Assessing knowledge and beliefs about low back pain and other musculoskeletal conditions
Low back pain is a highly prevalent and impactful condition. Current clinical guidelines for the management of low back pain recommend patient-centred education interventions to address a person’s understanding about their health condition, aiming to help patients to have knowledge and beliefs that are in line with evidence-based recommendations. Patient-reported outcome measures (PROMs) can inform targets for an individualised education intervention to address knowledge and beliefs. A barrier to implementation of patient-centred education interventions is that it is not clear which is the best PROM to assess knowledge and beliefs about musculoskeletal conditions, such as low back pain.
To bridge this gap, Chapter 2 presented a systematic review on the measurement properties of PROMs assessing knowledge and beliefs about musculoskeletal conditions, providing recommendations on the use of these PROMs. Most of the included PROMs were rated as “potentially suitable for use”, but further research is needed to confirm their measurement properties. PROMs that quantify knowledge and beliefs about low back pain should reflect current understanding about how patients conceptualise their pain and the PROMs need to address current recommendations for the management of low back pain. However, PROMs included in this review that assess knowledge and beliefs about low back pain are outdated due to both advances in understanding of low back pain and advances in methodological guidelines for the development and assessment of measurement properties of PROMs.
As found in the review in Chapter 2, the Back Beliefs Questionnaire (BBQ) is a PROM originally designed to assess beliefs about inevitable consequences of low back pain, but is commonly used to assess general beliefs about low back pain. Chapter 3 presented the assessment of the measurement properties of the BBQ. This study assessed structural validity, internal consistency, test-retest reliability, measurement error, and construct validity of the BBQ for the English-speaking Australian population and for the Portuguese-speaking Brazilian population. In addition, cross-cultural validity between the two languages was evaluated. This study found that the BBQ had adequate validity and reliability. However, the BBQ is not being used as originally intended.
Based on the lack of available PROMs to adequately assess general beliefs about low back pain, Chapter 4 reported the development of the Back pain Knowledge and beliefs Survey (BacKS). BacKS was found to be a valid and reliable PROM to assess knowledge and beliefs about low back pain. BacKS has the potential to contribute to both clinical and research settings, by providing an evidence-based PROM to inform pain education interventions and to potentially assess their effect on knowledge and beliefs. Finally, Chapter 5 presented a translation and cross-cultural adaptation study for BacKS to allow its use for the Brazilian population with low back pain (BacKS-BR). BacKS-BR was also found to have adequate measurement properties.
This body of work demonstrated the lack of high-quality PROMs to assess knowledge and beliefs about musculoskeletal conditions. This thesis provides an important contribution to the field of low back pain by developing a contemporary evidence-based PROM to assess knowledge and beliefs about low back pain.
