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Back Pain Attitude Questionnaire

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. There is a 34-item version that may be appropriate for population surveys and a shorter 10-item version that may be appropriate for research or clinical screening use.

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).


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.


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.

34-item Back-PAQ

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

10-item Back-PAQ

When the 10-item scale is used as a research or 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.

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.


One translation is 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.


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.


The Back-PAQ is currently being translated into Portuguese by R.C. Krug, J.-P. Caneiro, D. Ribeiro, B. Darlow, J. Loss.


The Back-PAQ is currently being translated into Japanese by Assoc. Prof. Tomohiko Nishigami, Konan Womanʼs University, Kobe, Japan.

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Use in research

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

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.

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).

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