the Short form of the Örebro Musculoskeletal pain Screening Questionnaire (ÖMpSQ-short) and the Start Back tool (SBt) have been developed to screen for risk factors for future low back pain (LBp)related disability and work loss respectively. The aim of this study was to investigate the accordance of the two questionnaires and to evaluate the accumulation of risk factors in the risk groups of both screening tools in a large population-based sample. The study population consisted of 3079 participants of the Northern Finland Birth Cohort 1966 who had reported LBP over the previous 12 months and had SBT and ÖMPSQ-short data. We evaluated the association of depressive and anxiety symptoms (Hopkins symptom check list-25, Generalized anxiety disorder 7 questionnaire, and Beck's Depression Inventory 21), psychological features (Fear-Avoidance Beliefs Questionnaire), lifestyle characteristics (BMI, smoking, alcohol abuse, physical inactivity) and social factors (education level) with the SBT and ÖMPSQ-short risk groups. The high-risk groups of both questionnaires were associated (p < 0.001) with depressive and anxiety symptoms and fear-avoidance beliefs. In addition, adverse lifestyle factors accumulated in the higher risk groups, especially from the ÖMPSQ-short. Agreement between the two questionnaires was moderate for men and fair for women. Low back pain (LBP) is the most disabling health condition worldwide 1. No cost-effective or widely available preventive LBP interventions have yet been developed 2. Predictors of persistent LBP-related disability include symptom-related factors such as previous LBP episodes, pain intensity and the presence of leg pain; lifestyle factors such as overweight/obesity, smoking and physical inactivity; psychological factors such as depression, catastrophizing and fear-avoidance beliefs; and social factors such as education, physical workload and work satisfaction 3. To improve the effectiveness of healthcare, care processes need to take these factors into account individually and systematically 2. Early identification of patients who are at the highest risk of developing a prolonged or persistent pain problem is important 2. The short form of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-short) and the STarT Back Tool (SBT) have been developed for the easy and systematic identification of predictive psychosocial and symptom-related factors 4-6. The SBT was developed to identify subgroups of patients with non-specific LBP in order to determine which kind of treatment would benefit each patient. Cutoff scores divide patients into low-, medium-and high-risk

Background: The Determinants of Implementation Behavior Questionnaire (DIBQ) identifies factors that are facilitators of or barriers to professionals´ change of behavior after evidence-based training. The original English DIBQ consists of 93 items covering 18 domains. The DIBQ is built upon the Theoretical Domains Framework and the Behavioral Change Wheel. The purpose of the study is to tailor the DIBQ to the multiprofessional rehabilitation context as well as cross-culturally adapt it to the Finnish context. Methods: Cross-cultural translation followed by a two round, Delphi method involving experts in rehabilitation with diversity of professions (physicians, physiotherapists, occupational therapists, psychologists, nursing scientists, social scientists and health care policymakers) was conducted, 25 experts participated in Round 1, and 21 in Round 2. Participants evaluated the importance of each DIBQ item in changing professionals´ implementation behavior. Consensus to include items was defined as a mean score of ≥4 on a Likert scale (1 = Strongly Disagree, 2 = Disagree, 3 = Neither Agree nor Disagree, 4 = Agree, 5 = Strongly Agree) by ≥75% of Delphi participants. Items rated at agreement of ≤74% were either excluded or reviewed depending on qualitative judgements. The relevance of each item was indexed using content validity index (CVI). A second-round survey followed the same process. Comparison with tailored versions of Danish and Swedish (DIBQ-t) was also performed before reaching the consensus of the results.Results: The final validated multiprofessional DIBQ (DIBQ-mp) consists of 23 questions. Twenty-nine percent (n = 27) of the Round 1 questions did not reach acceptable agreement. Second-round survey was developed based on the results of the first round. In all, 4% (n=2) of the Round 2 questions did not reach acceptable agreement. Agreement was achieved on all items after Round 2 in comparison with DIBQ-t, and the Delphi process was concluded. The final DIBQ-mp has evidence of excellent content validity with 0.93 average item-level CVI.Conclusions: The study resulted in the Determinants of Implementation Behavior Questionnaire tailored to the multiprofessional rehabilitation context as well as a Finnish cross-culturally adapted version.

Background To prevent low back pain (LBP) from developing into a prolonged disabling condition, clinical guidelines advocate early stage assessment, risk‐screening, and tailored interventions. Occupational health services recommend guideline‐oriented biopsychosocial screening and individualized assessment and management. However, it is not known whether training a limited number of health care professionals improves the management process. The primary objective of this study is to investigate whether training in the biopsychosocial practice model is effective in reducing disability. Furthermore, we aim to evaluate health‐economic impacts of the training intervention in comparison to usual medical care. Methods The occupational health service units will be allocated into a training or control arm in a two‐arm cluster randomized controlled design. The training of occupational physiotherapists and physicians will include the assessment of pain‐related psychosocial factors using the STarT Back Tool and the short version of the Örebro Musculoskeletal Pain Screening Questionnaire, the use of an evidence‐based patient education booklet as part of the management of LBP, and tailored individualized management of LBP according to risk stratification. The control units will receive no training. The study population will include patients aged 18–65 with nonspecific LBP. The primary outcome is a patient‐reported Oswestry Disability Index from baseline to 12 months. By estimating group differences over time, we aim to evaluate the effectiveness of the training intervention in comparison to usual medical care, and to undertake an economic evaluation using individual patients' health care records (participant‐level data) and the participating units' registries (cluster‐level data). In addition, through interviews and questionnaires, we will explore the health care professionals' conceptions of the adoption of, the barriers to, and the facilitators of the implementation of the practice model. Discussion The evaluation of training in the guideline‐oriented biopsychosocial management of LBP in occupational health services is justified because LBP represents an enormous burden in terms of work disability.