Health care providers' attitudes and beliefs about functional impairments and chronic back pain

Clin J Pain. 1995 Dec;11(4):287-95. doi: 10.1097/00002508-199512000-00006.


Objective: This study validated a measure entitled the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) for assessing the attitudes and beliefs of health care providers about functional expectation for chronic low back pain patients. HC-PAIRS was developed by modifying the Pain and Impairment Relationship Scale (PAIRS) used to assess the attitudes and beliefs of chronic pain patients.

Design: This study surveyed 150 community health care providers and 66 functional restoration providers using HC-PAIRS. HC-PAIRS consists of 15 items attributing back pain patients' impairment and disability to pain, followed by a seven-point Likert scale anchored with degrees of agreement and disagreement. Reliability of HC-PAIRS was determined using Cronbach's alpha. Factor analysis was performed to explore the dimensions of attitudes and beliefs. Validity was determined by HC-PAIRS accurately measuring the pain attitudes and beliefs of functional restoration providers, who have a stated philosophy concerning this notion.

Results: For the 150 community health care providers, HC-PAIRS revealed a Cronbach's alpha of 0.78. Factor analysis showed four dimensions of attitudes and beliefs measures by HC-PAIRS, which were entitled "functional expectations," "social expectations," "need for cure," and "projected cognition." Community providers showed a mean score of 52 (S.D. = 10). Most respondents were neutral or disagreed somewhat with the notion that chronic back pain should limit functional performance, but a wide range of responses were noted (range 33-80), indicating that diverse pain attitudes and beliefs are held. The 66 functional restoration providers had a mean HC-PAIRS score of 38 (S.D. = 7), and a range of scores from 26 to 52 was found. As expected, these scores corresponded to disagreement with the notion that chronic low back pain justifies impairments and disability. This was accurately measured by HC-PAIRS and is evidence of HC-PAIRS validity. Comparison of HC-PAIRS between community and functional restoration providers revealed a significantly lower score for function restoration providers (t = 12.14, p < 0.000).

Conclusion: These results suggested that HC-PAIRS can be used to measure health care providers' attitudes and beliefs about the degree to which chronic low back pain justifies impairments and disability. HC-PAIRS may be useful to health care providers interested in examining this notion.

MeSH terms

  • Attitude of Health Personnel*
  • Back Pain / complications
  • Back Pain / physiopathology*
  • Back Pain / rehabilitation
  • Community Health Services
  • Disabled Persons
  • Factor Analysis, Statistical
  • Female
  • Health Personnel*
  • Humans
  • Male
  • Middle Aged
  • Pain Clinics
  • Surveys and Questionnaires