French physical activity perception questionnaire for chronic low back pain: development and preliminary validation

BACKGROUND: Non-pharmacological interventions targeting physical activity (PA) are recommended for managing chronic low back pain (CLBP) as they reduce pain, disability, and recurrence while improving functional outcomes. However, their success depends on adherence to PA, which many people struggle to maintain. Assessing PA perceptions may help address these challenges, yet no validated tool is currently available. AIM: This study aimed to develop the French Assessment of Physical Activity Perception in CLBP individuals (APAP-CLBP) and to provide a preliminary evaluation of its psychometric properties. Secondary objectives were to explore the associations between APAP-CLBP scores and clinical characteristics of individuals with CLBP. METHODS AND ANALYSIS: A 26-item questionnaire was developed based on a qualitative study identifying PA barriers and facilitators in CLBP. The APAP-CLBP questionnaire was completed by 97 participants with CLBP, included during a medical consultation or on the first day of a 3-week lumbar rehabilitation program. Psychometric analyses included acceptability, construct validity, internal consistency, convergent validity, test-retest reliability, and sensitivity to change. RESULTS: Principal factor analysis identified 3 subscales that demonstrated good internal consistency: 'Constraints' (5 items, Cronbach's alpha 0.75), 'Barriers' (5 items, Cronbach's alpha 0.73), and 'Pain' (3 items, Cronbach's alpha 0.80). Test-retest reliability, constrained by a small subsample size (n = 22), was substantial for 'Constraints' (Intraclass Correlation Coefficient, ICC=0.66), 'Barriers' (ICC=0.69), and 'Pain' (ICC=0.75) subscales. Only the 'Barriers' subscale showed an exploratory trend toward sensitivity to change. CONCLUSION: The French APAP-CLBP is the first questionnaire assessing PA perceptions in CLBP. While preliminary findings support a concise 13-item, 3-factor structure focused on barriers to PA, psychometric properties are not yet sufficient for clinical implementation of the APAP-CLBP. Further validation in larger samples using the original 26-item version is required to confirm these results and explore additional factors, such as facilitators of PA or motivation. TRIAL REGISTRATION: ClinicalTrial.gov NCT05942196.