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Objective Although negative back beliefs are associated with high-intensity low back pain (LBP)/disability, whether they influence incident high-intensity LBP/high disability over the long-term is unknown. This study aimed to investigate whether negative back beliefs were associated with developing high-intensity LBP and/or high disability over 10 years in men. Methods Men with no or low-intensity LBP and/or disability attending the Geelong Osteoporosis Study between 2006 and 2010 were included. Data on age, body mass index, mobility, education, back beliefs (Back Beliefs Questionnaire), LBP and disability (Graded Chronic Pain Scale) were collected between 2006 and 2010. Beliefs, LBP and disability were re-assessed in 2016–2021. Binary logistic regression was used to examine the association between negative back beliefs and incident high-intensity pain and/or high disability, adjusting for age, body mass index, mobility and education. Results At baseline, 705 participants (mean age 53.8 years) had no or low LBP and no or low disability; 441 (62.6%) participants completed a 10-year follow-up. Of these, 37 (8.4%) developed high-intensity pain and/or high disability. In multivariate analyses, participants with more negative back beliefs at baseline were more likely to develop high-intensity pain and/or high disability (odds ratio 1.05; 95% CI: 1.00, 1.11). Developing more negative back beliefs was also associated with incident high-intensity pain and/or high disability (odds ratio 1.20; 95% CI: 1.12, 1.30). Conclusion In a male community-based population, negative beliefs regarding the consequences of LBP were associated with an increased likelihood of developing high-intensity pain and/or high disability. Addressing negative back beliefs in the community may reduce the incidence of high-intensity pain and/or high disability over 10 years in men. [ABSTRACT FROM AUTHOR]

Back pain (BP) is a major cause of absenteeism in National Health Service (NHS) staff in the UK. However, the back beliefs of NHS staff with BP are unknown. To explore the BP beliefs of UK NHS staff presenting with BP, and how these beliefs are constructed. Purposive sampling of NHS staff with BP who had self-referred to University Hospitals of Leicester NHS Trusts occupational health physiotherapy service. 30 participants completed the Back-Pain Attitudes Questionnaire. Ten participants with a range of BP beliefs also completed semi-structured interviews. Mean responses, and frequency of different responses were reported, for the questionnaire data. Interviews were analysed using thematic analysis. Total Back-PAQ scores (mean −9.6, SD 9.16) indicated unhelpful BP beliefs overall, though some BP beliefs such as the potential benefit of exercise were more positive. Key themes identified from the interviews were; (i) the uniquely vulnerable nature of BP, (ii) the need to protect the back through avoidance behaviours, and (iii) the importance of being active for BP. NHS staff presenting with BP generally held negative BP beliefs, based on both questionnaire responses and the qualitative interviews. Awareness of the potential benefits of activity contrasted with the notion that ongoing protection of the back was required, and was evident in questionnaire data and interviews. Back pain beliefs were influenced by health care professional advice (both formal and informal settings), moving and handling training, family opinion and childhood experiences, offering insights into the settings where BP beliefs could be targeted. [ABSTRACT FROM AUTHOR]

Work absence due to back pain is best predicted by beliefs and attitudes. Lots of money is spent on training in the NHS trying to prevent back pain; this study explores the effect of that training on back pain beliefs. 151 NHS employees were surveyed using the Back Pain Attitudes Questionnaire before and after manual handling training. NHS employees had mixed beliefs. Before training, staff had positive beliefs about activity participation (8.25, SD 1.78), neutral beliefs about psychological influences (6.11, SD 2.51) and prognosis (6.34, SD 2.18), negative beliefs about relationship with injury (5.26, SD 2.09) and strongly negative beliefs about vulnerability of the back (2.81, SD 1.45). Training had a small negative effect (–1.57, SD 4.06 p < 0.001) primarily through exacerbating beliefs regarding the vulnerability of the back (–0.45, SD 1.24, p < 0.001) and the relationship between pain and injury (–0.80, SD 1.83 p < 0.001). NHS employees hold many outdated views on back pain. The immediate effects of manual handling training based on the traditional paradigm of 'protect your back' appeared to make respondents slightly more cautious about using the spine; viewing it as easy to injure, that pain and damage may be linked, and slightly less optimistic about recovery. [ABSTRACT FROM AUTHOR]

Abstract Background Low back pain (LBP) is one of the most common reasons for seeking health care and is costly to the health care system. Recent evidence has shown that LBP care provided by many providers is divergent from guidelines and one reason may be patient’s beliefs and expectations about treatment. Thus, examining the nature of patient beliefs and expectations regarding low back pain treatment will help coordinate efforts to improve consistency and quality of care. Methods This study was a cross-sectional population-based survey of adults living in Newfoundland, Canada. The survey included demographic information (e.g. age, gender, back pain status and care seeking behaviors) and assessed outcomes related to beliefs about the inevitable consequences of back pain with the validated back beliefs questionnaire as well as six additional questions relating beliefs about imaging, physical activity and medication. Surveys were mailed to 3000 households in July–August 2018 and responses collected until September 30th, 2018. Results Fout hundred twenty-eight surveys were returned (mean age 55 years (SD 14.6), 66% female, 90% had experienced an episode of LBP). The mean Back Beliefs Questionnaire score was 27.3 (SD 7.2), suggesting that people perceive back pain to have inevitable negative consequences. Large proportions of respondents held the following beliefs that are contrary to best available evidence: (i) having back pain means you will always have weakness in your back (49.3%), (ii) it will get progressively worse (48.0%), (iii) resting is good (41.4%) and (iv) x-rays or scans are necessary to get the best medical care for LBP (54.2%). Conclusions A high proportion of the public believe LBP to have inevitable negative consequences and hold incorrect beliefs about diagnosis and management options, which is similar to findings from other countries. This presents challenges for clinicians and suggests that considering how to influence beliefs about LBP in the broader community could have value. Given the high prevalence of LBP and that many will consult a range of healthcare professionals, future efforts could consider using broad reaching public health campaigns that target patients, policy makers and all relevant health providers with specific content to change commonly held unhelpful beliefs.

Abstract Background The Back Belief Questionnaire (BBQ) measures beliefs about negative consequences of back pain. The aim of this study was to describe the back beliefs of a large clinical population with low back pain (LBP), to investigate the associations between back beliefs and patient characteristics when care-seeking, and between on-going pain and back beliefs at follow up. Methods Patients aged over 18, consulting with LBP with or without radicular pain of all symptom durations, were recruited from chiropractic clinics. The BBQ was completed on the first visit and at 3- and 12-month follow-ups. Sociodemographic- and symptom-related questions were answered at baseline. A BBQ sum score was calculated at all three time points, and linear regression was used to analyse the cross-sectional association between baseline patient characteristics and BBQ scores. Wilcoxon signed-rank test was used to test differences in BBQ scores for patients with and without on-going LBP at 3- and 12-months follow up. Results The baseline population consisted of 2295 participants. The median BBQ sum scores at baseline, 3 and 12 months had interquartile ranges of 33 [29–36], 33 [29–37], and 31 [27–35] respectively. Patient characteristics and symptoms were associated with baseline BBQ scores (p

Background: Low back pain (LBP) is one of the most common reasons for seeking health care and is costly to the health care system. Recent evidence has shown that LBP care provided by many providers is divergent from guidelines and one reason may be patient's beliefs and expectations about treatment. Thus, examining the nature of patient beliefs and expectations regarding low back pain treatment will help coordinate efforts to improve consistency and quality of care.Methods: This study was a cross-sectional population-based survey of adults living in Newfoundland, Canada. The survey included demographic information (e.g. age, gender, back pain status and care seeking behaviors) and assessed outcomes related to beliefs about the inevitable consequences of back pain with the validated back beliefs questionnaire as well as six additional questions relating beliefs about imaging, physical activity and medication. Surveys were mailed to 3000 households in July-August 2018 and responses collected until September 30th, 2018.Results: Fout hundred twenty-eight surveys were returned (mean age 55 years (SD 14.6), 66% female, 90% had experienced an episode of LBP). The mean Back Beliefs Questionnaire score was 27.3 (SD 7.2), suggesting that people perceive back pain to have inevitable negative consequences. Large proportions of respondents held the following beliefs that are contrary to best available evidence: (i) having back pain means you will always have weakness in your back (49.3%), (ii) it will get progressively worse (48.0%), (iii) resting is good (41.4%) and (iv) x-rays or scans are necessary to get the best medical care for LBP (54.2%).Conclusions: A high proportion of the public believe LBP to have inevitable negative consequences and hold incorrect beliefs about diagnosis and management options, which is similar to findings from other countries. This presents challenges for clinicians and suggests that considering how to influence beliefs about LBP in the broader community could have value. Given the high prevalence of LBP and that many will consult a range of healthcare professionals, future efforts could consider using broad reaching public health campaigns that target patients, policy makers and all relevant health providers with specific content to change commonly held unhelpful beliefs. [ABSTRACT FROM AUTHOR]

Lower back pain is a leading cause of disability and a common condition seen by osteopaths. Evidence and advice for the safest lifting posture vary, as do healthcare practitioners' attitudes and beliefs towards back pain. The aim of this study was to understand osteopaths' beliefs about safe lifting postures in relation to their attitudes towards back pain, and to compare these findings with published data from physiotherapists and manual handling advisors. Cross-sectional study. Between October and November 2018 a cross-sectional electronic survey was used to invite a sample of UK osteopaths to select images that best represent their perception of safe lifting posture (straight or rounded back), and to complete the Back Pain Attitudes Questionnaire (Back-PAQ). Data was analysed to assess lifting posture selection and relationship to back pain attitudes. 46 (85.2%) out of 54 osteopaths selected straight back posture as the safest, these participants had significantly more negative attitudes to back pain injury (i.e. higher Back-PAQ scores), than the 8 osteopaths who selected a rounded back posture (p = 0.007). Data from 266 physiotherapists and 132 manual handling advisors revealed an overall agreement about straight back lifting posture, and differences in Back-PAQ attitude between the professions. Despite a lack of evidence and inconsistent recommendations, osteopaths in this study believed that straight back lifting posture is the safest and were associated with more negative back pain beliefs. Practitioners' attitudes and beliefs are known to influence their patients' attitudes and recovery behaviour. Further research is recommended to identify reasons for different beliefs, and their impact on advice-giving and patient outcomes. • Osteopaths believe that straight back lifting is safer for the back. •Unhelpful and negative back pain beliefs are common amongst osteopaths. •Osteopaths who believe straight back lifting is safer view the back as more vulnerable. •Osteopaths should provide evidence-based information to patients such as 'trust your back' while staying active. [ABSTRACT FROM AUTHOR]

Background: The Back Belief Questionnaire (BBQ) measures beliefs about negative consequences of back pain. The aim of this study was to describe the back beliefs of a large clinical population with low back pain (LBP), to investigate the associations between back beliefs and patient characteristics when care-seeking, and between on-going pain and back beliefs at follow up.Methods: Patients aged over 18, consulting with LBP with or without radicular pain of all symptom durations, were recruited from chiropractic clinics. The BBQ was completed on the first visit and at 3- and 12-month follow-ups. Sociodemographic- and symptom-related questions were answered at baseline. A BBQ sum score was calculated at all three time points, and linear regression was used to analyse the cross-sectional association between baseline patient characteristics and BBQ scores. Wilcoxon signed-rank test was used to test differences in BBQ scores for patients with and without on-going LBP at 3- and 12-months follow up.Results: The baseline population consisted of 2295 participants. The median BBQ sum scores at baseline, 3 and 12 months had interquartile ranges of 33 [29-36], 33 [29-37], and 31 [27-35] respectively. Patient characteristics and symptoms were associated with baseline BBQ scores (p < 0.05), but most association were weak. The strongest association was with severe disability (4.0 points (95% CI 3.3-4.6) lower BBQ than no disability). Negative beliefs were related to more severe LBP at baseline and with on-going pain at follow up.Conclusion: At a population level, back beliefs were generally positive and relatively constant over time, but misconceptions about a poor prognosis were common. Studies exploring individual patterns of back beliefs and associations with clinical outcomes over time are recommended. [ABSTRACT FROM AUTHOR]

Objective: Although negative back beliefs are associated with high-intensity low back pain (LBP)/disability, whether they influence incident high-intensity LBP/high-disability over the long-term is unknown. This study aimed to investigate whether negative back beliefs were associated with developing high-intensity LBP and/or high-disability over 10 years in men., Methods: Men with no or low-intensity LBP and/or disability attending the Geelong Osteoporosis Study between 2006-2010 were included. Data on age, body mass index, mobility, education, back beliefs (Back Beliefs Questionnaire), LBP and disability (Graded Chronic Pain Scale) were collected between 2006-2010. Beliefs, LBP and disability were re-assessed in 2016-2021. Binary logistic regression was used to examine the association between negative back beliefs and incident high-intensity pain and/or high-disability, adjusting for age, body mass index, mobility, and education., Results: At baseline, 705 participants (mean age 53.8 years) had no or low LBP and no or low-disability; 441 (62.6%) participants completed a 10-year follow-up. Of these, 37 (8.4%) developed high-intensity pain and/or high-disability. In multivariate analyses, participants with more negative back beliefs at baseline were more likely to develop high-intensity pain and/or high-disability (Odds ratio 1.05, 95% CI 1.00-1.11). Developing more negative back beliefs was also associated with incident high-intensity pain and/or high-disability (Odds Ratio 1.20, 95% CI 1.12-1.30)., Conclusion: In a male community-based population, negative beliefs regarding the consequences of LBP were associated with an increased likelihood of developing high-intensity pain and/or high-disability. Addressing negative back beliefs in the community may reduce the incidence of high-intensity pain and/or high-disability over 10 years in men., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Background: Low back pain (LBP) is one of the most prevalent and expensive health care problems in industrialised countries. LBP leads to high health care utility and productivity losses; leaving the individual, the employer, and society with substantial costs. To improve the care for LBP patients and reduce the high societal and financial burden of LBP, in 2010 the 'Multidisciplinary care guideline for nonspecific low back pain' was developed in the Netherlands. The current paper describes the design of a study aiming to evaluate the (cost-) effectiveness of a multifaceted strategy to implement this guideline. Methods: In a cluster-randomised controlled trial, the (cost-) effectiveness of a multifaceted implementation strategy will be compared to passive guideline dissemination. Using a stepped-wedge approach, participating general practitioners, physiotherapists, and occupational physicians are allocated into clusters and will attend a multidisciplinary continuing medical education training session. The timing these clusters receive the training is the unit of randomisation. LBP patients visiting the participating health care providers are invited to participate in the trial and will receive access to a multimedia intervention aimed at improving beliefs, cognitions, and self-management. The primary outcome measure of this study is patient back beliefs. Secondary outcome measures on patient level include pain, functional status, quality of life, health care utility, and productivity losses. Outcome measures on professional level include knowledge and attitude towards the guideline, and guideline adherence. A process evaluation for the implementation strategy will be performed among the health care providers and the patients. Furthermore, a qualitative subgroup analysis among patients with various ethnic backgrounds will be performed. Discussion: This study will give insight into the (cost-) effectiveness of a multifaceted implementation strategy for the Dutch multidisciplinary guideline for non-specific back pain to improve outcomes on patient and professional level. The valuable information gained with this study may prove useful for policy-makers, health care providers, and researchers who are in the process of reducing the burden of back pain on individuals and society. [ABSTRACT FROM AUTHOR]

Abstract: The fear-avoidance beliefs of patients with subacute low back pain (LBP) considered at risk for chronic disabling LBP are not well known. The objectives of this cross-sectional descriptive survey, conducted in secondary care practice, were to assess fear-avoidance beliefs about back pain in patients with subacute LBP and to seek an association between physician or patient characteristics and level of fear-avoidance beliefs. A total of 286 rheumatologists completed a self-administered questionnaire assessing physicians’ demographic, professional data, personal history of back pain, and back pain fear-avoidance beliefs (on the Fear-Avoidance Belief Questionnaire [FABQ]) and 443 patients with sLBP completed one on pain, perceived handicap and disability (Quebec Back Pain Disability Scale), anxiety and depression (Hospital Anxiety Depression questionnaire), and back pain beliefs (FABQ). Mean FABQ scores for rheumatologists for physical activities (FABQ Phys) and occupational activities (FABQ Work) were 9.2±4.4 (range 0–21) and 16.7±6.9 (range 2–37), respectively, and patient scores were 16.7±5.2 and 19.3±12.4, respectively. A total of 68% of patients and 10% of physicians had a high rating on the FABQ Phys (>14). Patients’ fear-avoidance beliefs about physical activity were associated with low level of education (odds ratio [OR] 4.19; 95% confidence interval [CI] 1.83–9.57), patients’ perceived disability (OR 1.05; CI 1.03–1.07), and physicians’ high FABQ Phys score (OR 5.92; CI 1.31–26.32). Here we show that fear-avoidance beliefs about back pain were high in patients with subacute LBP and their rheumatologists. [Copyright &y& Elsevier]

Abstract: Introduction: Psychobehavioural assessment may be a complementary approach to assess response to treatment for pain and disability in patients with low back pain. Objectives: To assess the correlation between psychobehavioural factors and pain and disability in patients with chronic low back pain in France. Methods: We asked 83 patients with chronic low back pain to complete questionnaires during a primary care consultation by a general practitioner. Pain was measured by a visual analog scale (VAS), disability by the Quebec Back Pain Disability Scale and psychobehavioural factors by the Fear–Avoidance Beliefs Questionnaire (FABQ) and the Coping Strategy Questionnaire (CSQ). Results: Pain was poorly correlated with anxiety (R =0.36) and scores on the FABQ 1 (R =0.46) and FABQ 2 (R =0.30) and not correlated with depression (R =0.22), duration of pain evolution (R =0,10) and body mass index (R =0.12). The duration of stopping work was poorly correlated with disability (R =0.35) and FABQ 1 score (R =0.43) and not correlated with pain (R =0.11), anxiety (R =0.11), depression (R =0.26) and FABQ 2 score (R =0.23). Disability was poorly correlated with scores on the FABQ 1 (R =0.45) and FABQ 2 (R =0.3), anxiety (R =0.39) and depression (R =0.47) and not correlated with pain (R =0.25). Dramatization is the only way to cope with pain and was correlated with pain (R =0.34), scores on the FABQ 1 (R =0.47) and FABQ 2 (R =0.43), disability (R =0.38), anxiety (R =0.44) and depression (R =0.46). The use of prayer was poorly correlated with FABQ 1 score (R =0.37) and anxiety (R =0.30). Distraction was poorly correlated with scores on the FABQ 1 (R =0.40) and FABQ 2 (R =0.30). No strategy was correlated with duration of pain and stopping work. Discussion–conclusion: All the correlation assessments with psychobehaviour factors are weak. So evaluating each of these parameters will be interesting. Duration of pain was not correlated with increasing pain or change in behavioural strategy. Psychobehavioural factors are more invalidating than pain. More study is needed to assess psychobehavioural therapies in patients with low back pain. [Copyright &y& Elsevier]

Background: The Back-Pain Attitudes (Back-PAQ) questionnaire measures back beliefs across 6 domains. Our previous study showed that manual handling advisors (MHAs) have more negative beliefs than physiotherapists (PTs), and those who think straight back lifting is safer than a rounder back have more negative beliefs. However, exactly which domains of the Back-PAQ are most negative is unknown., Objectives: Gain deeper understanding of how MHAs and PTs construct their back beliefs, and relate this safe lifting posture beliefs., Design: Data was collected via an electronic survey., Method: Participants' back beliefs were collected via the Back-PAQ. They were also asked to select the safest lifting posture from four options: two with a straight back; two with a rounder back. Back beliefs were analysed in the 6 domains that construct the Back-PAQ. Relationships were investigated using multiple linear and regression models., Results: 400 PTs and MHAs completed the survey. MHAs scored higher (more negative beliefs) than PTs across all 6 domains, and those who perceive straight back lifting as safest scored higher across five of the 6 domains. The belief to keep active with back pain was common among all groups, but MHAs and those who prefer straight back lifting believe the back is vulnerable and more in need of protection., Conclusion: While all believe staying active is beneficial for back pain, residual negative beliefs regarding the vulnerability of the spine persist. Education campaigns may need to emphasise a 'trust your back' message rather than a 'protect your back' message while encouraging activity., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: It is commonly believed lifting is dangerous and the back should be straight during lifting. These beliefs may arise from healthcare professionals, yet no study has evaluated the lifting and back beliefs of manual handling advisors (MHAs) and physiotherapists (PTs)., Objectives: To evaluate (i) what lifting technique MHAs and PTs perceive as safest, and why, and (ii) the back pain beliefs of MHAs and PTs., Design: Data was collected via an electronic survey., Method: Participants selected the safest lifting posture from four options: two with a straight back and two with a more rounded back, with justification. Back beliefs were collected via the Back-Pain Attitudes Questionnaire (Back-PAQ). Relationships were investigated using multiple linear and logistic regression models., Results: 400 PTs and MHAs completed the survey. 75% of PTs and 91% of MHAs chose a straight lifting posture as safest, mostly on the basis that it avoided rounding of the back. MHAs scored significantly higher than PTs on the Back-PAQ instrument (mean difference = 33.9), indicating more negative back beliefs. Those who chose the straight back position had significantly more negative back beliefs (mean 81.9, SD 22.7) than those who chose a round back lift (mean 61.7, SD 21.1)., Conclusion: Avoiding rounding the back while lifting is a common belief in PTs and MHAs, despite the lack of evidence that any specific spinal posture is a risk factor for low back pain. MHAs, and those who perceived a straight back position as safest, had significantly more negative back beliefs., (Copyright © 2017 Elsevier Ltd. All rights reserved.)