Introducing the BacKS: a survey to measure your patients’ knowledge and beliefs about low back pain

Posted on by bjsm

Authors: Leticia Corrêa, Simon French, Mark Hancock, and Stephanie Mathieson

Low back pain is a leading cause of disability worldwide and pain education is one of the first-line recommended treatments for people with low back pain [1-3]. The assessment of people’s knowledge and beliefs about low back pain is important to provide an individualised treatment plan. By addressing unhelpful beliefs, healthcare professionals can empower patients to manage their pain more effectively. To date, there was no high quality questionnaire available to evaluate contemporary knowledge and beliefs aligned with current clinical guidelines for the management of low back pain  – until the Back pain Knowledge and beliefs Survey (BacKS) [4]. The BacKS was recently published in the BJSM [5].

Why is this study important?

New research about managing low back pain emphasises patient-centred treatment as pain education. Yet, outdated myths and misconceptions about low back pain persist. These misconceptions can lead to unnecessary imaging, overtreatment, or advice that may not align with the latest evidence-based care recommendations.

This is what BacKS is about and why it matters. By using the BacKS, researchers and clinicians can evaluate what patients with low back pain know and believe about their health condition. The BacKS can be used by researchers and clinicians to identify gaps in knowledge and beliefs that subsequently need to be addressed. Based on this, BacKS has the potential to improve health care and to inform healthcare professionals on how to empower patients with accurate and evidence-based information.

How did the study go about this?

The development of BacKS was based on a multi-step approach using robust research methods for developing patient-reported outcome measures [6]. The first step involved creating preliminary survey items based on current evidence and input from experts in low back pain, and from people with lived experience. This step ensured that the items were easy to understand while capturing key and relevant topics regarding knowledge and beliefs about low back, such as the causes of low back pain, its prognosis, and appropriate management strategies.

Next, the survey underwent rigorous testing to ensure that the questionnaire accurately measures what it is intended to measure (validity) and to confirm that the BacKS produces consistent results (reliability). To evaluate the validity and reliability of the BacKS, we enrolled 258 adults (>18 years) across Australia with self-reported low back pain. All participants completed an online survey that comprised the BacKS and other relevant characteristics (e.g., education level, exposure to pain education, low back pain average intensity, low back pain related disability).

What did the study find?

BacKS was confirmed to be a valid and reliable questionnaire. The final version of BacKS includes 20 items about two key areas of knowledge and beliefs about low back pain: biomedical beliefs and self-care strategies.

The final version of BacKS is ready to be used in clinical practice and research and can be accessed through the BacKS website. BacKS provides a resource for targeted pain education and low back pain management based on current clinical and methodological guidelines.

What are the key take-home points?

  • Despite advances in research, general public misconceptions and myths about low back pain persist.
  • BacKS was recently developed to measure knowledge and beliefs about low back pain.
  • BacKS has the potential to inform researchers and clinicians about topics to be covered in patient-centred education for low back pain aligned with evidence-based guidelines.
  • BacKS is ready for implementation. It is a valid, reliable, and user-friendly questionnaire, making it a valuable addition to healthcare professionals and researchers.

References

[1] Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27:2791-803.

[2] National Guideline Centre (UK). Low Back Pain and Sciatica in Over 16s: Assessment and Management. London: National Institute for Health and Care Excellence (UK). 2016.

[3] Maher CG, Archambeau A, Buchbinder R, French SD, Morphet J, Nicholas MK, et al. Introducing Australia’s clinical care standard for low back pain. The Medical journal of Australia. 2023;218:354-6.

[4] Corrêa LA, Mathieson S, Hancock M, Verhagen A, Nogueira LAC, Young A, et al. Questionnaires assessing knowledge and beliefs about musculoskeletal conditions are potentially suitable for use, but further research is needed. Journal of Clinical Epidemiology. 2024;172:111398.

[5] Correa LA, Hancock M, Mathieson S, Verhagen A, Darlow B, Hodges PW, et al. Back pain Knowledge and beliefs Survey (BacKS): development and assessment of measurement properties. British journal of sports medicine. 2024;58:1426-33.

[6] Gagnier JJ, Lai J, Mokkink LB, Terwee CB. COSMIN reporting guideline for studies on measurement properties of patient-reported outcome measures. Qual Life Res. 2021;30:2197-218.

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