10-item versions), with the 20-item Back-PAQ representing a unidimensional scale appropriate for outcome measurement. The Back-PAQ has been translated and cross-culturally adapted to numerous languages and used globally. The Back-PAQ has been used for a range of applications (1) to explore and compare the beliefs of different populations (i.e., general population; different professions), (2) to evaluate the results of interventions aimed to modify unhelpful beliefs, and (3) as an outcome measure in clinical trials. Clinicians may use the Back-PAQ to assess the beliefs of patients with low back pain and monitor changes during rehabilitation. Future studies should assess the responsiveness and interpretability (minimal clinical important difference) of the Back-PAQ and confirm the unidimensionality of the 20-item Back-PAQ in the translated versions.