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Back Pain Attitude Questionnaire
(Back-PAQ)

The Back Pain Attitudes Questionnaire (Back-PAQ) was developed in the Department of Primary Health Care and General Practice at the University of Otago by Darlow et al. in 2012. This page contains information about the development of the Back-PAQ and versions that can be downloaded and used (including official translations).

The Back-PAQ can be used in research or clinical practice. The original questionnaire and all translations are publically available. No permission is required for their use or reproduction. No charge should be made for their use.

The Back-PAQ’s source can be cited as: Darlow B, Perry M, Mathieson F, Stanley J, Melloh M, Marsh R, Baxter GD, Dowell A: The development and exploratory analysis of the Back Pain Attitudes Questionnaire (Back-PAQ). BMJ Open 2014, 4(5).

Development

The Back-PAQ was developed based on qualitative interviews with people who had acute and chronic back pain. An open-access paper describing the development of the Back-PAQ has been published in BMJ Open. The Back-PAQ can be downloaded from this page.

The instrument was initially developed to test whether back pain-related attitudes and beliefs identified through analysis of these qualitative interviews were also held in the wider New Zealand population. The findings from this survey are presented in an open-access paper published in BMJ Open.

Items are worded so that the instrument may be appropriate for people with back pain, people without back pain, and health professionals.

Subsequent Rasch analysis has developed a psychometrically robust version using 20 items from the original scale. The development process is described in a paper published in Disability and Rehabilitation.

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Versions and scoring

The Back-PAQ uses a 5-point Likert scale. Each scale point is labelled with a descriptive title. The scale ranges from ‘False’ to ‘True’ (intermediate labels: ‘Possibly False’, ‘Unsure’, ‘Possibly True). The ‘True’ response option normally represents beliefs that are unhelpful for recovery from back pain.

All versions are drawn from the same set of 34-items.

34-item Back-PAQ

The original Back-PAQ contains 34-items. This may be useful for exploring the presence or prevalence of certain beliefs or as a discussion tool. A version that may be appropriate for population surveys, a 20-item version developed through Rash analysis and a shorter 10-item version that may be appropriate for research or clinical screening use.

Eleven items (1, 2, 3, 15, 16, 17, 27, 28, 29, 30, 31) are reversed compared with the normal direction of the survey.

Total scores range from 34 to 170. Higher scores indicate more unhelpful beliefs.

20-item Back-PAQ

The 20-item Back-PAQ is a psychometrically robust unidimensional instrument appropriate for measuring levels of back pain beliefs in individuals and populations. It has been validated in general public and general practitioner populations. Back-PAQ-20 scores correlate highly with Back-PAQ-34 scores.

Two items (1, 17) are reversed compared to the normal direction of the survey.

Total scores range from 20 to 100. Higher scores indicate more unhelpful beliefs.

Ordinal-to-interval conversion tables are available (XLSX)

10-item Back-PAQ

The 10-item Back-PAQ may be considered for use as a clinical screening tool but is not sufficiently robust to use as an outcome measure or research tool. The tool contains five two-item components: vulnerability of the back (items 1 and 2); relationship between back pain and injury (items 3 and 4); activity participation during back pain (items 5 and 6); psychological influences on back pain (items 7 and 8); prognosis of back pain (items 9 and 10).

Three items (6, 7, 8) are reversed compared with the normal direction of the survey.

When the 10-item scale is used as a clinical screening tool, responses can be scored from −2 (‘True’) to +2 (‘False’). Beliefs that are unhelpful for recovery from back pain attract negative scores and vice versa. This may allow clinicians to quickly interpret scale and component scores and identify where explanations could be directed to address unhelpful beliefs or strengthen helpful beliefs.

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Translation

Four translations from the original English version are currently available. Further translations may be made to other languages. Translations should be published on this site and no restrictions should be made on their use. Please contact Ben Darlow if you wish to translate the Back-PAQ using a rigorous translation process.

Arabic

The Back-PAQ has been translated into Arabic by SF Kanaan, H Khraise, KA Almhdawi, B Darlow, AO Oteir, ZM Mansour.

A publication describing the translation and psychometric properties of the Arabic version is available: Kanaan SF, Khraise H, Almhdawi KA, Darlow B, Oteir AO, Mansour ZM. Arabic version of the Back Pain Attitudes Questionnaire: Translation, cross-cultural adaptation, and psychometric properties. Journal of Back and Musculoskeletal Rehabilitation 2020. DOI: 10.3233/BMR-191758

The Arabic version can be downloaded from this page.

Argentinian Spanish

The Back-PAQ has been translated into Argentinian Spanish by A Pierobon, P. Policastro, S. Solino, B. Darlow, M. Andreu, G. Novoa, I. Raguzzi, F. Villalba.

A publication describing the translation and psychometric properties of the Spanish Argentinian version is available: Pierobon, A., Policastro, P. O., Soliño, S., Darlow, B., Andreu, M., Novoa, G. A., Raguzzi, I. A., Villalba, F. J. (2020). Spanish translation, cross-cultural adaptation and validation of the Argentine version of the Back Pain Attitudes Questionnaire. Musculoskeletal Science and Practice, 46, 102125. doi: https://doi.org/10.1016/j.msksp.2020.102125.

A publication further exploring the measurement properties is available: José VF, Oscar PP, Santiago S, et al. Standard measurement error and minimum detectable change of the Back-PAQ ArgSpan Questionnaire: Secondary analysis. Musculoskeletal Science and Practice. 2020:102315. https://doi.org/10.1016/j.msksp.2020.102315

The Argentinian Spanish version can be downloaded from this page.

Brazilian Portuguese

The Back-PAQ has been translated into Brazilian Portuguese by R.C. Krug, J.-P. Caneiro, D. Ribeiro, B. Darlow, MF Silva, J. Loss.

A publication describing the translation and psychometric properties of the Brazilian Portuguese version is available: Krug RC, Caneiro JP, Ribeiro D, Darlow B, Silva MC, Loss J (2020) Back Pain Attitudes Questionnaire: Measurement properties analysis and Cross-cultural adaptation to Brazilian-Portuguese. Brazilian Journal of Physical Therapy. https://doi.org/10.1016/j.bjpt.2020.07.001

The Brazilian Portuguese version can be downloaded from this page.

Danish

The Back-PAQ has been translated into Danish by M.S. Nicolaysen, D.B. Larsen, and T.S. Palsson.

A publication describing the translation and psychometric properties of the Danish version is available: Nicolaysen MS, Larsen DB, Palsson TS. The Danish version for the Back Pain Attitudes Questionnaire - Translation and cross-cultural adaptation. Musculoskeletal Science and Practice 2021;52:102348. https://doi.org/10.1016/j.msksp.2021.102348

The Danish version can be downloaded from this page.

French

The Back-PAQ has been translated to French by C. Demoulin, V. Halleux, B. Darlow, E. Martin, N. Roussel, F. Humblet, S. Bornheima, D. Flynn, I. Salamun, P. Renders, J.-M. Crielaard, O. Bruyère.
A publication describing the translation and psychometric properties of the French version is available: Demoulin , Halleux V, Darlow B, Martin E, Roussel N, Humblet F, Bornheim S, Flynn D, Salamun I, Renders P, Kaux JF, Bruyère.Traduction en langue française de la version longue du « Back Pain Attitudes Questionnaire » et étude de ses qualités psychométriques. Mains Libres 2017; 4: 19-27.

A conference presentation describing the translation process and psychometric properties of the French version is also available.

The French version can be downloaded from this page.

Greek

The Back-PAQ is being translated in Greek by Aspa Polydorou from the University of West Attica.

Italian

The Back-PAQ is being translated into Italian by Michele Marelli.

Latvian

The Back-PAQ is being translated into Latvian by Dr. Logina from Riga Stradins University Hospital.

Turkish

The Back-PAQ has been translated into Turkish by Hilal Alta and Zübeyir Sarı from Trakya University.

The Turkish version can be downloaded from this page.

Swedish

The Back-PAQ is being translated into Swedish by Patrik Numanovic from University of Gothenburg.

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Use in research

Caneiro, JP., O’Sullivan, P., Lipp, O. V., Mitchinson, L., Oeveraas, N., Bhalvani, P., Abrugiato, R., Thorkildsen, S., and Smith, A. (2018). Evaluation of implicit associations between back posture and safety of bending and lifting in people without pain. Scandinavian Journal of Pain 18, 4, 719-728, https://doi.org/10.1515/sjpain-2018-0056

Caneiro JP, Smith A, Linton SJ, Moseley GL, O'Sullivan P. How does change unfold? an evaluation of the process of change in four people with chronic low back pain and high pain-related fear managed with Cognitive Functional Therapy: A replicated single-case experimental design study. Behaviour Research and Therapy. 2019 Jun 1;117:28-39.

Darlow B, Perry M, Stanley J, Mathieson F, Melloh M, Baxter G.D, & Dowell A. Cross-sectional survey of attitudes and beliefs about back pain in New Zealand BMJ Open 2014;4:e004725. doi: 10.1136/bmjopen-2013-004725

Darlow B, Stanley J, Dean S, Abbott JH, Garrett S, Wilson R, Mathieson F, Dowell A. The Fear Reduction Exercised Early (FREE) approach to management of low back pain in general practice: A pragmatic cluster-randomised controlled trial. PLoS medicine. 2019 Sep 9;16(9):e1002897.

Karran EL, Medalian Y, Hillier SL, Moseley GL. The impact of choosing words carefully: an online investigation into imaging reporting strategies and best practice care for low back pain. PeerJ. 2017 Dec 6;5:e4151.

Moran RW, Rushworth W, Mason J. Investigation of four self-report instruments (FABT, TSK-HC, Back-PAQ, HC-PAIRS) to measure healthcare practitioners' attitudes and beliefs toward low back pain: Reliability, convergent validity and survey of New Zealand osteopaths and manipulative physiotherapists. Musculoskeletal Science and Practice 2017;32:44-50.

Nolan D, O’Sullivan K, Stephenson J, O'Sullivan P, Lucock M. What do physiotherapists and manual handling advisors consider the safest lifting posture, and do back beliefs influence their choice? Musculoskeletal Science and Practice 2018;33 (Supplement C):35-40.

Nolan D, O'Sullivan K, Stephenson J, O'Sullivan P, Lucock M. How do manual handling advisors and physiotherapists construct their back beliefs, and do safe lifting posture beliefs influence them?. Musculoskeletal Science and Practice. 2019 Feb 1;39:101-6.

Pierobon A, Policastro PO, Soliño S, et al. Beliefs and attitudes about low back pain in Argentina: A cross-sectional survey using social media. Musculoskeletal Science and Practice 2020;49:102183. doi: https://doi.org/10.1016/j.msksp.2020.102183

Rushworth W. Investigation of instruments measuring healthcare practitioners’ attitudes and beliefs toward low back pain: psychometric properties and survey of New Zealand osteopaths and manipulative physiotherapists (Master’s thesis).

Smith K, Thomson OP. What do UK osteopaths view as the safest lifting posture, and how are these views influenced by their back pain beliefs?. International Journal of Osteopathic Medicine. 2020 Sep 1;37:10-6.

If you have used the Back-PAQ in research and wish to profile your work on this page, please contact Ben Darlow.

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Versions for download and use

English

Arabic

Argentinian Spanish

Brazilian Portuguese

Danish

French

Turkish