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 publicly 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).
A book chapter has been published describing the Back-PAQ's development, psychometric properties, translations, and use in research. Pierobon, A., Darlow, B. (2023). Back Pain Attitudes Questionnaire (Back-PAQ). In: Krägeloh, C.U., Alyami, M., Medvedev, O.N. (eds) International Handbook of Behavioral Health Assessment. Springer, Cham.
Development
The Back-PAQ was developed based on qualitative interviews with people who had acute and chronic back pain.
- View the open-access paper describing the development of the Back-PAQ on BMJ Open
- Versions of Back-PAQ available for download
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.
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.
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.
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.
Translation
Ten translations from the original English version are currently available with more underway. Further translations may be made to other languages. Translations should be published on this site and no restrictions should be made on their use.
If you wish to translate the Back-PAQ using a rigorous translation process, please contact:
Associate Professor Ben Darlow
Email ben.darlow@otago.ac.nz (subject: Back-PAQ translation enquiry)
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.
https://doi: 10.3233/BMR-191758
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.
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
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
Chilean Spanish
The Back-PAQ is being cross-culturally adapted into Chilean Spanish and validated by Cristhian Mendoza Sepúlveda, Nicole Albistur Gutiérrez and Diego Constanzo Garrido from the School of Medicine, San Sebastian University, Chile.
Chinese Mandarin
The Back-PAQ has been translated into Chinese Mandarin by Shu Zhen-Lu, Gui Fei-Li, Fei Fei Wang, Qiu-He, Qi-Li, William Kao, Anna Zaderman, Qun Yan-Xiang, Yaona Hua, Hai peng-Chen, and Kai-Wang at Hunan Normal University, PR China and Ben Darlow.
Czech
The Back-PAQ is being translated into Czech by Tomas Kavka from Charles University in Prague, Czech Republic
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
Dutch
The Back-PAQ is being translated into Dutch by Anne Westerweel, Eline Meuleman, and Nathan Hutting at the HAN University of Applied Sciences in collaboration with Nathalie Roussel and Rob Vanderstraeten at the University of Antwerp, and Ben Darlow.
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; 19-27.
Mains Libres (PDF)
German
The Back-PAQ is being translated into German by Micha Mohler, Denise Nyfeler, Marina Bruderer-Hofstetter, and Fabian Pfeiffer from the Zurich University of Applied Sciences (ZHAW)
Greek
The Back-PAQ is being translated in Greek by Aspa Polydorou from the University of West Attica.
Hebrew
The Back-PAQ has been translated into Hebrew by Noa Ben Ami from Ariel University and Ben Darlow.
Hindi
The Back-PAQ is being translated into Hindi by Swati Meshram of TPCT's Terna Physiotherapy College, Navi Mumbai, India.
Italian
The Back-PAQ is being translated into Italian by Michele Marelli and Ben Darlow.
Latvian
The Back-PAQ is being translated into Latvian by Dr. Logina from Riga Stradins University Hospital.
Marathi
The Back-PAQ is being translated into Marathi by Swati Meshram of TPCT's Terna Physiotherapy College, Navi Mumbai, India.
Persian
The Back-PAQ is being translated into Persian by: Ashraf Mahmoudzadeh at the Isfahan University of Medical Sciences.
Portuguese
The Back-PAQ is being translated into Portuguese by Alexis Ramos de Sousa and Prof. Ricardo Cardoso from Escola Superior de Saúde Fernando Pessoa.
Turkish
The Back-PAQ has been translated to Turkish by Hilal Ata Tay, Bahar Özgül, Ben Darlow, and Zübeyir Sarı.
A publication describing the translation and psychometric properties of the Turkish version is available:
Cross-cultural translation, validity, and reliability of the Turkish version of the Back Pain Attitudes Questionnaire, Musculoskeletal Science and Practice 2022; 57: 102472.
https://doi.org/10.1016/j.msksp.2021.102472
Swedish
The Back-PAQ has been translated into Swedish by: Patrik Numanovic, Maria EH. Larsson, and Ben Darlow.
Urdu
The Back-PAQ is being translated into Urdu by Naseeb Khan at the University of Southern Queensland.
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.
https://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.
https://www.sciencedirect.com/science/article/pii/S2468781217301406
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.
https://www.sciencedirect.com/science/article/pii/S2468781217301595
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.
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 (PDF)
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.
Research requests
If you have used the Back-PAQ in research and wish to profile your work on this page, please contact:
Associate Professor Ben Darlow
Email ben.darlow@otago.ac.nz (subject: Back-PAQ research)
Versions for download and use
English
- Back Pain Attitudes Questionnaire – 10 item (PDF)
- Back Pain Attitudes Questionnaire – 20 item (PDF)
- Back Pain Attitudes Questionnaire – 34 item (PDF)
Arabic
- Back Pain Attitudes Questionnaire (Arabic) – 10 item (PDF)
- Back Pain Attitudes Questionnaire (Arabic) – 34 item (PDF)
Argentinian Spanish
- Back Pain Attitudes Questionnaire (Argentinian Spanish) – 10 item (PDF)
- Back Pain Attitudes Questionnaire (Argentinian Spanish) – 34 item (PDF)
Brazilian Portuguese
- Back Pain Attitudes Questionnaire (Brazilian Portuguese) 10 item (PDF)
- Back Pain Attitudes Questionnaire (Brazilian Portuguese) 34 item (PDF)
Chinese Mandarin
Danish
- Back Pain Attitudes Questionnaire (Danish) – 10 item (PDF)
- Back Pain Attitudes Questionnaire (Danish) – 20 item (PDF)
- Back Pain Attitudes Questionnaire (Danish) – 34 item (PDF)
French
- Back Pain Attitudes Questionnaire (French) – 10 item (PDF)
- Back Pain Attitudes Questionnaire (French) – 34 item (PDF)
Hebrew
Italian
Swedish
- Back Pain Attitudes Questionnaire (Swedish) – 10 item (PDF)
- Back Pain Attitudes Questionnaire (Swedish) – 20 item (PDF)
- Back Pain Attitudes Questionnaire (Swedish) – 34 item (PDF)