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      The development and exploratory analysis of the Back Pain Attitudes Questionnaire (Back-PAQ)


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          To develop an instrument to assess attitudes and underlying beliefs about back pain, and subsequently investigate its internal consistency and underlying structures.


          The instrument was developed by a multidisciplinary team of clinicians and researchers based on analysis of qualitative interviews with people experiencing acute and chronic back pain. Exploratory analysis was conducted using data from a population-based cross-sectional survey.


          Qualitative interviews with community-based participants and subsequent postal survey.


          Instrument development informed by interviews with 12 participants with acute back pain and 11 participants with chronic back pain. Data for exploratory analysis collected from New Zealand residents and citizens aged 18 years and above. 1000 participants were randomly selected from the New Zealand Electoral Roll. 602 valid responses were received.


          The 34-item Back Pain Attitudes Questionnaire (Back-PAQ) was developed. Internal consistency was evaluated by the Cronbach α coefficient. Exploratory analysis investigated the structure of the data using Principal Component Analysis.


          The 34-item long form of the scale had acceptable internal consistency (α=0.70; 95% CI 0.66 to 0.73). Exploratory analysis identified five two-item principal components which accounted for 74% of the variance in the reduced data set: ‘vulnerability of the back’; ‘relationship between back pain and injury’; ‘activity participation while experiencing back pain’; ‘prognosis of back pain’ and ‘psychological influences on recovery’. Internal consistency was acceptable for the reduced 10-item scale (α=0.61; 95% CI 0.56 to 0.66) and the identified components (α between 0.50 and 0.78).


          The 34-item long form of the scale may be appropriate for use in future cross-sectional studies. The 10-item short form may be appropriate for use as a screening tool, or an outcome assessment instrument. Further testing of the 10-item Back-PAQ's construct validity, reliability, responsiveness to change and predictive ability needs to be conducted.

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          Most cited references33

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          A review of psychological risk factors in back and neck pain.

          S J Linton (2000)
          The literature on psychological factors in neck and back pain was systematically searched and reviewed. To summarize current knowledge concerning the role of psychological variables in the etiology and development of neck and back pain. Recent conceptions of spinal pain, especially chronic back pain, have highlighted the role of psychological factors. Numerous studies subsequently have examined the effects of various psychological factors in neck and back pain. There is a need to review this material to ascertain what conclusions may be drawn. Medical and psychological databases and cross-referencing were used to locate 913 potentially relevant articles. A table of 37 studies was constructed, consisting only of studies with prospective designs to ensure quality. Each study was reviewed for the population studied, the psychological predictor variables, and the outcome. The available literature indicated a clear link between psychological variables and neck and back pain. The prospective studies indicated that psychological variables were related to the onset of pain, and to acute, subacute, and chronic pain. Stress, distress, or anxiety as well as mood and emotions, cognitive functioning, and pain behavior all were found to be significant factors. Personality factors produced mixed results. Although the level of evidence was low, abuse also was found to be a potentially significant factor. Psychological factors play a significant role not only in chronic pain, but also in the etiology of acute pain, particularly in the transition to chronic problems. Specific types of psychological variables emerge and may be important in distinct developmental time frames, also implying that assessment and intervention need to reflect these variables. Still, psychological factors account for only a portion of the variance, thereby highlighting the multidimensional view. Because the methodologic quality of the studies varied considerably, future research should focus on improving quality and addressing new questions such as the mechanism, the developmental time factor, and the relevance that these risk factors have for intervention.
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            Low back pain.

            The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF). The purpose of these low back pain clinical practice guidelines, in particular, is to describe the peer-reviewed literature and make recommendations related to (1) treatment matched to low back pain subgroup responder categories, (2) treatments that have evidence to prevent recurrence of low back pain, and (3) treatments that have evidence to influence the progression from acute to chronic low back pain and disability.
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              Discovering Statistics Using SPSS : (and Sex, Drugs and Rock 'n' Roll)

              Get the Statistics Book That's Sweeping the Nation!<br> <br> Appropriate for All Levels--Undergraduate to Doctorate Programs in Every Discipline!<br> <br> This new edition of Field's bestselling textbook provides students of statistical methods with everything they need to understand, use and report statistics - at every level. Written in Andy Field's vivid and entertaining style, and furnished with playful examples from everyday student life (among other places), the book forms an accessible gateway into the often intimidating world of statistics and a unique opportunity for students to ground their knowledge of statistics through the use of SPSS. The text is fully compliant with the latest release of SPSS (version 13).<br> <br> Key updates in Second Edition:<br> <br> - More coverage with completely new material on non-parametric statistics, loglinear analysis, effect sizes and how to report statistical analysis<br> <br> - Even more student-friendly features, including a glossary of key statistical terms and exercises at the end of chapters for students to work through, with datasets and answers to chapter exercises on the accompanying CD-ROM<br> <br> - A larger and more easy-to-reference format: notation in each section identifies the intended level of study while the new 2-color text design enhances the features in the book and, together with the larger format, provides extra clarity throughout<br> <br> <p>- A companion website is available at www.sagepub.co.uk/field, containing resources for both students and instructors: a testbank of MCQs for students to test their own knowled≥ online glossary in flash card format; multiple choice questions and answers to use for class assessment ? available on restricted access basis to instructors via entry password; and PowerPoint Slides of all fo</p>

                Author and article information

                BMJ Open
                BMJ Open
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                23 May 2014
                : 4
                : 5
                : e005251
                [1 ]Department of Primary Health Care and General Practice, University of Otago , Wellington, New Zealand
                [2 ]Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago , Dunedin, New Zealand
                [3 ]Department of Psychological Medicine, University of Otago , Wellington, New Zealand
                [4 ]Biostatistical Group, University of Otago, Wellington, New Zealand
                [5 ]Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences , Winterthur, Switzerland
                [6 ]Gillies McIndoe Research Institute , Newtown, Wellington South, New Zealand
                Author notes
                [Correspondence to ] Ben Darlow; ben.darlow@ 123456otago.ac.nz
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                : 13 March 2014
                : 22 April 2014
                : 2 May 2014
                Research Methods

                epidemiology,primary care,pain management
                epidemiology, primary care, pain management


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