Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), 139 Barker Street, Randwick, NSW, 2031, Australia.
Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
Health Qual Life Outcomes. 2022 Jan 10;20(1):4. doi: 10.1186/s12955-021-01908-4.
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.
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.
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.
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.
如果医生提供的治疗方案与患者的期望和态度不匹配，那么他们的时间和资源可能会被浪费。我们开发了一个问卷（AxEL-Q），旨在指导医生关注与患有慢性腰痛患者相关的一线治疗要素。
我们遵循 COSMIN 协作组的指导，开发了该问卷，并在一组不同病程的慢性腰痛患者中对其进行了评估。参与者是从社区招募的，年龄在 18 岁以上，且能流利地使用英语。确定了代表一线治疗的陈述。使用语义量表来衡量对这些陈述的态度。将这些项目组合起来，形成问卷草案。通过探索性因子分析和假设检验，与腰痛信念问卷和改良疼痛自我效能问卷进行比较，对结构效度进行评估。评估了可靠性，并计算了地板效应和天花板效应。
我们招募了 345 名参与者，其中 313 名参与者的数据完整，可用于分析。通过探索性因子分析，问卷草案被简化为 3 个因子问卷。因子 1 包含 9 个项目，评估了保持活动的态度；因子 2 包含 4 个项目，评估了腰痛很少由严重健康问题引起的态度；因子 3 包含 4 个项目，评估了无需了解腰痛病因即可有效管理腰痛的态度。每个因子与腰痛信念问卷呈强烈的负相关，与改良疼痛自我效能问卷呈中度正相关。每个独立因子的内部一致性均良好；因子 1 的 Cronbach α 值为 0.92，因子 2 的 Cronbach α 值为 0.91，因子 3 的 Cronbach α 值为 0.90，且组内相关系数也足够高；因子 1 的组内相关系数为 0.71，因子 2 的组内相关系数为 0.73，因子 3 的组内相关系数为 0.79。
本研究表明，AxEL-Q 具有可接受的结构效度和可靠性，为临床医生提供了患者在初始阶段是否遵循一线治疗的洞察力。
