Abstract
Purpose of the study and background
Healthcare practitioners' (HCPs) attitudes and beliefs about MSK pain influence their practice behaviour. The Pain Attitudes and Beliefs Scale (PABS), developed for use in the context of LBP, consists of two subscales (biomedical and biopsychosocial) is the most widely used measure. However, poor performance of the biopsychosocial orientation scale is attributed, in part, to inadequate conceptualisation of the orientation.
Purpose
To develop a new biopsychosocial scale and adapt the PABS to assess HCPs' attitudes and beliefs about common MSK pain.
Methods and results
A grounded conceptualisation process was conducted with 40 MSK HCPs and/or researchers using concept mapping methodology. The resultant conceptual framework consisted of six primary domains of biopsychosocial clinical orientation (bio-clinical, therapeutic relationship, individual patient aspects, emotions, social and work) and informed development of new scale items. These items were included with existing PABS items in a national survey of UK-based HCPs, and analysis was conducted on 587 responses.
Exploratory and confirmatory factor analyses identified and confirmed a new 10-item biopsychosocial scale (Cronbach's alpha of 0.83). The new biopsychosocial and existing biomedical scales demonstrated good test-retest reliability (ICC(2,1) 0.77 and 0.74 respectively). Standard error of measurement and smallest detectable change were also established.
Conclusion
The new generic MSK version of the PABS biopsychosocial scale shows promising structural validity and test-retest reliability. The existing PABS biomedical scale's structure and performance was upheld.
The new conceptual framework provides a contemporary, comprehensive understanding of the biopsychosocial clinical approach to common MSK pain, with potential value for the development, delivery and evaluation of biopsychosocial clinical practice.
No conflicts of interest
Sources of funding: Kirsty Duncan was the holder of an ACORN PhD studentship from Keele University. Part of the conceptualisation component of this work was also supported by a Chartered Society of Physiotherapy Charitable Trust International Lecture Fund Award. Annette Bishop and Nadine Foster were supported through an NIHR Research Professorship for Nadine Foster (NIHR-RP-011-015). NEF is an NIHR Senior Investigator. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health
