73 to 0.84). The behavioural subscale has proved to be more problematic. The different versions that have been developed have largely been attempts to improve the structure of the original behavioural subscale, although internal consistency (Cronbach’s α 0.52 to 0.68) has consistently fallen short of recommended levels ( Terwee et al 2007). There is evidence for content and construct validity BAY 73-4506 in vitro (Ostelo et al 2003, Houben et al 2005, Bishop et al 2008), although there is no ‘gold standard’ with which to compare scores on the PABS. There is evidence for

satisfactory test-retest reliability for the amended PABS (Bishop, 2008) and for the Jersey GP version (Bowey-Morris 2010). Minimum clinically important change is yet to be determined and thus responsiveness of the PABS in detecting change in HCPs treatment orientations is not yet known. LBP is common, resulting in high numbers of consultations with HCPs. Despite a multitude of guidelines for the management GSK J4 cost of patients presenting with LBP, best-evidence recommendations are often not

translated into clinical practice. HCP attitudes and beliefs are associated with the adoption of guideline recommendations. Implementation research has described a range of factors that can act as obstacles and facilitators to the translation of best practice recommendations into clinical practice and one such factor is the attitudes and beliefs that the individual HCP holds. In order to investigate the role of attitudes and beliefs in the adoption of best practice, robust measurement tools are essential. Initially this is likely Thiamine-diphosphate kinase to be in the context of research studies but use in educational and clinical settings will inevitably follow in due course. The biomedical subscale of the PABS has been shown to have good clinimetric properties and the composition of items has shown a high degree of consistency when tested in a variety of HCP populations.

Users of the PABS should be aware of the varied composition of the behavioural scale in the different reported versions that have been developed in attempts to improve the internal consistency of this subscale. Further work on the behavioural scale is required to achieve similar stability to the biomedical subscale. The PABS is currently the most thoroughly tested tool available for the measurement of attitudes and beliefs of HCPs towards spinal pain, although gaps undoubtedly still exist in clinimetric testing. As the tool undergoes further testing and development the content and structure of the tool may well be refined, but this is a promising tool for this recently expanding area of research interest. “
“We have read with interest the systematic review for neck pain treatment in the June issue of the journal (Leaver et al 2010), but find the review conclusion on low level laser therapy (LLLT) misleading.