Dutch translation, cross-cultural adaptation, validation, and reliability of the Back Pain Attitudes Questionnaire (Back-PAQ)

Abstract

Purpose: To translate and cross-culturally adapt the Back Pain Attitudes Questionnaire (Back-PAQ) to Dutch for the Belgian and Dutch populations, and to investigate its measurement properties in the general population and physiotherapists. Methods: The adaptation followed established guidelines. Content validity, internal consistency, test–retest reliability (intraclass correlation coefficient), floor and ceiling effects, minimal detectable change (MDC), construct validity, and structural validity were assessed in physiotherapists and the general population. The modified Fear-Avoidance Beliefs Questionnaire (mFABQ) investigated the Back-PAQ’s convergent validity, and Confirmatory Factor Analysis evaluated structural validity. Discriminant validity was assessed between physiotherapists and the general population. Results: Two hundred and sixty participants (mean age: 29 ± 13.3) completed the initial survey and 147 completed the test–retest survey. All Back-PAQ versions (34-item, 20-item, and 10-item) demonstrated good internal consistency, good to excellent test–retest reliability. Moderate correlations with the mFABQ (p < 0.001) and adequate discriminant validity between physiotherapists and the general population supported robust construct validity. The Back-PAQ 10 exhibited a good model fit and enables meaningful sub-score comparisons. Conclusions: This collaboration produced a validated Dutch Back-PAQ suitable for use in both the Netherlands and Belgium. All versions demonstrated robust measurement properties, supporting their use in clinical and research settings assessing unhelpful beliefs in back pain management.