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Health Care Providers' Attitudes and Beliefs Towards Common Low Back Pain: Factor Structure and Psychometric Properties of the HC-PAIRS

Houben, Ruud M. A.*; Vlaeyen, Johan W. S. PhD*; Peters, Madelon PhD*; Ostelo, Raymond W. J. G.; Wolters, Pieter M. J. C.; Stomp-van den Berg, Suzanne G. M.§

Original Article
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Objective The factor structure, reliability and validity of the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) were determined in the current study. Furthermore, the ability of the HC-PAIRS to serve as a predictor for work and activity recommendations of paramedical health care providers was examined.

Design For the current study, 156 therapists from several paramedical disciplines (mostly physiotherapy, manual therapy, chiropractic, and McKenzie) completed the HC-PAIRS and questionnaires measuring the perceived harmfulness of physical activities. Furthermore, the therapists gave recommendations for work and physical activity for patients described in vignettes. Since a factor structure was already known for the HC-PAIRS a confirmatory factor analysis was carried out. Reliability of the HC-PAIRS was determined by computing Cronbach's α. Validity was examined by reviewing associations between scores on the HC-PAIRS and scores on measures of the harmfulness of physical activities and recommendations for work and physical activity. Regression analyses were carried out to determine whether scores on the HC-PAIRS were a predictor of recommendations for work and physical activity while controlling for other variables.

Results In contrast to previous research, factor analysis revealed only 1 factor and suggested that 2 items should be removed from the HC-PAIRS. This factor had a Cronbach's α of 0.84. The HC-PAIRS showed adequate validity. All associations between scores on the HC-PAIRS and scores on measures of the harmfulness of physical activities and recommendations for work and physical activity were in the expected directions and ranged between 0.25 and 0.62 (P < 0.01). Scores on the HC-PAIRS were the only significant predictor of recommendations for work and physical activity when controlling for possible confounders including gender, years of experience in the treatment of back pain, judgments of severity of symptoms, and judgments of severity of pathology.

Conclusion The HC-PAIRS appears to be a reliable and valid measure of health care providers' attitudes and beliefs about the relationship between pain and impairment. The role of health care providers' attitudes in the treatment of low back pain is discussed.

From the *Department of Medical, Clinical and Experimental Psychology, Maastricht University, Maastricht, The Netherlands; †EMGO Institute, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; ‡Department of Physiotherapy, Hogeschool Zuyd, Heerlen, The Netherlands; and §Netherlands Institute for Health Services Research, Utrecht, The Netherlands

Received for publication June 15, 2002;

revised August 21, 2002; accepted August 28, 2002.

This study was supported by grant 904-59-108 of the Council for Medical and Health Research of the Netherlands Organization for Scientific Research (MW-NWO) and by grant 5214 of the National Fund for Public Mental Health.

Reprints: Ruud M.A. Houben, Department of Medical, Clinical and Experimental Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands (e-mail: ruud.houben@dep.unimaas.nl).

© 2004 Lippincott Williams & Wilkins, Inc.