Motor action observation evaluation questionnaire: development and initial validity evidence for the scores in people with and without chronic low back pain

Chronic low back pain (CLBP) is highly prevalent and associated with functional limitations. Although action observation is increasingly used as a cognitive-motor rehabilitation strategy, no brief instrument exists to assess how individuals appraise and understand movements during observation.

The Questionnaire for the Assessment of Motor Action Observation (CENOAM) was developed using a sequential mixed-methods design. Phase 1 involved item generation based on literature review and qualitative analysis, followed by expert content validation using Aiken's V. Phase 2 consisted of a cross-sectional study including 280 participants (140 with CLBP and 140 asymptomatic). Dimensionality and psychometric properties of the CENOAM scores were examined using exploratory factor analysis, complementary dimensionality methods, internal consistency (α, ω), floor and ceiling effects, concurrent associations, and known-groups comparisons, following COSMIN recommendations.

The final seven-item instrument showed a parsimonious two-dimensional structure, comprising Familiarity and Competence-Demand, supported by converging evidence across multiple methods. Internal consistency was high for both total and subscale scores, and no floor or ceiling effects were observed. CENOAM scores were positively associated with motor imagery ability, physical activity, and pain self-efficacy, and negatively associated with fear of movement. Participants with CLBP showed significantly lower scores than asymptomatic individuals across all dimensions, with large effect sizes.

The CENOAM provides a brief and interpretable measure of movement appraisal during action observation. Its scores show initial evidence of validity and may support the individualization of action-observation-based rehabilitation in musculoskeletal conditions.