Body perception outcome measures in chronic non-specific low back pain: A systematic review of measurement properties using the COSMIN approach

Chronic low back pain (CLBP) is a highly prevalent health problem. Recent research has suggested that disruption of body perception might contribute to the problem and represent a target for treatment. Valid and reliable outcome measures are required to understand the relationship between disrupted body perception and clinical status. This systematic review aimed to identify patient reported outcome measures (PROMs) used to assess body perception disruption in people with CLBP and evaluate their psychometric properties. Five databases were searched for studies investigating the psychometric properties of PROMs designed to assess body perception in people with CLBP. The appraisal of the methodological quality and measurement properties adhered to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Sixteen studies were included, evaluating two PROMs: the Fremantle Back Awareness Questionnaire (FreBAQ) and the Body Awareness Rating Questionnaire (BARQ). The studies included data from 2545 participants, comprising 1694 individuals with CLBP. The following measurement properties were investigated: content validity; structural validity; internal consistency; cross-cultural validity; test-retest reliability; measurement error and construct validity. While there is evidence for test-retest reliability and construct validity, neither questionnaire demonstrated adequate content validity and there was a low level of evidence for sufficient internal consistency. Consequently, both the FreBAQ and BARQ were classified as 'B', indicating their potential for recommendation, contingent upon further research to evaluate their quality. Future research should address identified limitations of the questionnaires, particularly content validity. This will lead to the development of more useful tools to measure body perception in the CLBP population.