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Psychometric properties and factor structure of the Spanish version of the HC-PAIRS questionnaire

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Abstract

Objective

To develop a Spanish version of the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) and to test its psychometric properties.

Methods

A forward and backward translation methodology was used to translate the questionnaire, which was then applied to 206 participants (174 physiotherapy students and 32 family physicians). The intraclass correlation coefficient was calculated to assess test–retest reliability. Internal consistency was evaluated using Cronbach’s alpha and item analysis. Construct validity was measured using Pearson correlation coefficients between HC-PAIRS and FABQ, FABQ-Phys, FABQ-Work and the responses given by participants to three clinical case scenarios. An exploratory factor analysis was carried out following the Kaiser normalization criteria and principal axis factoring with an oblique rotation (quartimax). Sensitivity to change was assessed after a teaching module.

Results

Test–retest reliability was ICC 0.50 (p < 0.01) and Cronbach’s alpha was 0.825. The HC-PAIRS scores correlated significantly with the scores of the FABQ and also with the recommendations for work and activity given by the participants in the three clinical case scenarios. Sensitivity to change test showed an effect size of 1.5, which is considered a large change. Factor analysis suggests that the Spanish version of HC-PAIRS measures a unidimensional construct.

Conclusion

The Spanish version of the HC-PAIRS has proven to be a reliable, valid and sensitive instrument to assess health care providers’ attitudes and beliefs about LBP. It can be used in evaluating clinical practice and in undergraduate acquisition of skills and knowledge.

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References

  1. Deyo RA, Mirza SK, Martin BI (2006) Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine 31:2724–2727

    Article  PubMed  Google Scholar 

  2. Carragee EJ, Alamin TF, Miller JL, Carragee JM (2005) Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Spine J 5:24–35

    Article  PubMed  Google Scholar 

  3. Chou R, Fu R, Carrino JA, Deyo RA (2009) Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet 373:463–472

    Article  PubMed  Google Scholar 

  4. Picavet HSJ, Vlaeyen JWS, Schouten SAG (2002) Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. Am J Epidemiol 156:1028–1034

    Article  PubMed  Google Scholar 

  5. Pincus T, Burton AK, Vogel S, Field AP (2002) A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine 27:E109–E120

    Article  PubMed  Google Scholar 

  6. Bishop A, Foster NE (2005) Do physical therapists in the United Kingdom recognize psychosocial factors in patients with acute low back pain? Spine 30:1316–1322

    Article  PubMed  Google Scholar 

  7. Francke AL, Smit MC, de Veer AJ, Mistiaen P (2008) Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak 8:38. doi:10.1186/1472-6947-8-38

    Article  PubMed  Google Scholar 

  8. Gonzalez-Urzelai V, Palacio-Elua L, Lopez-de-Muniain J (2003) Routine primary care management of acute low back pain: adherence to clinical guidelines. Eur Spine J 12:589–594

    Article  PubMed  Google Scholar 

  9. Parsons S, Harding G, Breen A, Foster N, Pincus T, Vogel S, Underwood M (2007) The influence of patients’ and primary care practitioners’ beliefs and expectations about chronic musculoskeletal pain on the process of care: a systematic review of qualitative studies. Clin J Pain 23:91–98

    Article  PubMed  Google Scholar 

  10. Coudeyre E, Rannou F, Tubach F, Baron G, Coriat F, Brin S, Revel M, Poiraudeau S (2006) General practitioners’ fear-avoidance beliefs influence their management of patients with low back pain. Pain 124:330–337

    Article  PubMed  Google Scholar 

  11. Poiraudeau S, Rannou F, Le Henanff A, Coudeyre E, Rozenberg S, Huas D, Martineau C, Jolivet-Landreau I, Revel M, Ravaud P (2006) Outcome of subacute low back pain: influence of patients’ and rheumatologists’ characteristics. Rheumatology 45:718–723

    Article  PubMed  CAS  Google Scholar 

  12. Vlaeyen JWS, Linton SJ (2006) Are we “fear-avoidant”? Pain 124:240–241

    Article  PubMed  Google Scholar 

  13. Rainville J, Bagnall D, Phalen L (1995) Health care providers’ attitudes and beliefs about functional impairments and chronic back pain. Clin J Pain 11:287–295

    Article  PubMed  CAS  Google Scholar 

  14. Houben RM, Vlaeyen JWS, Peters M, Ostelo RW, Wolters PM, Stompvan den Berg SG (2004) Health care providers’ attitudes and beliefs towards common low back pain: factor structure and psychometric properties of the HC-PAIRS. Clin J Pain 20:37–44

    Article  PubMed  Google Scholar 

  15. Burnett A, Sze CC, Tam SM, Yeung KM, Leong M, Wang WT, Tan BK, O’Sullivan P (2009) A cross-cultural study of the back pain beliefs of female undergraduate healthcare students. Clin J Pain 25:20–28

    Article  PubMed  Google Scholar 

  16. Ferreira PH, Ferreira ML, Latimer J, Maher C, Refshauge K, Sakamoto A, Garofalo R (2004) Attitudes and beliefs of Brazilian and Australian physiotherapy students towards chronic back pain: a cross cultural comparison. Physiother Res Int 9:13–23

    Article  PubMed  Google Scholar 

  17. Latimer J, Maher C, Refshauge K (2004) The attitudes and beliefs of physiotherapy students to chronic back pain. Clin J Pain 20:45–50

    Article  PubMed  Google Scholar 

  18. Kovacs FM, Muriel A, Abriaira V, Medina JM, Castillo-Sanchez MD, Olabe J (2005) The influence of fear avoidance beliefs on disability and quality of life is sparse in Spanish low back pain patients. Spine 30:676–682

    Article  Google Scholar 

  19. Bullinger M, Alonso J, Apolone G, Leplege A, Sullivan M, Wood- Dauphinee S, Gandek B, Wagner A, Aaronson N, Bech P, Fukuhara S, Kaasa S, Ware JE (1998) Translating health status questionnaires and evaluating their quality: the IQOL A project approach. International quality of life assessment. J Clin Epidemiol 51:913–923

    Article  PubMed  CAS  Google Scholar 

  20. Waddell G, Newton M, Henderson I, Somerville D, Main CJ (1993) A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52:157–168

    Article  PubMed  CAS  Google Scholar 

  21. Kovacs FM, Muriel A, Medina JM, Abraira V, Castillo MD, Olabe J (2006) Psychometric characteristics of the Spanish version of the FAB questionnaire. Spine 31:104–110

    Article  PubMed  Google Scholar 

  22. Pfingstein M, Kröner-Herwig B, Leibning E, Kroshage U, Hildebrandt J (2000) Validation of the German version of the Fear Avoidance Beliefs Questionnaire (FABQ). Eur J Pain 4:259–266

    Article  Google Scholar 

  23. Chaory K, Fayad F, Rannou F, Fermanian J, Revel M, Poiraudeau S (2004) Validation of the French version of the Fear Avoidance Beliefs Questionnaire (FABQ). Spine 14:908–913

    Article  Google Scholar 

  24. Rainville J, Carlson N, Polatin P, Gatchel RJ, Indahl A (2000) Exploration of physicians’ recommendations for activities in chronic low back pain. Spine 25:2210–2220

    Article  PubMed  CAS  Google Scholar 

  25. Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428

    Article  PubMed  CAS  Google Scholar 

  26. Cohen J (1988) Statistical power analysis for the behavioral sciences. Erlbaun Associates, Hillsdale

    Google Scholar 

  27. Pett MA, Lackey NR, Sullivan JJ (2003) Making sense of factor analysis. the use of factor analysis for instrument development in health care research. Sage Publications, Thousand Oaks

  28. Bishop A, Thomas E, Foster NE (2007) Health care practitioners attitudes and beliefs about low back pain: a systematic search and critical review of available measurement tools. Pain 132:91–101

    Article  PubMed  Google Scholar 

  29. Chen G, Tan BK, Jia HL, O’Sullivan P, Burnett A (2011) Questionnaires to examine back pain beliefs held by health care professionals: a psychometric evaluation of simplified Chinese versions. Spine 36:1505–1511

    Article  PubMed  Google Scholar 

  30. Sanders SH, Brena SF, Spier CJ, Beltrutti D, McConnell H, Quintero O (1992) Chronic low back pain patients around the world: cross cultural similarities and differences. Clin J Pain 8:317–323

    Article  PubMed  CAS  Google Scholar 

  31. Pincus T, Santos R, Breen A, Burton AK, Underwood M (2008) A review and proposal for a core set of factors for prospective cohorts in low back pain. A consensus statement. Arthr Rheum 59:14–24

    Article  Google Scholar 

  32. Nyland LJ, Grimmer KA (2003) Is undergraduate physiotherapy study a risk factor for low back pain? A prevalence study in physiotherapy students. BMC Musculoeskelet Disord 4:22. doi:10.1186/1471-2474-4-22

    Article  Google Scholar 

  33. Domenech J, Sánchez-Zuriaga D, Segura-Ortí E, Espejo-Tort B, Lisón JF (2011) Impact of biomedical and biopsychosocial training sessions on the attitudes, beliefs, and recommendations of health care providers about low back pain: a randomised clinical trial. Pain 152:2557–2563

    Article  PubMed  CAS  Google Scholar 

  34. Adams AS, Soumerai SB, Lomas J, Ross-Degnan D (1999) Evidence of self-report bias in assessing adherence to guidelines. Int J Qual Health Care 11:187–192

    Article  PubMed  CAS  Google Scholar 

  35. Peabody JW, Luck J, Glassman P, Dresselhaus TR, Lee M (2000) Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA 283:1715–1722

    Article  PubMed  CAS  Google Scholar 

  36. Peabody JW, Luck J, Glassman P, Jain S, Hansen J, Spell M, Lee M (2004) Measuring the quality of physician practice by using clinical vignettes: a prospective validation study. Ann Intern Med 141:771–780

    Article  PubMed  Google Scholar 

  37. Veloski J, Tai S, Evans AS, Nash DB (2005) Clinical vignette-based surveys: a tool for assessing physician practice variation. Am J Med Qual 20:151–157

    Article  PubMed  Google Scholar 

  38. Baker FB (1985) The basics of item response theory. Heinemann, Portsmouth

    Google Scholar 

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Acknowledgments

This study was supported in part by grant 09/2010 of the Conselleria de Sanitat (Health Ministry) of the Government of Valencia, Spain.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Physiotherapy, Faculty of Health Sciences, CEU-Cardenal Herrera University, Av. Del Seminario, s/n, 46113, Moncada (Valencia), Spain

    Julio Domenech, Eva Segura-Ortí & Juan Francisco Lisón

  2. Department of Orthopedic Surgery, Hospital Arnau de Vilanova, Valencia, Spain

    Julio Domenech

  3. Department of Methodology and Behavioural Sciences, Faculty of Psychology, Universitat de València, Valencia, Spain

    Begoña Espejo-Tort

  4. Department of Anatomy and Human Embryology, Faculty of Medicine, Universitat de València, Valencia, Spain

    Daniel Sánchez-Zuriaga

Authors
  1. Julio Domenech
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  2. Eva Segura-Ortí
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  4. Begoña Espejo-Tort
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Correspondence to Julio Domenech.

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Domenech, J., Segura-Ortí, E., Lisón, J.F. et al. Psychometric properties and factor structure of the Spanish version of the HC-PAIRS questionnaire. Eur Spine J 22, 985–994 (2013). https://doi.org/10.1007/s00586-012-2604-5

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  • DOI: https://doi.org/10.1007/s00586-012-2604-5

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