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Health care practitionersattitudes and beliefs about low back pain: A systematic search and critical review of available measurement tools

Bishop, Annette*; Thomas, Elaine; Foster, Nadine E.

doi: 10.1016/j.pain.2007.01.028
Research papers

The attitudes and beliefs that health care practitioners (HCPs) hold about back pain have been shown to affect the advice they provide to patients seeking healthcare. In order to develop a questionnaire for a national survey of attitudes, beliefs and practice behaviour of HCPs about back pain, a systematic review of available measurement tools was undertaken. Measurement tools were identified from a systematic search of databases (Medline, Embase, CINAHL, Psychinfo, AMED and British Nursing Index) in the English language for papers published from January 1990 to October 2006. Quality criteria were applied to each of the tools by two independent reviewers. The initial search strategy generated a total of 5269 references. Following assessment of titles and abstracts, 12 papers describing five tools were identified for inclusion in the review. The tools were the Attitudes to Back Pain scale for musculoskeletal practitioners (, a fear avoidance beliefs tool, the Fear Avoidance Beliefs Questionnaire (FABQ) adapted for HCPs, the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS.PT). The HC-PAIRS and PABS.PT have undergone the most thorough testing to date, but gaps in the properties of all the tools remain, particularly test–retest reliability and responsiveness. This review identified only five tools and demonstrated limited reporting of their validity and reliability. Further development and testing of existing tools should be a priority to ensure they are robust and valid measures of attitudes and beliefs of HCPs about back pain.

Primary Care Musculoskeletal Research Centre, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, UK

*Corresponding author. Tel.: +44 1782 583900; fax: +44 1782 583911.


Submitted September 1, 2006; received in revised form December 13, 2006; accepted January 29, 2007.

© 2007 Lippincott Williams & Wilkins, Inc.
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