Development and Psychometric Validation of the Guideline-Concordant Low Back Pain Vignette (GCLBP-V) in Undergraduate Physiotherapy Students.

BACKGROUND

Low back pain (LBP) is a leading cause of global disability. Clinical guidelines recommend maintaining activity, early return to work, exercise, and avoiding bed rest. Although vignette-based assessments are common in pain education, they are rarely psychometrically evaluated. This study aimed to develop and validate the Guideline-Concordant Low Back Pain Vignette (GCLBP-V) in undergraduate physiotherapy students.

METHODS

A cross-sectional study included 126 undergraduate physiotherapy students in Jordan. The four-item GCLBP-V assesses guideline-concordant recommendations across activity, work, exercise, and bed rest. Content validity was evaluated via expert review (n = 8) and cognitive pre-testing. Construct validity was assessed using known-groups comparisons (junior vs senior) and convergent validity with pain knowledge and pain-related beliefs. Test-retest reliability (intraclass correlation coefficient, ICC (2,1)), measurement error (standard error of measurement, SEM; minimal detectable change at 95% confidence, MDC9 5), internal consistency (Kuder-Richardson Formula 20, KR-20), and score distribution were evaluated in accordance with COSMIN recommendations.

RESULTS

Content validity was excellent (scale-level average content validity index, S-CVI/Ave = 0.969). Known-groups validity was supported by higher scores among senior versus junior students (Cliff's δ = 0.510, p < 0.001). The GCLBP-V showed moderate associations with pain knowledge (ρ = 0.603) and maladaptive pain-related beliefs (ρ = -0.466) (p < 0.001). Test-retest reliability was good to excellent (ICC (2,1) = 0.858, 95% CI 0.769-0.921), with SEM = 0.531 and MDC9 5 = 1.471. Internal consistency was modest (KR-20 = 0.549). Ceiling and floor effects were 18.3% and 12.7%, respectively.

CONCLUSION

The GCLBP-V demonstrates acceptable psychometric properties as a brief measure of guideline-concordant clinical recommendations. It addresses a key methodological gap by providing a standardized vignette-based behavioral outcome measure suitable for group-level comparisons in pain education. Further research should evaluate responsiveness and generalizability across different populations, disciplines, and settings.