The Back Beliefs Questionnaire (BBQ)

The reality: In 2020, low back pain (LBP) affected 619 million people globally, and it is estimated that this number will rise to 843 million by 2050, driven largely by population growth and aging. Non-specific LBP is the most common form, accounting for about 90% of cases (World Health Organization).

Furthermore, back pain is the leading cause of work absence. The longer the time off work, the greater the risk of long-term quality of life deterioration. The likelihood of returning to work decreases significantly over time, with only 50% of people returning at six months and just 5% after one year. In many cases, taking time off work can exacerbate the problem, as inactivity may worsen the condition (Faculty of Occupational Medicine, 2000).

In 2022/23, most work-related ill health days in Great Britain were due to stress, depression, anxiety, and musculoskeletal disorders. LBP was the most reported musculoskeletal issue, with individuals taking an average of 13.9 days off work for these disorders (Health and Safety Executive, UK).

The BBQ: developed at the University of Huddersfield, evaluates individuals’ beliefs regarding the impact of lower back trouble (LBT). It emphasises psychosocial factors that can prolong absenteeism, recovery periods, and disability due to negative perceptions of LBT. By identifying and addressing these negative beliefs, the BBQ offers a cost-effective approach to supporting the reduction of LBT-related absences through education on the topic and enhancing employee well-being and productivity.

References 
World Health Organization. Low back pain. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/low-back-pain

Faculty of Occupational Medicine. (2000, March). Back pain at work: A guide for people at work and their employers. https://www.fom.ac.uk/wp-content/uploads/backpain_leaflet.pdf

Health and Safety Executive. Working days lost in Great Britain. Health and Safety Executive. https://www.hse.gov.uk/statistics/dayslost.htm

A simple-to-use scoring system is utilised throughout. The score is calculated by reversing the individual scores (i.e. 5,4,3,2,1) and then summing all 9 statements: High scores = more positive beliefs.

Additional written guidance on scoring and administration is provided upon obtaining a license to use the BBQ.

The Back Beliefs Questionnaire (BBQ) was designed, developed, and validated to measure psychosocial beliefs about lower back trouble (LBT). It highlights that negative attitudes and beliefs can significantly impact low back disability, often more than ergonomic factors. Individuals with negative beliefs about back trouble tend to take longer absences from work compared to those with positive beliefs.

The BBQ assesses these psychosocial factors and can be used as a stand-alone instrument or as part of a multimethod protocol.

The BBQ was tested for validity, and its level of internal consistency and reliability established. Various groups were used to develop the instrument.

The component structure of the BBQ was explored using Principle Component Analysis (PCA) on the responses of 158 individuals from various occupational backgrounds, and subsequently on data from 466 employees in a large biscuit manufacturing factory in the north of England. A single component was derived in both instances, accounting for 32% and 44%  of the explained variance respectively. The reliability of the measure was estimated on the both samples, with a Cronbach’s α statistic of 0.70 and 0.84 respectively. Test-retest analysis was carried out on the BBQ using a subgroup (n=77) of the initial 158 workers with a resulting intraclass correlation coefficient of 0.84.  In terms of construct validity scores on the BBQ were found to be significantly different between those with no history of back trouble and those with high work absence caused by back pain (p<0.05). 

For more information on the development and validation of the BBQ, please refer to the publications listed under ‘Key References’ on the right-hand side of this page.

The Back Beliefs Questionnaire (BBQ) was developed, tested and validated in a large industrial study at a biscuit factory in northern England to assess workers’ attitudes towards lower back trouble (LBT). The findings indicated that addressing negative beliefs about LBT could reduce absenteeism and enhance employee well-being and productivity. This study underscored the importance of psychosocial factors in managing LBT and offered valuable insights into interventions to improve workplace health and reduce associated costs.

The BBQ has been widely used in numerous studies and successfully translated into multiple languages, further confirming its validity and robustness as a reliable measure for research, clinical practice, and occupational therapy applications. For instance, a study using the Norwegian translation included 116 patients, with 63 participating in a test-retest assessment. The results demonstrated that the Norwegian version of the BBQ has test-retest reliability and good construct validity, making it suitable for assessing pessimistic beliefs in elderly patients with back pain.

Similarly, the French translation of the BBQ was tested for its psychometric properties. According to Eriksen et al. (2014), “The BBQ showed good psychometric properties to assess false beliefs and related fear in French or English LBP populations and can be used either for evaluation in international trials or as a part of self-care training.”

• Paper and pen completion
• Digital (eCOA) completion, upon request.

For furthter information on eCOA vendors authorsied to deploy the BBQ, or platforms the BBQ is available on, please email us at enquiries@inspiredoutcomes.co.uk.

• Scoring and administration instructions
• Concept Elaboration Document (to assist in translating the BBQ)

The Back Beliefs Questionnaire (BBQ) © Copyright, The University of Huddersfield 1996. All Rights Reserved. The authors have asserted their moral rights.

All users must seek a licence to use the BBQ prior to use. Licences can be requested here -  Licence Request Form.

Licences to use the copyirght in the BBQ are at no cost for most academic research and other non-commercial purposes. For other uses, we will advise on any licensing costs (prior to granting a licence) based on the details you provide in the Licence Request Form.