The French APAP-CLBP is the first questionnaire assessing physical activity perceptions in chronic low back pain, with preliminary findings supporting a concise 13-item, 3-factor structure focused on barriers to PA, though psychometric properties are not yet sufficient for clinical implementation.
Key Findings
Methods
A 26-item questionnaire (APAP-CLBP) was developed to assess physical activity perceptions in individuals with chronic low back pain, based on a prior qualitative study identifying PA barriers and facilitators.
The questionnaire was developed based on a qualitative study identifying PA barriers and facilitators in CLBP populations.
97 participants with CLBP completed the questionnaire, recruited during a medical consultation or on the first day of a 3-week lumbar rehabilitation program.
The study was registered on ClinicalTrials.gov (NCT05942196).
Secondary objectives included exploring associations between APAP-CLBP scores and clinical characteristics of individuals with CLBP.
Results
Principal factor analysis identified a 3-subscale structure from the APAP-CLBP questionnaire: 'Constraints' (5 items), 'Barriers' (5 items), and 'Pain' (3 items), resulting in a concise 13-item instrument.
The three subscales were labeled 'Constraints,' 'Barriers,' and 'Pain.'
Each subscale contained 3 to 5 items, totaling 13 items across all three factors.
The factor structure was derived from principal factor analysis conducted in the full sample of 97 participants.
The original 26-item version was reduced to 13 items through this analysis.
Results
All three subscales demonstrated good internal consistency, with Cronbach's alpha values of 0.75 for 'Constraints,' 0.73 for 'Barriers,' and 0.80 for 'Pain.'
'Constraints' subscale: Cronbach's alpha = 0.75.
'Barriers' subscale: Cronbach's alpha = 0.73.
'Pain' subscale: Cronbach's alpha = 0.80.
Internal consistency was assessed across all 97 participants.
All three values meet commonly accepted thresholds for adequate internal consistency (≥0.70).
Results
Test-retest reliability was 'substantial' for all three subscales, with ICC values of 0.66 for 'Constraints,' 0.69 for 'Barriers,' and 0.75 for 'Pain.'
Test-retest reliability was assessed in a small subsample of n = 22 participants.
The authors described reliability as 'substantial' for all three subscales.
The authors noted this analysis was 'constrained by a small subsample size (n = 22).'
Results
Only the 'Barriers' subscale showed an exploratory trend toward sensitivity to change.
Sensitivity to change was assessed as part of the psychometric evaluation.
The 'Constraints' and 'Pain' subscales did not demonstrate sensitivity to change.
The finding for the 'Barriers' subscale was described as an 'exploratory trend' rather than a confirmed result.
This suggests that the 'Barriers' subscale may be the most responsive to detecting clinical changes over time.
Conclusions
The psychometric properties of the APAP-CLBP were deemed not yet sufficient for clinical implementation, and further validation in larger samples is required.
The authors concluded that 'psychometric properties are not yet sufficient for clinical implementation of the APAP-CLBP.'
Further validation using the original 26-item version in larger samples is recommended.
The authors noted the need to explore additional factors such as facilitators of PA or motivation.
The study is described as a 'preliminary validation,' indicating the tool is still in development.
Background
The APAP-CLBP is identified as the first questionnaire specifically designed to assess physical activity perceptions in individuals with chronic low back pain.
The authors state that 'no validated tool is currently available' for assessing PA perceptions in CLBP.
Assessing PA perceptions is presented as potentially important for addressing adherence challenges.
Non-pharmacological interventions targeting PA are recommended for managing CLBP as they 'reduce pain, disability, and recurrence while improving functional outcomes.'
The lack of existing tools motivated the development of the APAP-CLBP.
What This Means
This research describes the development and early testing of a new French-language questionnaire called the APAP-CLBP, designed to measure how people with chronic low back pain (CLBP) perceive physical activity (PA). Exercise and physical activity are recommended treatments for CLBP, but many patients struggle to stick with them. The researchers believed that understanding patients' attitudes and perceptions about PA — including what they see as barriers — could help healthcare providers better support them. Starting from a qualitative study that identified common barriers and facilitators, the team created a 26-item questionnaire and tested it in 97 patients with CLBP.
Statistical analysis narrowed the questionnaire down to 13 items grouped into three categories: 'Constraints' (practical or situational obstacles), 'Barriers' (perceived personal obstacles), and 'Pain' (pain-related concerns about PA). All three categories showed acceptable internal consistency, meaning the questions within each group reliably measured the same concept. Test-retest reliability — how consistently participants answered the same questions over time — was 'substantial' for all three categories, though this was tested in only 22 people. Notably, only the 'Barriers' category showed a preliminary tendency to detect changes over time, which is important for tracking treatment progress.
This research suggests that the APAP-CLBP shows early promise as a tool to help clinicians understand why patients with CLBP may avoid physical activity, but the authors caution that it is not yet ready for routine clinical use. The sample size was relatively small, the test-retest analysis included very few participants, and additional psychometric testing is needed. Larger studies using the full 26-item version are recommended to further refine and validate the questionnaire, and to explore whether it can also capture positive factors like motivation or facilitators of PA.
Check Your Own Numbers
Upload your bloodwork. We'll cross-reference your results against this study and 4,700 others.
Monborne I, Ducret J, Visa M, Coudeyre E, Lanhers C, Guiguet-Auclair C. (2026). French physical activity perception questionnaire for chronic low back pain: development and preliminary validation.. Annals of physical and rehabilitation medicine. https://doi.org/10.1016/j.rehab.2026.102113