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Treatment Beliefs in Low Back Pain: development and validation of a condition-specific patient-report measure Felicity L. Bishop 1, A. Dima1,2, G.T. Lewith1, P. Little1, R. Moss-Morris3, N.E. Foster4, M. Hankins1, G Surtees1 [1] University of Southampton. [2] University of Amsterdam. [3] King’s College London. [4] Keele University. CONTACT: Background Many treatments are available for low back pain (LBP). In the United Kingdom, government guidelines say that clinicians should take patients’ preferences into account when selecting treatments. Patient’s treatment preferences are based on their treatment beliefs, which can be measured for clinical and research purposes. Existing questionnaires do not measure the range of treatment beliefs that have been documented in qualitative research as relevant across multiple diverse LBP treatments. In particular, in a recent focus group study, we showed that patients evaluate LBP treatments according to four specific dimensions: perceived credibility, individual fit, concerns, and effectiveness [1]. In this study, we aimed to develop a measure of these 4 dimensions of specific treatment beliefs. Methods We reviewed our qualitative data to write items for each of the four dimensions (perceived credibility, individual fit, concerns, and effectiveness). We chose item content and wording that reflected topics and terminology used by focus group participants. After a small think-aloud study to refine items, the new questionnaire was included with validating measures in a self-report survey of adults (at least 18 years) with LBP (duration at least 6 weeks). Participants were recruited between November 2011 and March 2012 from GP surgeries, private sector complementary and alternative medicine (CAM) clinics, and advertisements on online patient forums. Validating measures included: Beliefs about Medicine Questionnaire (BMQ) - General Beliefs [2]; Complementary and Alternative Medicine Beliefs Inventory (CAMBI) [3] - Holistic Health subscale; The BIPQ (Brief Illness Perceptions Questionnaire) [4]; Credibility Expectancy Questionnaire (CEQ) [5]; HCAMQ (Holistic Complementary and Alternative Medicine Questionnaire) [6] Attitudes to CAM subscale; Tampa Scale of Kinesiophobia (TSK-11) Activity Avoidance subscale [7]. Statistics Data were analysed to assess psychometric properties: homogeneity and monotonicity (Non-parametric Item Response Theory), structural validity (Confirmatory Factor Analysis), internal consistency (Cronbach’s alpha), and test-retest reliability (Pearson’s R), convergent and discriminant validity (Pearson’s R) and criterion validity (t-tests). Results Finalising the Scales Items were selected iteratively based on homogeneity and monotonicity at item, item-pair, and scale level for all 4 treatments. This achieved four 4-item subscales with two reversed items each and good homogeneity and monotonicity (Table ). Structural Validity For each treatment, the hypothesized 4-factor model was compared to several alternatives using CFA. Although none of the models reached threshold values for all fit indices for all treatment types, the 4-factor model performed slightly better (Figure). Content H (SE) Pain medication Exercise Manual therapy Acupuncture Credibility 0.51 (0.04) 0.67 (0.03) 0.69 (0.03) 0.67 (0.04) Taking/Having […] for back pain makes a lot of sense 0.53 (0.04) 0.70 (0.03) 0.71 (0.03) 0.68 (0.04) Generally, […] is a believable therapy for back pain 0. 72 (0.04) 0. 71 (0.04) I am sceptical about […] as a treatment for back pain in general (r) 0.52 (0.05) 0.66 (0.04) 0.62 (0.05) I do not understand how […] could help people with back pain (r) 0.46 (0.05) 0.65 (0.04) Effectiveness 0.57 (0.04) 0.63 (0.03) 0.74 (0.03) 0.72 (0.04) […] cannot help people with back pain (r) 0.58 (0.05) 0.61 (0.05) 0.75 (0.04) […] can work well for people with back pain 0.56 (0.05) 0.79 (0.03) 0.70 (0.05) I think […] is pretty useless for people with back pain (r) 0.60 (0.04) 0.76 (0.03) 0.72 (0.05) […] can make it easier for people to cope with back pain 0.54 (0.05) 0.70 (0.04) 0.73 (0.05) Concerns 0.46 (0.04) 0.62 (0.03) 0.48 (0.03) 0.64 (0.04) I worry that […] could make my back worse (r) 0.35 (0.04) 0.61 (0.04) 0.60 (0.03) 0.62 (0.04) I have concerns about taking/having […] for my back pain (r) 0.68 (0.03) 0.59 (0.03) I would feel at ease about taking/having […] for my back pain 0.50 (0.04) 0.58 (0.03) I feel that […] would not harm me 0.48 (0.04) 0.55 (0.05) 0.52 (0.03) 0.60 (0.05) Individual Fit 0.85 (0.02) 0.71 (0.04) I think […] could suit me as a treatment for my back pain 0.84 (0.03) For me, taking/having […] would be a waste of time (r) 0.77 (0.03) 0.87 (0.02) 0.73 (0.04) I am confident […] would be a suitable treatment for my back pain 0.86 (0.02) 0.74 (0.04) Given what I know about my back pain, I doubt […] would be right for me (r) 0.75 (0.03) 0.83 (0.03) 0.66 (0.05) Reliability All 4 subscales showed: good internal consistency, Cronbach’s α to 0.94 good stability when completed 1-2 weeks apart, Pearson’s r ranged 0.63 to 0.83 Convergent, Discriminant, Criterion Validity Hypothesized correlations between new scales and validating measures were generally supported Participants who ranked a treatment as their first choice had more positive beliefs about that treatment. This difference was significant (t-tests) for every treatment and every scale, except Pain Medication Effectiveness Conclusions Our new questionnaire measures patients’ beliefs about common LBP therapies and distinguishes four specific beliefs: credibility, effectiveness, concerns, individual fit. The same items assess beliefs about diverse treatments: pain medication, exercise, manual therapy, acupuncture. The scales have good initial psychometric properties and could be used in future studies of treatment decision-making, patient choice, and adherence to treatment. We plan to explore clinical applications in relation to doctor-patient communication about treatment options. References 1. Dima A, et al 2013 BJGP DOI: /bjgp13X Horne R, et al 1999 Psychol Health 14: Bishop FL, et al 2005 Complement Ther Med 13: Broadbent E, et al 2006 J Psychosom Res 60: Devilly GJ, Borkovec TD 2000 J Behav Ther Exp Psychiatry 31: Hyland ME, et al 2003 Complement Ther Med 11: Woby SR, et al Pain 117:
![Treatment Beliefs in Low Back Pain: development and validation of a condition-specific patient-report measure Felicity L. Bishop 1, A. Dima1,2, G.T. Lewith1, P. Little1, R. Moss-Morris3, N.E. Foster4, M. Hankins1, G Surtees1 [1] University of Southampton. [2] University of Amsterdam. [3] King’s College London. [4] Keele University. CONTACT:](http://slideplayer.com./slide/13722263/85/images/1/Treatment+Beliefs+in+Low+Back+Pain%3A+development+and+validation+of+a+condition-specific+patient-report+measure+Felicity+L.+Bishop+1%2C+A.+Dima1%2C2%2C+G.T.+Lewith1%2C+P.+Little1%2C+R.+Moss-Morris3%2C+N.E.+Foster4%2C+M.+Hankins1%2C+G+Surtees1+%5B1%5D+University+of+Southampton.+%5B2%5D+University+of+Amsterdam.+%5B3%5D+King%E2%80%99s+College+London.+%5B4%5D+Keele+University.+CONTACT%3A.jpg "Background. Many treatments are available for low back pain (LBP). In the United Kingdom, government guidelines say that clinicians should take patients’ preferences into account when selecting treatments. Patient’s treatment preferences are based on their treatment beliefs, which can be measured for clinical and research purposes. Existing questionnaires do not measure the range of treatment beliefs that have been documented in qualitative research as relevant across multiple diverse LBP treatments. In particular, in a recent focus group study, we showed that patients evaluate LBP treatments according to four specific dimensions: perceived credibility, individual fit, concerns, and effectiveness [1]. In this study, we aimed to develop a measure of these 4 dimensions of specific treatment beliefs. Methods. We reviewed our qualitative data to write items for each of the four dimensions (perceived credibility, individual fit, concerns, and effectiveness). We chose item content and wording that reflected topics and terminology used by focus group participants. After a small think-aloud study to refine items, the new questionnaire was included with validating measures in a self-report survey of adults (at least 18 years) with LBP (duration at least 6 weeks). Participants were recruited between November 2011 and March 2012 from GP surgeries, private sector complementary and alternative medicine (CAM) clinics, and advertisements on online patient forums. Validating measures included: Beliefs about Medicine Questionnaire (BMQ) - General Beliefs [2]; Complementary and Alternative Medicine Beliefs Inventory (CAMBI) [3] - Holistic Health subscale; The BIPQ (Brief Illness Perceptions Questionnaire) [4]; Credibility Expectancy Questionnaire (CEQ) [5]; HCAMQ (Holistic Complementary and Alternative Medicine Questionnaire) [6] Attitudes to CAM subscale; Tampa Scale of Kinesiophobia (TSK-11) Activity Avoidance subscale [7]. Statistics. Data were analysed to assess psychometric properties: homogeneity and monotonicity (Non-parametric Item Response Theory), structural validity (Confirmatory Factor Analysis), internal consistency (Cronbach’s alpha), and test-retest reliability (Pearson’s R), convergent and discriminant validity (Pearson’s R) and criterion validity (t-tests). Results. Finalising the Scales. Items were selected iteratively based on homogeneity and monotonicity at item, item-pair, and scale level for all 4 treatments. This achieved four 4-item subscales with two reversed items each and good homogeneity and monotonicity (Table ). Structural Validity. For each treatment, the hypothesized 4-factor model was compared to several alternatives using CFA. Although none of the models reached threshold values for all fit indices for all treatment types, the 4-factor model performed slightly better (Figure). Content. H (SE) Pain medication. Exercise. Manual therapy. Acupuncture. Credibility (0.04) 0.67 (0.03) 0.69 (0.03) 0.67 (0.04) Taking/Having […] for back pain makes a lot of sense (0.04) 0.70 (0.03) 0.71 (0.03) 0.68 (0.04) Generally, […] is a believable therapy for back pain (0.04) (0.04) I am sceptical about […] as a treatment for back pain in general (r) 0.52 (0.05) 0.66 (0.04) 0.62 (0.05) I do not understand how […] could help people with back pain (r) 0.46 (0.05) 0.65 (0.04) Effectiveness (0.04) 0.63 (0.03) 0.74 (0.03) 0.72 (0.04) […] cannot help people with back pain (r) 0.58 (0.05) 0.61 (0.05) 0.75 (0.04) […] can work well for people with back pain (0.05) 0.79 (0.03) 0.70 (0.05) I think […] is pretty useless for people with back pain (r) 0.60 (0.04) 0.76 (0.03) 0.72 (0.05) […] can make it easier for people to cope with back pain (0.05) 0.70 (0.04) 0.73 (0.05) Concerns (0.04) 0.62 (0.03) 0.48 (0.03) 0.64 (0.04) I worry that […] could make my back worse (r) 0.35 (0.04) 0.61 (0.04) 0.60 (0.03) 0.62 (0.04) I have concerns about taking/having […] for my back pain (r) 0.68 (0.03) 0.59 (0.03) I would feel at ease about taking/having […] for my back pain (0.04) 0.58 (0.03) I feel that […] would not harm me (0.04) 0.55 (0.05) 0.52 (0.03) 0.60 (0.05) Individual Fit (0.02) 0.71 (0.04) I think […] could suit me as a treatment for my back pain (0.03) For me, taking/having […] would be a waste of time (r) 0.77 (0.03) 0.87 (0.02) 0.73 (0.04) I am confident […] would be a suitable treatment for my back pain (0.02) 0.74 (0.04) Given what I know about my back pain, I doubt […] would be right for me (r) 0.75 (0.03) 0.83 (0.03) 0.66 (0.05) Reliability. All 4 subscales showed: good internal consistency, Cronbach’s α 0.73 to good stability when completed 1-2 weeks apart, Pearson’s r ranged 0.63 to Convergent, Discriminant, Criterion Validity. Hypothesized correlations between new scales and validating measures were generally supported. Participants who ranked a treatment as their first choice had more positive beliefs about that treatment. This difference was significant (t-tests) for every treatment and every scale, except Pain Medication Effectiveness. Conclusions. Our new questionnaire measures patients’ beliefs about common LBP therapies and distinguishes four specific beliefs: credibility, effectiveness, concerns, individual fit. The same items assess beliefs about diverse treatments: pain medication, exercise, manual therapy, acupuncture. The scales have good initial psychometric properties and could be used in future studies of treatment decision-making, patient choice, and adherence to treatment. We plan to explore clinical applications in relation to doctor-patient communication about treatment options. References. 1. Dima A, et al 2013 BJGP DOI: /bjgp13X Horne R, et al 1999 Psychol Health 14: Bishop FL, et al 2005 Complement Ther Med 13: Broadbent E, et al 2006 J Psychosom Res 60: Devilly GJ, Borkovec TD 2000 J Behav Ther Exp Psychiatry 31: Hyland ME, et al 2003 Complement Ther Med 11: Woby SR, et al 2005 Pain 117:")
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