Development and measurement properties of the AxEL (attitude toward education and advice for low-back-pain) questionnaire

Abstract

Introduction Clinician time and resources may be underutilised if the treatment they offer does not match patient expectations and attitudes. We developed a questionnaire (AxEL-Q) to guide clinicians toward elements of first-line care that are pertinent to their patients with low back pain. Methods We used guidance from the COSMIN consortium to develop the questionnaire and evaluated it in a sample of people with low back pain of any duration. Participants were recruited from the community, were over 18 years and fluent in English. Statements that represented first-line care were identified. Semantic scales were used to measure attitude towards these statements. These items were combined to develop the questionnaire draft. Construct validity was evaluated with exploratory factor analysis and hypotheses testing, comparing to the Back Beliefs Questionnaire and modified Pain Self-Efficacy Questionnaire. Reliability was evaluated and floor and ceiling effects calculated. Results We recruited 345 participants, and had complete data for analysis for 313 participants. The questionnaire draft was reduced to a 3-Factor questionnaire through exploratory factor analysis. Factor 1 comprised 9 items and evaluated Attitude toward staying active, Factor 2 comprised 4 items and evaluated Attitude toward low back pain being rarely caused by a serious health problem, Factor 3 comprised 4 items and evaluated Attitude toward not needing to know the cause of back pain to manage it effectively. There was a strong inverse association between each factor and the Back Beliefs Questionnaire and a moderate positive association with the modified Pain Self-Efficacy Questionnaire. Each independent factor demonstrated acceptable internal consistency; Cronbach α Factor 1 = 0.92, Factor 2 = 0.91, Factor 3 = 0.90 and adequate interclass correlation coefficients; Factor 1 = 0.71, Factor 2 = 0.73, Factor 3 = 0.79. Conclusion This study demonstrates acceptable construct validity and reliability of the AxEL-Q, providing clinicians with an insight into the likelihood of patients following first-line care at the outset.

Validation of the Arabic Version of the Attitude Toward Education and Advice for Low Back Pain Questionnaire

“…The validity and reliability of the instrument must be ensured across various groups and cultures, according to the theoretical literature on cross-cultural adaptation and validation of questionnaires. 10 , 18 This process includes language translation, cultural adaptation, content and construct validity, as well as reliability testing. Achieving conceptual equivalence with the original form ensures the questionnaire measures the same construct within the target population.…”

“…The validity and reliability of the instrument must be ensured across various groups and cultures, according to the theoretical literature on cross-cultural adaptation and validation of questionnaires. 10,18 This process includes language https://doi.org/10.2147/PPA.S449265…”

It’s safe to move! A protocol for a randomised controlled trial investigating the effect of a video designed to increase people’s confidence becoming more active despite back pain

“…The secondary outcome will be Factor 1 of the AxEL-Q Questionnaire 36. The AxEL-Q is a questionnaire designed to assess attitudes toward first-line education and advice for low back pain, Factor 1 comprises nine items and evaluates Attitude toward staying active .…”

“…The secondary outcome will be Factor 1 of the AxEL-Q Questionnaire. 36 The AxEL-Q is a questionnaire designed to assess attitudes toward first-line education and advice for low back pain, Factor 1 comprises nine items and evaluates Attitude toward staying active . The score range for Factor 1 is 0 to 54, with higher scores indicating a more positive attitude toward messages about staying active.…”

What messages predict intention to self-manage low back pain? A study of attitudes towards patient education

“…We set the multicollinearity threshold at r >0.85, identified highly correlated pairs, and eliminated one pair through discussion. 32 This process resulted in 4 adjective pairs, 2 to represent affective components of attitude: frustrated–encouraged and worried–reassured, and 2 adjective pairs to represent cognitive components of attitude: disagree–agree and surprising–expected.…”