Poster Presentation Sydney Spinal Symposium 2025

Translation, cross-cultural adaptation, and measurement properties of the Back pain Knowledge and beliefs Survey (BacKS) for the Brazilian population. (#25)

Leticia Correa 1 , Mark Hancock 1 , Stephanie Mathieson 2 , Leandro Nogueira 3 , Tatiane Mota 4 , Bruno Saragiotto 5 , Louise Fernandes 3 , Ben Darlow 6 , Simon French 1
  1. Macquarie University, Macquarie Park, Sydney, NSW, Australia
  2. The University of Sydney, Sydney, NSW, Australia
  3. Centro Universitario Augusto Motta, Rio de Janeiro, RJ, Brazil
  4. Universidade Cidade de Sao Paulo, Sao Paulo, SP, Brazil
  5. University of Technology Sydney, Sydney, NSW, Australia
  6. University of Otago Wellington, Wellington, New Zealand

Introduction: A measurement instrument to assess people’s knowledge and beliefs about low back pain was recently developed in Australia, but a Brazilian-Portuguese translation is not yet available. The lack of adequate cross-cultural adaptation of measurement instruments is a barrier to developing low back pain management in different cultures.

Aims: To translate, cross-culturally adapt, and test the measurement properties of the Back pain Knowledge and beliefs Survey (BacKS) to allow its use with Portuguese-speaking Brazilians with low back pain (BacKS-BR).

Methods: A forward and backward translation was performed, and measurement properties of the BacKS-BR were assessed following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Pilot testing was performed including 15 participants to assess content validity using focus groups. An online survey including 208 participants with a one-week follow-up was undertaken to assess the following measurement properties: structural validity (confirmatory factor analysis), cross-cultural validity (multigroup confirmatory factor analysis), construct validity (hypothesis tested: moderate positive Pearson correlation between BacKS-BR and the Back Beliefs Questionnaire), internal consistency (Cronbach’s alpha), reliability (intra-class correlation coefficient), and measurement error (Smallest Detectable Change).

Results: Focus groups confirmed good content validity and feasibility of the BacKS-BR. The 2-factors structure of the BacKS-BR was confirmed (Biomedical: 9 items, scores from 9-45; and Self-care: 11 items, scores from 11-55). Multigroup confirmatory factor analysis produced acceptable measurement invariance. Pearson test confirmed our construct validity hypothesis (r=0.59). Internal consistency and reliability were adequate (>0.70) for total score and each factor. Smallest detectable change was 11.09 for total scale, 7.87 for Biomedical factor, and 9.35 for Self-care factor. It took on average 6 minutes to complete the BacKS-BR. No floor or ceiling effects were found.

Conclusion: The BacKS was successfully translated into Brazilian-Portuguese and proved to have adequate measurement properties. Its use is recommended for research and clinical purposes.

  1. Correa LA, Hancock M, Mathieson S, Verhagen A, Darlow B, Hodges PW, et al. Back pain Knowledge and beliefs Survey (BacKS): development and assessment of measurement properties. British Journal of Sports Medicine. 2024;58:1426-33.
  2. Maher CG, Latimer J, Costa LOP. The relevance of cross-cultural adaptation and clinimetrics for physical therapy instruments. Brazilian Journal of Physical Therapy. 2007-08-01 2007;11(4):245-252.