How do physiotherapists understand and interpret the "Pain Attitudes and Beliefs Scale"? A cognitive interview study

Area of Science:

• Rehabilitation Sciences
• Pain Management
• Clinical Psychology

Background:

• The Pain Attitudes and Beliefs Scale (PABS) assesses physiotherapists' biomedical vs. biopsychosocial treatment orientations for low back pain (LBP).
• Content validity, including relevance, comprehensibility, and comprehensiveness, is crucial for accurate measurement of treatment beliefs.

Purpose of the Study:

• To evaluate the content validity of the Norwegian version of the PABS for physiotherapists.
• To assess the relevance, comprehensibility, and comprehensiveness of the PABS concerning nonspecific LBP management.

Main Methods:

• Cognitive interviews utilizing the Three-Step Test Interview (think-aloud, retrospective probing, in-depth interviews).
• Eleven Norwegian physiotherapists with diverse professional backgrounds participated in the study.
• Qualitative analysis of participant feedback on PABS item clarity and relevance.

Main Results:

• Physiotherapists found the PABS generally easy to complete, with most items deemed relevant and important.
• Minor ambiguities were noted in five PABS items, requiring simple adjustments for improved clarity.
• The biomedical subscale comprehensively represented biomedical treatment orientation, while the biopsychosocial subscale lacked items on cognitive-behavioral aspects (e.g., patient education, therapeutic alliance).

Conclusions:

• The Norwegian PABS-PT is relevant and comprehensible for assessing physiotherapists' treatment orientations for LBP, with minor revisions.
• The biopsychosocial subscale requires enhancement to adequately encompass key elements of contemporary biopsychosocial care.
• Current measurement of biopsychosocial treatment orientation using the PABS may be incomplete, potentially affecting assessment accuracy.