Chronic Pain Acceptance Questionnaire: Confirmatory Factor Analysis, Reliability, and Validity in Italian Subjects With Chronic Low Back Pain
Abstract
STUDY DESIGN: Cross-sectional evaluation of the psychometric properties of a translated questionnaire. OBJECTIVE: To validate the Italian version of the Chronic Pain Acceptance Questionnaire (CPAQ) to allow its use with Italian-speaking patients with chronic low back pain (LBP). SUMMARY OF BACKGROUND DATA: Growing attention is being given to cognitive-behavioral measures to improve interventions for LBP. The CPAQ has never been validated in Italian subjects with chronic LBP. METHODS: The psychometric testing included confirmatory factor analysis, reliability by internal consistency (Cronbach α), test-retest reliability (intraclass correlation coefficient), sensitivity to change by calculating the smallest detectable change, and construct validity by comparing CPAQ with a pain numerical rating scale, the Roland-Morris Disability Questionnaire Scale, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale, and the Tampa Scale of Kinesiophobia (Pearson correlations). Hierarchical multiple regression analyses were computed to further investigate construct validity of the CPAQ subscales. RESULTS: The questionnaire was administered to 142 subjects with chronic LBP. Factor analysis confirmed a 2-factor (viz., Activities Engagement and Pain Willingness) 20-item solution, achieving a good data-model fit. Internal consistency (α = 0.88) and test-retest reliability (intraclass correlation coefficient = 0.86) were good. The smallest detectable change was 22. Construct validity showed a moderate correlation between the CPAQ and numerical rating scale (r = -0.485), Roland-Morris Disability Questionnaire Scale (r = -0.594), and Tampa Scale of Kinesiophobia (r = -0.595), and a close correlation with Hospital Anxiety and Depression Scale (r = -0.610 for the Anxiety score and r = -0.659 for the Depression score) and Pain Catastrophizing Scale (r = -0.658). The standardized regression coefficients for Activity Engagement were significant in all of the equations, and those for Pain Willingness were significant in the anxiety, depression, and disability equations. CONCLUSION: The Italian CPAQ had a good factorial structure and psychometric properties that replicated the results of other versions. Its use is recommended for clinical and research purposes. LEVEL OF EVIDENCE: 2.
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The Chronic Pain Acceptance Questionnaire has well-established internal consistency (Cronbach's α 0.72-0.92) and test-retest reliability (interclass correlation coefficient=0.86; 95%CI 0.81 to 0.90).
“The internal consistency and the test–retest reliability of the CPAQ are well established (Cronbach's α 0.72–0.92 and interclass correlation coefficient=0.86; 95%CI 0.81 to 0.90), respectively.48–51”
Cites
Hu, L., & Bentler, P. M. (1999) · Structural Equation Modeling A Multidisciplinary Journal · doi:10.1080/10705519909540118 · Cited by 108,788 · see citing works
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Quality criteria were proposed for measurement properties of health status questionnaires
Terwee, C. B., Bot, S. D. M., de Boer, M. R., van der Windt, D. A. W. M., Knol, D. L., Dekker, J., Bouter, L. M., & de Vet, H. C. W. (2007) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2006.03.012 · Cited by 10,764 · see citing works
The Pain Catastrophizing Scale: Development and validation.
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995) · Psychological Assessment · doi:10.1037//1040-3590.7.4.524 · Cited by 8,227 · see citing works
HUSKISSON, E. C. (1974) · The Lancet · doi:10.1016/s0140-6736(74)90884-8 · Cited by 4,533 · see citing works
A Study of the Natural History of Back Pain: Part I
ROLAND, M., & MORRIS, R. (1983) · Spine · doi:10.1097/00007632-198303000-00004 · Cited by 3,395 · see citing works
Balagué, F., Mannion, A. F., Pellisé, F., & Cedraschi, C. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60610-7 · Cited by 1,861 · see citing works
Acceptance of chronic pain: component analysis and a revised assessment method
McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004) · Pain · doi:10.1016/j.pain.2003.10.012 · Cited by 1,101 · see citing works
Kinesiophobia : a new view of chronic pain behavior
Kori, S. (1990) · Medical Entomology and Zoology · Cited by 1,040 · see citing works
Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain
McCracken, L. M. (1998) · Pain · doi:10.1016/s0304-3959(97)00146-2 · Cited by 685 · see citing works
Costantini, M., Musso, M., Viterbori, P., Bonci, F., Mastro, L. D., Garrone, O., Venturini, M., & Morasso, G. (1999) · Supportive Care in Cancer · doi:10.1007/s005200050241 · Cited by 536 · see citing works
de Vet, H. C. W., Adèr, H. J., Terwee, C. B., & Pouwer, F. (2005) · Quality of Life Research · doi:10.1007/s11136-004-5742-3 · Cited by 302 · see citing works
Vowles, K. E., McCracken, L. M., & Eccleston, C. (2007) · European Journal of Pain · doi:10.1016/j.ejpain.2006.12.007 · Cited by 253 · see citing works
Vowles, K. E., McCracken, L. M., McLeod, C., & Eccleston, C. (2008) · Pain · doi:10.1016/j.pain.2008.08.012 · Cited by 226 · see citing works
McCracken, L. M., MacKichan, F., & Eccleston, C. (2007) · European Journal of Pain · doi:10.1016/j.ejpain.2006.05.004 · Cited by 167 · see citing works
Wicksell, R. K., Olsson, G. L., & Melin, L. (2009) · European Journal of Pain · doi:10.1016/j.ejpain.2008.09.003 · Cited by 135 · see citing works
Monticone, M., Baiardi, P., Ferrari, S., Foti, C., Mugnai, R., Pillastrini, P., Rocca, B., & Vanti, C. (2011) · Quality of Life Research · doi:10.1007/s11136-011-0007-4 · Cited by 134 · see citing works
Self-citationPadua, L., Padua, L., Ceccarelli, E., Romanini, E., Zanoli, G. A., Bondì, R., & Campi, A. (2001) · European Spine Journal · doi:10.1007/s005860100262 · Cited by 89 · see citing works
Nilges, P., Köster, B., & Schmidt, C. O. (2007) · Der Schmerz · doi:10.1007/s00482-006-0508-1 · Cited by 82 · see citing works
Rodero, B., García-Campayo, J., Casanueva, B., del Hoyo, Y. L., Serrano-Blanco, A., & Luciano, J. V. (2010) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-8-37 · Cited by 79 · see citing works
Monticone, M., Baiardi, P., Calabrò, D., Calabrò, F., & Foti, C. (2010) · Spine · doi:10.1097/brs.0b013e3181e88981 · Cited by 58 · see citing works
Self-citationNing, M. C., Ming, T. W. C., Mae, J. Y. C., & Ping, C. P. (2008) · The Journal of Pain · doi:10.1016/j.jpain.2008.04.005 · Cited by 37 · see citing works
Bernini, O., Pennato, T., Cosci, F., & Montiel, C. B. (2010) · Journal of Health Psychology · doi:10.1177/1359105310365576 · Cited by 32 · see citing works
Ojala, T., Piirainen, A., Sipilä, K., Suutama, T., & Häkkinen, A. (2013) · Disability and Rehabilitation · doi:10.3109/09638288.2012.694572 · Cited by 15 · see citing works
Cho, S., Heiby, E. M., McCracken, L. M., Moon, D. E., & Lee, J.-H. (2011) · Quality of Life Research · doi:10.1007/s11136-011-0010-9 · Cited by 14 · see citing works
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Day, M. A., & Thorn, B. E. (2017) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2017.06.009 · Cited by 27 · see citing works
Åkerblom, S., Perrin, S., Fischer, M. R., & McCracken, L. M. (2016) · International Journal of Behavioral Medicine · doi:10.1007/s12529-016-9539-x · Cited by 26 · see citing works
Williams, R. M., Ehde, D. M., Day, M., Turner, A. P., Hakimian, S., Gertz, K., Ciol, M., McCall, A., Kincaid, C., Pettet, M. W., et al. (2020) · Contemporary Clinical Trials · doi:10.1016/j.cct.2020.105935 · Cited by 19 · see citing works
Hayes, S., Hogan, M., Dowd, H., Doherty, E., O'Higgins, S., Nic Gabhainn, S., MacNeela, P., Murphy, A. W., Kropmans, T., O'Neill, C., et al. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-005092 · Cited by 19 · see citing works
Bernstein, C. A., Connor, J. P., Vilsmark, E. S., Paschali, M., Rozenkrantz, L., Rist, P. M., Wayne, P. M., & Lazaridou, A. (2022) · Contemporary Clinical Trials · doi:10.1016/j.cct.2022.106907 · Cited by 8 · see citing works
- Authors
- Monticone, M., Ferrante, S., Rocca, B., Nava, T., Parini, C., & Cerri, C.
- Affiliations
- Fondazione Salvatore Maugeri (IT)
- University of Milan (IT)
- University of Milano-Bicocca (IT)
- Corresponding author
- Monticone, Marco
- Rocca, Barbara
- Venue
- Spine
- Published
- 2013-06
- Volume
- 38
- Issue
- 13
- Pages
- E824-E831
- ISSN
- 0362-2436 (ISSN-L)
- OpenAlex
- W2043116634
- Cited by
- 27
- References
- 25
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 1 · 2019: 3 · 2018: 1 · 2017: 3 · 2016: 3 · 2015: 1 · 2014: 2 · 2013: 1
- FWCI
- 1.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Spine (publishedVersion)
- PubMed (publishedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- UNICA IRIS Institutional Research Information System (University of Cagliari) (submittedVersion)
- Virtual Community of Pathological Anatomy (University of Castilla La Mancha) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- Chronic Pain Acceptance Questionnaire, chronic low back pain, Italian translation, psychometric validation, questionnaire reliability, construct validity, pain acceptance, activity engagement, kinesiophobia, anxiety and depression, pain catastrophizing
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Cross-Cultural Comparison, Disability Evaluation, Factor Analysis, Statistical, Female, Humans, Italy, Language, Male, Middle Aged, Pain Measurement, Psychometrics, Surveys and Questionnaires, Regression Analysis, Reproducibility of Results, Low Back Pain, Young Adult, Chronic Pain
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