The development and testing of a generic musculoskeletal version of the Pain Attitudes and Beliefs Scale

Background: Attitudes and beliefs that healthcare practitioners (HCPs) hold about musculoskeletal (MSK) pain influence their clinical behaviour. The Pain Attitudes and Beliefs Scale (PABS), originally developed for low back pain (LBP), is the most widely used and tested measure of HCPs’ attitudes and beliefs, however further development and testing is indicated. Poor performance of its biopsychosocial orientation scale is attributed to inadequate conceptualisation of the orientation. Aims: To develop a new biopsychosocial orientation scale for the PABS and adapt the original LBP specific version as a measure of HCPs' attitudes and beliefs about common MSK pain. Methods: The research was conducted in six stages. Firstly, a scoping review identified constructs used to quantify HCPs’ attitudes towards common MSK pain. Stage two used a concept mapping methodology to develop a new conceptual framework for biopsychosocial clinical orientation to common MSK pain. This framework was used to generate candidate items for redevelopment of the biopsychosocial scale (stage three) and then included in a national survey of physiotherapists, GPs and chiropractors (stage four) to collect data for initial development and testing (stage five and six). Methods: The research was conducted in six stages. Firstly, a scoping review identified constructs used to quantify HCPs’ attitudes towards common MSK pain. Stage two used a concept mapping methodology to develop a new conceptual framework for biopsychosocial clinical orientation to common MSK pain. This framework was used to generate candidate items for redevelopment of the biopsychosocial scale (stage three) and then included in a national survey of physiotherapists, GPs and chiropractors (stage four) to collect data for initial development and testing (stage five and six). Conclusion: The new version of the PABS (the PABS-MSK) is the most comprehensively developed measure of HCPs’ attitudes and beliefs concerning MSK pain to date. The biomedical scale is robust and while both scales require further validation, the research provides a solid conceptual grounding for further amendments of the measure. The conceptual framework provides a contemporary comprehensive understanding of the biopsychosocial clinical approach to MSK pain