Development and validation of aquestionnaire to assess physiotherapists' postural-structural-biomechanical-oriented beliefs about pain

Abstract

Therapists frequently use the postural-structural-biomechanical (PSB) model in clinical practice to explain the symptom of pain using biomechanical deficits. Adequate knowledge about pain encompasses not only the neurophysiology of pain but also knowledge that existing PSB-oriented explanations of the development and enhancement of pain are outdated. There is no assessment to evaluate physiotherapists' PSB-oriented beliefs about pain. The aim of the present study was to develop aquestionnaire to assess physiotherapists' PSB-oriented beliefs about pain and to evaluate its reliability (internal consistency), validity, and agreement. The Essential Knowledge of Pain Questionnaire (EKPQ) was constructed on the basis of aliterature search and discussions between experts. In apilot study, 32pupils of aphysiotherapy school were then asked to complete the German version of the revised Neurophysiology of Pain Questionnaire (rNPQ-D) and the EKPQ using the SoSci Survey in order to assess their knowledge and beliefs about pain. The internal consistency of the EKPQ was acceptable with aCronbach's α = 0.784. There was astrong positive significant correlation between the questionnaires (r = 0.518; p = 0.002). The Bland-Altman analysis revealed amean difference of 28.9% (± standard deviation of the difference 15.3%) with an upper limit of 95% agreement of 58.8% and alower limit of 95% agreement of -1.0% between the questionnaires. Participants achieved amean score of 60.7% in the rNPQ‑D and amean score of 31.8% in the EKPQ. The newly developed EKPQ questionnaire seems to be areliable and valid assessment to determine physiotherapists' PSB-oriented beliefs about pain. The results also confirm that ahigh level of knowledge about the neurophysiology of pain does not exclude aPSB orientation. Whether the EKPQ can be used alongside the rNPQ as an additional assessment to evaluate beliefs about pain should be investigated in the future with suitable study designs, e.g. Delphi study.