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pdfOMB CONTROL NUMBER: 0720-PBRD
OMB EXPIRATION DATE: XX/XX/XXXX
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0720-PBRD, is estimated to average 10 minutes per
response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. Send comments regarding the burden
estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at
whs.mc- alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding
any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of
information if it does not display a currently valid OMB control number.
Privacy Advisory
Information is being collected for this Survey under authorities cited in the publicly available EDHA 08, Defense
Health Agency Survey and Study Data Base (July 28, 2014; 79 FR 43727) and EDHA 07, Military Health Information
System (June 15, 2020; 85 FR 36190), and will be used for a doctoral research project and dissertation. The goal of
this Survey is to describe provider beliefs regarding the maximum deadlift (MDL) event and their relationship to
treatment behaviors for patients presenting with a deadlift injury. You will be asked to provide your demographic
information (e.g., age, sex, military service status, specialty, duty and unit locations, facility and unit types), and
information related to your experiences with back pain and activities. Individual Survey results will not be published.
Completing this Survey is voluntary. Maximum participation is encouraged so the data will be complete and
representative, but you may stop the Survey at any time and skip any questions you choose. There is no penalty if
you decide not to respond.
Help Us Improve Soldier Readiness and Care – 10-minute survey
The Army Fitness Test (formerly the Army Combat Fitness Test) includes the three-repetition maximum
deadlift (MDL) as a core event. As medical providers and Army leaders, we share a responsibility to
maximize Soldier resiliency and safety during MDL testing.
We are conducting a brief, one-time survey to better understand how healthcare providers view and
manage the deadlift in the context of Soldier care. Your input will directly support efforts to enhance
medical guidance, optimize readiness, and inform evidence-based practices.
Estimated time: ~10 minutes
Content: Demographics, a brief case scenario, clinical perspectives, and personal experiences with back
pain and deadlifts
Confidentiality: Responses are anonymous and coded to prevent participant identification
IRB Approved: Naval Medical Center Portsmouth
Your participation is vital to shaping clinical decision-making that impacts Soldier health and
performance. If you do not wish to participate, please disregard this message. If you proceed to the
survey and agree to the consent statement, your participation will be confirmed.
Thank you for considering this opportunity to contribute to military medicine and readiness!
Patient Demographic Information
Demographic Information
Question / Item
Proposed Responses
0.1.Cover Letter/Consent (Qualtrics Survey
Landing Page) (SHOWN ABOVE)
I have read the informed consent
document and AGREE to participate in the survey.
I have read the informed consent
document and DECLINE to participate in the
survey.
1. Please enter your age (in years).
[TEXT BOX BLANK]
2. Please select your sex.
- Male
- Female
3. Please select your military service status (as a
healthcare provider).
- Army – Active Duty
- Army – Reserves
- Army – National Guard
- Civilian – GS employee
- Civilian – Contractor
4. Please select the state or region where you are
currently stationed.
Active Duty or Civilian (GS / Contractor): Your
current duty location
Army Reserve / National Guard (do not practice
as a GS/CTR in a military setting): Your unit's duty
location
Army Reserve / National Guard (also currently
practice as a GS/CTR in a military setting): Your
primary duty location for providing Soldier care
- Alabama
- Alaska
- Arizona
- Arkansas
- California
- Colorado
- Connecticut
- Delaware
- Florida
- Georgia
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming
- North America (includes Central America,
Caribbean)
- South America
- Europe
- Africa
- Middle East
- Asia
- Australia / Oceania
5. Please select your healthcare provider
specialty.
6. Please enter how many years you have been
practicing as a licensed professional in your
specialty (whole numbers only).
7. Please select the type of unit or healthcare
facility setting in which you work.
- Occupational Therapist
- Physical Therapist
- Certified Athletic Trainer
- Strength & Conditioning Coach
- Nurse Practitioner
- Physician Assistant/Associate (Non-Orthopedic)
- Physician
- Orthopedic Physician Assistant/Associate
- Orthopedic Surgeon
[TEXT BOX BLANK – 4, 6, 12, 28, etc]
- Medical Treatment Facility (MTF) – Hospital or
Outpatient Clinic
- Operational Unit -- Holistic Health & Fitness
(H2F) Team
- Operational Unit – Non-H2F Personnel
- Other / Non-Operational (Education/Training,
Special Staff/Administrative)
** BLOCK CHANGE TO CLINICAL VIGNETTE **
** BLOCK CHANGE TO BACK-PAQ-10 **
** BLOCK CHANGE TO PABS-PT **
** BLOCK CHANGE TO DL-5 **
20. Are you currently experiencing an episode of
back pain that limits or disturbs your activities?
- No
- Yes
21. Have you experienced an episode of back
pain within the past 6 months that limited or
disturbed your activities?
- No
- Yes
22. Have you ever experienced back pain from
deadlifting that limited or disturbed your activities?
- No
- Yes
23. Do you currently perform deadlifts as part of
- No
your workout or exercise routine?
- Yes
Clinical Vignette and Patient Scenario-Based Questions
Clinical Scenario (adapted from Christe et al., 2021)
CASE SCENARIO (5 questions):
A 25-year-old active-duty soldier has been suffering from his first episode of low back pain since
deadlifting 205 lbs at the gym 3 weeks ago. He says he has difficulty doing his job as a wheeled
mechanic and has not performed regular vehicle maintenance tasks since the pain began. He is
concerned to go back to repairing vehicles and feels significantly limited by the pain. The demands of
his job are variable, but involve lifting and standing in a flexed position for extended periods of time. In
terms of activities, he says he can sit for about 15 minutes and walk 200 meters before the pain limits
him. He has difficulty falling asleep at night, and his back is stiff for about 10 minutes in the morning.
There have been no serious injuries or illnesses. The pain ranges from 1-3/10 and is limited to the
lower back without radiation. On physical examination there is a painful limitation of trunk flexion and
pain with palpation in the left paraspinal region. The neurological examination is normal, and the pain
does not worsen during a straight-leg raise (or Lasègue) test. The diagnosis is non-specific low back
pain.
1. Until pain improves, I would recommend that this patient
o Limits all physical activities o Limits activities to light
exertion o Limits activities to moderate exertion o
Avoids only painful activities o Does not limit any
activities
2. Until pain improves, I would recommend that this patient
o Remains on quarters
o Returns to limited duty with severe temporary profile restrictions o
Returns to limited duty with moderate temporary profile restrictions o
Returns to full duty with minimal temporary profile restrictions o
Returns to full duty without temporary profile restrictions
3. I would recommend that this patient o Rests
in bed until pain completely disappears o Rest
in bed until pain improves substantially o Rest
in bed only when pain is severe o Avoids
resting in bed as much as possible o Avoids
resting in bed entirely
4. For treatment, I propose as a first step:
(several answers possible) o Manual therapy (massage,
mobilizations, manipulations) o Electrotherapy (TENS) or
heat pack o Stretching
o Complementary techniques (acupuncture/dry needling, myofascial release, reflexology, etc)
o Progressive exercises (motor control, strengthening)
5. To avoid recurrent episodes, I would also suggest to the patient:
(several answers possible) o
To be careful of his posture
o To be careful to keep his back straight when carrying weights of more than 10 lbs
o Trying to avoid carrying weights over 20 lbs o Gradually resume flexion and
rotation of the back o Gradually resume deadlifting in his daily exercise
regimen
Correct answers are in bold. Scoring is as follows:
For Questions 1-3: one of the correct answers had to be selected
For Question 4: the correct answer had to be selected with or without the selection of other answers
For Question 5: ONLY the correct answers could be selected to receive full credit
Back-PAQ 10-item questionnaire (Back-PAQ-10)
Please rate each statement.
Question / Item
Responses
+2
+1
0
-1
-2
These statements are about your own back:
1. It is easy to injure your back.
FALSE
POSSIBLY
FALSE
UNSURE
POSSIBLY
TRUE
TRUE
2. You could injure your back if
you are not careful.
FALSE
POSSIBLY
FALSE
UNSURE
POSSIBLY
TRUE
TRUE
These statements are about back pain in general:
3. Back pain means that you
have injured your back.
FALSE
POSSIBLY
FALSE
UNSURE
POSSIBLY
TRUE
TRUE
4. A twinge in your back can be
the first sign of a serious injury.
FALSE
POSSIBLY
FALSE
UNSURE
POSSIBLY
TRUE
TRUE
These statements are about what you should do if you have back pain:
5. If you have back pain you
should avoid exercise.
FALSE
POSSIBLY
FALSE
UNSURE
POSSIBLY
TRUE
TRUE
6. If you have back pain you
should try to stay active.
FALSE
(True)
POSSIBLY
FALSE
(Poss. True)
UNSURE
POSSIBLY
TRUE
(Poss. False)
TRUE
(False)
These statements are about recovering from back pain:
7. Focusing on things other than
your back pain helps you
recover from back pain.
FALSE
(True)
POSSIBLY
FALSE
(Poss. True)
UNSURE
POSSIBLY
TRUE
(Poss. False)
TRUE
(False)
8. Expecting your back pain to
get better helps you recover
from back pain.
FALSE
(True)
POSSIBLY
FALSE
(Poss. True)
UNSURE
POSSIBLY
TRUE
(Poss. False)
TRUE
(False)
9. Once you have had back pain
there is always a weakness.
FALSE
POSSIBLY
FALSE
UNSURE
POSSIBLY
TRUE
TRUE
10. There is a high chance that
POSSIBLY
POSSIBLY
an episode of back pain will not
FALSE
UNSURE
TRUE
FALSE
TRUE
resolve.
Items 6-8 are reverse scored. Italicized font underneath represents answer that will generate scoring
value at the top of the table (i.e., for Questions 6-8, True = +2, False = -2).
Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) – Biomedical Subscale
Please rate the following statements:
Question/Item
Responses
1
2
3
4
5
6
TOTALLY
DISAGREE
LARGELY
DISAGREE
DISAGREE
TO SOME
EXTENT
AGREE
TO
SOME
EXTENT
LARGEL
Y AGREE
TOTALL
Y
AGREE
2. The severity of tissue TOTALLY
damage determines the DISAGREE
level of pain.
LARGELY
DISAGREE
DISAGREE
TO SOME
EXTENT
AGREE
TO
SOME
EXTENT
LARGEL
Y AGREE
TOTALL
Y
AGREE
3. If treatment does not
result in a reduction in
back pain, there is high
risk of severe
restrictions in the long
term.
TOTALLY
DISAGREE
LARGELY
DISAGREE
DISAGREE
TO SOME
EXTENT
AGREE
TO
SOME
EXTENT
LARGEL
Y AGREE
TOTALL
Y
AGREE
4. Pain is the
consequence of tissue
damage.
TOTALLY
DISAGREE
LARGELY
DISAGREE
DISAGREE
TO SOME
EXTENT
AGREE
TO
SOME
EXTENT
LARGEL
Y AGREE
TOTALL
Y
AGREE
5. If patients complain
of pain during exercise
and/or during physical
activities, I worry that
damage is being
caused.
TOTALLY
DISAGREE
LARGELY
DISAGREE
DISAGREE
TO SOME
EXTENT
AGREE
TO
SOME
EXTENT
LARGEL
Y AGREE
TOTALL
Y
AGREE
6. It is the task of the
provider to remove the
cause of back pain.
TOTALLY
DISAGREE
LARGELY
DISAGREE
DISAGREE
TO SOME
EXTENT
AGREE
TO
SOME
EXTENT
LARGEL
Y AGREE
TOTALL
Y
AGREE
7. In the long run,
patients with back pain
have a higher risk of
developing spinal
impairments.
TOTALLY
DISAGREE
LARGELY
DISAGREE
DISAGREE
TO SOME
EXTENT
AGREE
TO
SOME
EXTENT
LARGEL
Y AGREE
TOTALL
Y
AGREE
8. Reduction of daily
physical exertion is a
significant factor in
treating back pain.
TOTALLY
DISAGREE
LARGELY
DISAGREE
DISAGREE
TO SOME
EXTENT
AGREE
TO
SOME
EXTENT
LARGEL
Y AGREE
TOTALL
Y
AGREE
9. Not enough effort is
made to find the
underlying organic
causes of back pain.
TOTALLY
DISAGREE
LARGELY
DISAGREE
DISAGREE
TO SOME
EXTENT
AGREE
TO
SOME
EXTENT
LARGEL
Y AGREE
TOTALL
Y
AGREE
10. Patients with back
pain should preferably
practice only pain-free
movements.
TOTALLY
DISAGREE
LARGELY
DISAGREE
DISAGREE
TO SOME
EXTENT
AGREE
TO
SOME
EXTENT
LARGEL
Y AGREE
TOTALL
Y
AGREE
1. Increased pain
indicates new tissue
damage or the spread
of existing damage.
Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) – Biopsychosocial Subscale
Please rate the following statements:
Question/Item
Responses
1
2
3
4
5
6
1. Exercises that may
be back straining
should not be avoided
during treatments.
TOTALLY
DISAGREE
LARGELY
DISAGREE
DISAGREE
TO SOME
EXTENT
AGREE
TO
SOME
EXTENT
LARGEL
Y AGREE
TOTALL
Y
AGREE
2. Even if the pain has
worsened, the intensity
of the next treatment
can be increased.
TOTALLY
DISAGREE
LARGELY
DISAGREE
DISAGREE
TO SOME
EXTENT
AGREE
TO
SOME
EXTENT
LARGEL
Y AGREE
TOTALL
Y
AGREE
3. If activities of daily
living cause more back
pain, this is not
dangerous.
TOTALLY
DISAGREE
LARGELY
DISAGREE
DISAGREE
TO SOME
EXTENT
AGREE
TO
SOME
EXTENT
LARGEL
Y AGREE
TOTALL
Y
AGREE
4. A patient suffering
from severe back pain
will benefit from
physical exercises.
TOTALLY
DISAGREE
LARGELY
DISAGREE
DISAGREE
TO SOME
EXTENT
AGREE
TO
SOME
EXTENT
LARGEL
Y AGREE
TOTALL
Y
AGREE
Deadlift-5 (DL-5)
Please rate each statement.
Question / Item
Responses
+2
+1
0
-1
-2
These statements are about deadlifts and deadlifting:
1. It is easy to injure your
back while deadlifting.
FALSE
POSSIBLY
FALSE
UNSURE
POSSIBLY
TRUE
TRUE
FALSE
POSSIBLY
FALSE
UNSURE
POSSIBLY
TRUE
TRUE
FALSE
POSSIBLY
FALSE
UNSURE
POSSIBLY
TRUE
TRUE
FALSE
(True)
POSSIBLY
FALSE
(Poss. True)
UNSURE
POSSIBLY
TRUE
(Poss.
False)
TRUE
(False)
FALSE
POSSIBLY
FALSE
UNSURE
POSSIBLY
TRUE
TRUE
(Vulnerability of the back)
2. Back pain during the
deadlift means that you
have injured yourself.
(Relationship between
back pain and injury)
3. If you have back pain
you should avoid
deadlifting.
(Activity participation
during back pain)
4. Expecting your back
pain to get better helps
you to recover from a
deadlift injury.
(Psychological influences
on recovery)
5. Once you have had a
deadlift injury there is
always a weakness.
(Prognosis of back pain)
Italicized font will not be input into the online survey. It is only for reference of the construct being
tested. Point values will not be listed on the online survey. They are only for reference. Item 4 is
reverse scored (True = +2, False = -2).
| File Type | application/pdf |
| Author | Patrick Keenan |
| File Modified | 2025-11-14 |
| File Created | 2025-11-14 |