Psychometric validation of the cross-culturally adapted traditional Chinese version of the Back Beliefs Questionnaire (BBQ) and Fear-Avoidance Beliefs Questionnaire (FABQ)

Effects of Fu's subcutaneous needling on clinical efficacy and psychological cognitive characteristics in patients with chronic non-specific low back pain: A randomized controlled trial

BACKGROUND AND PURPOSE

Low back pain (LBP) is a major global public health problem. Evidence shows that LBP is also related to cognitive, psychological, and lifestyle factors. Fu's subcutaneous needling (FSN) has been used for the treatment of musculoskeletal problems for many years. This prospective randomized controlled trial aimed to evaluate the clinical efficacy and fear avoidance beliefs of FSN in the treatment of patients with chronic non-specific LBP.

MATERIAL AND METHODS

Ninety participants with chronic non-specific LBP were randomly divided into the FSN and the traditional acupuncture (TA) groups (n = 45) and received either FSN or TA treatment for three consecutive days from December 2021 to March 2023. The primary outcome was pain intensity measured by the visual analogue scale (VAS). Secondary outcomes were trunk extensor endurance (TEE), lumbar range of motion (ROM), and the Fear Avoidance Beliefs Questionnaire (FABQ). Outcome measurements were made before the first treatment and after each treatment. Follow-up assessments of VAS and FABQ scores were conducted one month after treatment.

RESULTS

The FSN group had significantly lower VAS and FABQ scores at each time point after intervention compared to the TA group (P < 0.01). The scores of TEE and lumbar ROM were higher in the FSN group than those in the TA group (P < 0.01). Repeated measures analysis of variance (ANOVA) showed significant time effects, group effects, and interaction effects for VAS, TEE, lumbar ROM, and FABQ in both groups (P < 0.01). One month after treatment, the FSN group had significantly lower VAS and FABQ scores compared to the TA group (P < 0.05).

CONCLUSION

This study suggested that FSN was superior to TA in terms of clinical efficacy and fear-avoidance beliefs in the treatment of chronic non-specific LBP. FSN could be used as an effective clinical treatment.

Questionnaires assessing knowledge and beliefs about musculoskeletal conditions are potentially suitable for use, but further research is needed: a systematic review

OBJECTIVES

To evaluate the measurement properties of Patient-reported outcome measures (PROMs) for knowledge and/or beliefs about musculoskeletal conditions.

STUDY DESIGN AND SETTING

A systematic review was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. This review was prospectively registered on PROSPERO - ID: CRD42022303111. Electronic databases, reference lists, forward citation tracking, and contact with experts were used to identify studies. Eligible studies were reports developing or assessing a measurement property of a PROM measuring musculoskeletal condition specific-knowledge and/or beliefs. We assessed the methodological quality and measurement properties of included studies. A modified Grading of Recommendations Assessment Development and Evaluation approach was used to rate the quality of evidence for each PROM.

RESULTS

The literature search was performed from inception to 11th September 2023. Sixty records were included, reporting 290 individual studies, and provided information on 25 PROMs. Five PROMs presented sufficient structural validity, three presented sufficient cross-cultural validity, ten presented sufficient reliability, three presented sufficient criterion validity, six presented sufficient hypothesis-testing, and four presented sufficient responsiveness. No PROM presented sufficient evidence for content validity, internal consistency, and measurement error. Based on the available evidence, no PROM was classified as suitable for use according to the COSMIN recommendations. Twenty-four PROMs are potentially suitable for use, and one PROM is not recommended for use.

CONCLUSION

No PROM designed to assess knowledge and/or beliefs about musculoskeletal conditions meets the COSMIN criteria of suitable for use. Most PROMs identified in this systematic review were considered as potentially suitable for use and need further high-quality research to assess their measurement properties.

The persian version of the fear-avoidance beliefs questionnaire among iranian post-surgery patients: a translation and psychometrics

INTRODUCTION

Fear-avoidance beliefs (FAB) play a crucial role in the treatment outcomes of post-surgery patients. These beliefs can lead to activity avoidance, increased pain, and decreased quality of life. Therefore, accurately measuring these beliefs in Iranian patients is of significant importance. The Fear-Avoidance Belief Questionnaire (FABQ) is a patient-reported questionnaire that evaluates individuals' FAB. Since the validity and reliability of the Persian version of FABQ (FABQ-P) have not been assessed based on the Iranian population and sociocultural contexts, the current study has been implemented to determine the reliability and validity of the FABQ-P among Iranian post-operative patients by translation and psychometric properties.

METHODS

This methodological study conducted in 2023, a sample of 400 patients who had undergone surgery were selected using a convenience sampling method. The scale used in the study was translated and its psychometric properties were evaluated through network analysis and assessments of construct validity (including exploratory and confirmatory factor analysis), convergent validity, and discriminant validity. Additionally, the study assessed the internal consistency of the scale.

RESULTS

The MLEFA results with Promax and Kaiser Normalization rotation yielded two factors explaining 57.91% of the variance, encompassing 13 items. Also, the model was approved by CFA. Convergent and discriminant validity have been confirmed through the following criteria: Average Variance Extracted (AVE) exceeding 0.5, Composite Reliability (CR) surpassing 0.7, and Heterotrait-Monotrait Ratio of Correlations (HTMT) equating to 0.597. As for reliability, Cronbach's alpha, composite reliability (CR), and MaxR for all constructs were greater than 0.7, demonstrating good internal consistency.

CONCLUSION

As demonstrated by the results, the FABQ-P has a satisfactory level of reliability along with authentic validity according to the sociocultural contexts of Iranian post-operative patients.

[Translation and cultural adaptation of the Exercise Fear Avoidance Scale for Chilean older adults]

OBJECTIVE

To translate and culturally adapt the Exercise Fear Avoidance Scale (EFAS) Into Spanish for Chilean older adults.

MATERIALS AND METHODS

Double direct translation with harmonization, back translation and analysis of text comprehensibility through cognitive interviews. A sample of 20 older adults between the ages of 63 and 83 participated in the cognitive interview process.

RESULTS

All items were assessed as clear and understandable. Using the paraphrasing and inquiry techniques, 3 items (out of 16) were adapted to achieve better understanding. Two of these adaptations consisted in replacing one concept with another, as the latter was more used in the Chilean context, and making a non-literal translation, since the literal one was too complex for the elderly to understand.

CONCLUSIONS

A Spanish version of the EFAS was obtained, which proved to be understandable and adapted for its use with Chilean older adults.

Are Morphometric and Biomechanical Characteristics of Lumbar Multifidus Related to Pain Intensity or Disability in People With Chronic Low Back Pain After Considering Psychological Factors or Insomnia?

INTRODUCTION

Lumbar multifidus muscle (LMM) dysfunction is thought to be related to pain and/or disability in people with chronic low back pain (CLBP). Although psychosocial factors play a major role in pain/disability, they are seldom considered as confounders in analyzing the association between LMM and CLBP.

OBJECTIVES

This study aimed to determine: (1) differences in psychological factors, insomnia, and LMM characteristics between people with and without CLBP; (2) associations between psychological factors, insomnia, or LMM characteristics and low back pain (LBP) intensity or LBP-related disability in people with CLBP; and (3) whether LMM characteristics are related to LBP symptoms in people with CLBP after considering confounders.

METHODS

Seventy-eight volunteers with CLBP and 73 without CLBP provided sociodemographic information, filled the 11-point numeric pain rating scale and Roland-Morris disability questionnaire (RMDQ). They completed the Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), Fear Avoidance Belief Questionnaire (FAB), and Insomnia Severity Index Scale (ISI). Resting and contracted thickness of LMM at L4-S1 levels were measured from brightness-mode ultrasound images. Percent thickness changes of LMM at L4-S1 levels during contraction were calculated. Resting LMM stiffness at L4-S1 was measured by shear wave elastography. Associations among LMM, psychosocial or insomnia parameters and clinical outcomes were analyzed by univariate and multivariate analyses.

RESULTS

People with CLBP demonstrated significantly higher LBP-intensity, RMDQ, HADS, FAB, PCS, and ISI scores than asymptomatic controls (p < 0.05). The former also had significantly smaller percent thickness changes of LMM at L4/L5 during contraction. LBP-intensity was positively related to scores of PCS-total, PCS-helplessness, FAB-total, FAB-work, and ISI in people with CLBP (p < 0.05). RMDQ scores were positively associated with the scores of HADS-total, HADS-depression, PCS-total, FAB-total, FAB-physical activity, PCS-helplessness, and ISI in people with CLBP (p < 0.05). FAB-work and ISI scores together explained 24% of LBP-intensity. FAB-total scores alone explained 34% of variance of LBP-related disability in people with CLBP.

CONCLUSION

More fear-avoidance belief or insomnia is related to greater LBP-intensity and/or LBP-related disability in people with CLBP. Although people with CLBP were thought to have aberrant LMM morphometry/function, no LMM characteristics were related to LBP-intensity or LBP-related disability after considering other confounders.

Predictors of poor pre-operative psychological status among patients with cartilage defects

BACKGROUND

We evaluated the risk factors for pain catastrophizing, kinesiophobia, and elevated depressive symptoms among patients undergoing high-grade cartilage defect surgery. We hypothesized that cartilage patients would demonstrate high scores on pain catastrophizing, kinesiophobia, and depression testing prior to surgery.

METHODS

Two hundred and ten patients undergoing surgery for high-grade cartilage defects (56% chondroplasty, 36% microfracture, 22% autologous chondrocyte implantation) completed a preoperative survey before undergoing surgery. Outcome scores assessed were: International Knee Documentation Committee-Symptom (IKDC-S) score, Tegner activity score, Pain catastrophizing scale (PCS), Tampa scale for kinesiophobia (TSK-11), and Patient Health Questionnaire depression scale (PHQ-9). Multivariate logistic regression was used to determine what pre-operative factors predicted pain catastrophizing, kinesiophobia, and elevated depressive symptoms.

RESULTS

The mean pre-operative Tegner score was 5.8 (SD 2.4) and IKDC-S score was 44.7 (SD 11.1). Prior to surgery, 19% had abnormal pain catastrophizing (PCS ≥ 20 points), 14.4% had moderate-severe depression (PHQ ≥ 10), and 49.0% had high kinesiophobia (TSK-11 ≥ 25). Lower pre-operative Tegner scores predicted moderate-severe depressive symptoms (per point decrease, OR 1.36, 95% CI 1.06, 1.76; p = 0.008). Predictors of elevated pain catastrophizing were lower pre-operative IKDC-S scores (per 5-point decrease, OR 1.28, 95% CI 1.08, 1.51; p = 0.002) and symptom duration >6 months (OR 2.20 CI 1.14, 4.32; p = 0.02). A lower pre-operative IKDC-S score (per 5-point decrease, OR 1.17, CI 1.03, 1.33; p = 0.02) predicted elevated kinesiophobia.

CONCLUSION

Low self-reported function, low activity level and symptom duration greater than six months are associated with poor preoperative psychological status.

The Hausa Back Beliefs Questionnaire: Translation, cross-cultural adaptation and psychometric assessment in mixed urban and rural Nigerian populations with chronic low back pain

INTRODUCTION

Negative attitudes and beliefs about low back pain (LBP) can lead to reduced function and activity and consequently disability. One self-report measure that can be used to assess these negative attitudes and beliefs and to determine their predictive nature is the Back Beliefs Questionnaire (BBQ). This study aimed to translate and cross-culturally adapt the BBQ into Hausa and assess its psychometric properties in mixed urban and rural Nigerian populations with chronic LBP.

METHODS

The BBQ was translated and cross-culturally adapted into Hausa (Hausa-BBQ) according to established guidelines. To assess psychometric properties, a consecutive sample of 200 patients with chronic LBP recruited from urban and rural clinics of Nigeria completed the questionnaire along with measures of fear-avoidance beliefs, pain catastrophizing, functional disability, physical and mental health, and pain. One hundred of the 200 patients completed the questionnaire twice at an interval of 7-14 days to assess test-retest reliability. Internal construct validity was assessed using exploratory factor analysis, and external construct validity was assessed by examining convergent, divergent, and known-groups validity. Reliability was assessed by calculating internal consistency (Cronbach's α), intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change at 95% confidence interval (MDC95), and limits of agreement using Bland-Altman plots. Reliability (ICC, SEM and MDC95) was also assessed separately for rural and urban subgroups.

RESULTS

The factor analysis revealed a four-factor solution explaining 58.9% of the total variance with the first factor explaining 27.1%. The nine scoring items loaded on the first factor hence supporting a unidimensional scale. The convergent and divergent validity were supported as 85% (6:7) of the predefined hypotheses were confirmed. Known-groups comparison showed that the questionnaire discriminated well for those who differed in education (p < 0.05), but not in age (p > 0.05). The internal consistency and ICC (α = 0.79; ICC = 0.91) were adequate, with minimal SEM and MDC95 (1.9 and 5.2, respectively). The limits of agreements were -5.11 to 5.71. The ICC, SEM and MDC95 for the urban and rural subgroups were comparable to those obtained for the overall population.

CONCLUSIONS

The Hausa-BBQ was successfully adapted and psychometrically sound in terms of internal and external construct validity, internal consistency, and test-retest reliability in mixed urban and rural Hausa-speaking populations with chronic LBP. The questionnaire can be used to detect and categorize specific attitudes and beliefs about back pain in Hausa culture to prevent or reduce potential disability due to LBP.

Multidisciplinary programme for rehabilitation of chronic low back pain - factors predicting successful return to work

Background

There are no clear indicators for predicting return to work for patients with chronic low back pain (LBP). We aim to report the outcomes of a 14-week multidisciplinary programme targeting patients with chronic LBP who failed conventional physiotherapy to provide functional rehabilitation. Also, this study will identify factors predicting successful return to work (RTW).

Methods

A collected cohort of patients with chronic LBP was consecutively enrolled into the programme from 1996 to 2014. All recruited patients failed to RTW despite at least 3 months of conservative treatment. Patient underwent weekly multidisciplinary sessions with physiotherapists, occupational therapists and clinical psychologists. Patient perceived function was considered the primary outcome of the programme. Patients were assessed for their sitting, standing and walking tolerance. Oswestry Disability Index (ODI) and Spinal Function Sort Score (SFSS) were used to assess patient perceived disability.

Results

One hundred and fifty-eight patients were recruited. After the programme, statistically significant improvement was found in ODI (47.5 to 45.0, p = 0.01) and SFSS (98.0 to 109.5, p <  0.001). There was statistically significant improvement (p <  0.01) in sitting, standing, walking tolerance and straight leg raise tests. 47.4% of the patients were able to meet their work demand. Multivariate logistic regression model (R² = 59.5%, χ² (9) = 85.640, p <  0.001) demonstrated that lower initial job demand level and higher patient-perceived back function correlated with greater likelihood of returning to work.

Conclusion

The results of this study may support the use of this multidisciplinary programme to improve patient function and return to work.

Differences in Proprioception Between Young and Middle-Aged Adults With and Without Chronic Low Back Pain

Introduction: While young adults with chronic low back pain (CLBP) exhibit impaired lumbar proprioception, it remains unclear if the same phenomenon is observed in middle-aged adults with CLBP. Objectives: This study aimed to investigate whether young or middle-aged adults with CLBP displayed different proprioception ability as compared to age-matched asymptomatic controls. Methods: Sixty-four young adults with [median age:34 [interquartile range (IQR): 29-37] years] and without [median age:29 (IQR; 23-34) years] CLBP, and 87 middle-aged adults with [median age:53 (IQR: 49-58) years] and without [median age: 54 (IQR: 45-64) years] CLBP underwent postural sway tests on a force-plate with (unstable surface) and without a foam (stable surface), while bilateral L5/S1 multifidi and triceps-surae were vibrated separately. An individual's proprioception reweighting ability was estimated by relative proprioceptive reweighting (RPW). Higher RPW values indicate less reliance on lumbar multifidus proprioceptive signals for balance. Participants also underwent lumbar repositioning tests in sitting to determine repositioning errors in reproducing target lumbar flexion/extension positions. Results: Young adults with CLBP demonstrated significantly higher median RPW values than age-matched asymptomatic controls for maintaining standing balance [stable surface: CLBP: 0.9 (IQR: 0.7-0.9), asymptomatic: 0.7 (IQR: 0.6-0.8), p < 0.05; unstable surface: CLBP: 0.6 (IQR: 0.4-0.8), asymptomatic: 0.5 (IQR: 0.3-0.7), p < 0.05]. No significant differences in repositioning error were noted between young or middle-aged adults with and without CLBP (p > 0.05). RPW values were unrelated to repositioning errors in all groups (p > 0.05). Conclusion: Young adults with CLBP, and middle-aged adults with and without CLBP had inferior proprioceptive reweighting capability. This finding may indicate potential age-related deterioration in central and peripheral processing of lumbar proprioceptive signals. Future studies should use advanced imaging and/or electroencephalogram to determine mechanisms underlying changes in proprioceptive reweighting in middle-aged adults.

Cross-cultural adaptation and psychometric evaluation of the Yoruba version of the Back beliefs questionnaire among patients with chronic low-back pain

Purpose

To translate, culturally adapt and conduct a psychometric evaluation of the Yoruba version of the Back Beliefs Questionnaire (BBQ) among patients with chronic low-back pain.

Methods

The English version of the BBQ was translated into the Yoruba language through a process of forward-backward translation, reconciliation and harmonization of the reconciled items sequentially. Thereafter, Cronbach’s Alpha, Intra-Class Correlation (ICC), Bland-Altman’s analysis were used to determine the internal consistency, test-retest reliability and limits of agreement of the Yoruba version of the BBQ (BBQ-Y). Other psychometric properties of the BBQ-Y explored comprised acceptability, standard error of measurement (SEM), minimal detectable change (MDC), convergent validity and floor and ceiling effects. While 119 respondents participated in the validity testing, only 51 of them were involved in the reliability testing of the BBQ-Y. Data were analysed using descriptive and inferential statistics. Alpha level was set at p < 0.05.

Results

The mean age of the respondents all the respondents was 56.8 ± 8.5 years. The BBQ-Y had excellent acceptability with a global Cronbach Alpha score of 0.71. The SEM and MDC of the BBQ-Y were 2.3 and 6.4. The BBQ-Y ICC score for test-retest was 0.89, while the Bland-Altman analysis showing limits of agreements for the test-retest reliability were − 6.84 and 5.70. The convergent validity of the BBQ-Y showed a weak correlation (r = 0.273, p = 0.001) with pain intensity using the visual analogue scale.

Conclusion

This is the first study to culturally adapt the BBY-Y and determined its psychometric properties. The BBQ-Y has adequate psychometric properties and it is an appropriate outcome measure for use among Yoruba speaking patients with chronic low-back pain.

Back beliefs among elderly seeking health care due to back pain; psychometric properties of the Norwegian version of the back beliefs questionnaire

BACKGROUND

The Back Beliefs Questionnaire (BBQ) is a 14-item patient-reported questionnaire that measures attitudes and beliefs about the consequences of back pain. The BBQ has recently been translated into Norwegian, but its psychometric properties have not yet been tested. The aim of this study is to evaluate the reliability and construct validity of the BBQ when used on elderly patients with back pain.

METHOD

A prospective cohort study with a test-retest design among 116 elderly patients (> 55 years of age) seeking primary care for a new episode of back pain. Test-retest, standard error of measurement (SEM), minimal detectable change (MDC), internal consistency and construct validity by a priori hypotheses (Spearman's- and Pearson correlation coefficient) were tested.

RESULTS

A total of 116 patients, mean age (SD) 67.7 (8.3), were included and 63 patients responded to the test-retest assessment. The mean (SD) BBQ sum scores (range 9-45) were 29.8 (7.0) and 29.2 (6.7) for the test and retest respectively. The test-retest was acceptable with an intraclass correlation coefficient of 0.71 (95% CI, 0.54-0.82), SEM was 3.8 and MDC 10.5. Internal consistency with Cronbach's alpha was good (0.82) and acceptable construct validity was supported by the confirmation of 75% of the a priori hypotheses.

CONCLUSION

The Norwegian version of the BBQ demonstrated acceptable test-retest reliability and good construct validity and can be used to assess pessimistic beliefs in elderly patients with back pain.

Validation of the LOCOMO-25 and its minimum clinically important differences in domain scores for Chinese patients with low back pain and neck pain

BACKGROUND

The 25-question Geriatric Locomotive Function Scale (LOCOMO-25) was developed to assess any decline in mobility functions. This study aims to validate the LOCOMO-25 in Chinese patients with chronic low back pain and/or neck pain.

METHODS

Adult patients with chronic low back pain and/or neck pain completed the LOCOMO-25, SF-36, EQ-5D-5L, ODI, VAS and/or NDI. Internal consistency was assessed by Cronbach's alpha coefficient (α). Test-retest reliability was assessed by intra-class correlation coefficients. Construct validity was assessed by Spearman correlation tests against other outcome measures. Sensitivity to detect differences between groups was assessed by Mann-Whitney U or Kruskal-Wallis H test, where appropriate. Intergroup comparison was performed further in terms of domain scores and their changes at test-retest.

RESULTS

A total of 111 patients were consecutively recruited. LOCOMO-25 demonstrated excellent internal consistency (α = 0.915) and test-retest reliability (Intraclass correlation: 0.705 to 0.826). LOCOMO-25 was significantly correlated with all domains of SF-36, EQ-5D, ODI, NDI, and VAS (p < 0.01). It was found to be sensitive in differentiating between patients with neural compression (32.8 ± 16.9) and without (21.2 ± 12.7), with history of fall(s) within the previous one year (30.8 ± 16.0) and without (24.2 ± 15.1), requires assistive devices for ambulation (40.6 ± 21.6) or independent (23.6 ± 13.1) and various pain levels (mild: 17.2 ± 10.6; moderate: 23.5 ± 11.7; severe: 38.5 ± 16.5). Patients with neural compression scored significantly higher in the domain of pain and patients requiring assistive devices for ambulation scored significantly higher in the domains of ADL and social functions. The minimum detectable differences for various domains of the LOCOMO-25 score included pain (2.76), activities of daily living (6.07), social function (1.59), and mental health status (2.06).

CONCLUSIONS

LOCOMO-25 has been validated in Chinese patients with chronic low back and neck pain with satisfactory psychometric properties, and with individual domain minimum clinically important differences. There is adequate internal consistency, test-retest reliability, construct validity and sensitivity to detect differences between patients with/without neural compression, different ambulatory statuses and pain severity.

Psychometric Properties of the Hindi Version of the Fear-Avoidance Beliefs Questionnaire in Patients With Chronic Non-Specific Low Back Pain

STUDY DESIGN

Prospective cohort study.

OBJECTIVE

To translate, adapt, and establish psychometric properties of the Fear-Avoidance Beliefs Questionnaire (FABQ) for Hindi-speaking patients with chronic non-specific low back pain.

SUMMARY OF BACKGROUND DATA

The FABQ is a patient-reported measure to assess beliefs regarding how physical activity and work are influenced based on fear related to low back pain.

METHODS

Standardized translation guidelines were implemented to confirm Hindi-version of the FABQ (FABQ-H). A cross-sectional study design was utilized. Construct validity analysis included factor analysis of the FABQ and use of Pearson correlation coefficients to report convergent and divergent validity. Reliability assessment included calculation of intraclass correlation coefficient (ICC) and Cronbach α for internal consistency. Outcome measures consisted of Numeric Rating Scale (NRS), Roland Morris Disability Questionnaire (RMDQ) Hindi, and Tampa Scale of Kinesiophobia (TSK).

RESULTS

In total, 100 patients with chronic non-specific low back pain were recruited, with a mean age of 36.89 (±7.78). Factor analysis revealed a three-factor structure of the FABQ, which consisted of subscales FABQ Physical activity, FABQ Work, and FABQ Work prognosis. Convergent validity analysis demonstrated a moderate correlation between FABQ-H and TSK (r = 0.413). Divergent validity analysis displayed a moderate correlation between FABQ-H and NRS (r = 0.362) and RMDQ Hindi (r = 0.399). ICC value for the FABQ-H was observed as 0.938 indicating high significance for test-retest reliability. Cronbach α for the FABQ-H was recorded as 0.806 demonstrating high internal consistency.

CONCLUSION

A successful translation and adaptation of the Hindi version of FABQ is reported in this study. The three-factored FABQ-H exhibited satisfactory construct validity, test-retest reliability, and internal consistency. Based on findings of this study, the FABQ-H can be implemented in Hindi-speaking patients with chronic non-specific low back pain (LBP).

LEVEL OF EVIDENCE

3.

Differential Psychometric Properties of EuroQoL 5-Dimension 5-Level and Short-Form 6-Dimension Utility Measures in Low Back Pain

STUDY DESIGN

Prospective study.

OBJECTIVE

To examine the acceptability and validity of EuroQoL 5-dimension 5-level (EQ-5D-5L) and Short-Form 6-Dimension (SF-6D) health utility measures in patients with low back pain (LBP).

SUMMARY OF BACKGROUND DATA

LBP requires multiple diagnostic tests and treatment that can incur high medical costs. It is thus desirable to have an appropriate measure for cost-utility analysis of various LBP-related interventions.

METHODS

Health-related quality of life (HRQoL) questionnaires including generic 12-item Short Form Health Survey (SF-12), EQ-5D-5L, and low back/back-related questionnaires were administered at a specialty clinic. SF-12 items responses were transformed to SF-6D utility scores using the Hong Kong population scoring algorithm whereas EQ-5D-5L responses were mapped onto EQ-5D-3L response, then converted to EQ-5D-5L utility scores using the Chinese-specific value set. Construct validity was determined by evaluating Spearman correlation between SF-12 and EQ-5D-5L scores. Correlation between back-specific questionnaires and HRQoL scores were assessed.

RESULTS

A total of 100 patients were recruited. No significant (>15%) floor and ceiling effects were observed for EQ-5D-5L and SF-6D scores. Detailed proportion of respondents for each EQ-5D-5L domain indicated that Pain/Discomfort domain was the most prevalent problem. SF-6D utility score and EQ-5D-5L had respective strong (0.600-0.855) and moderate-to-strong (0.455-0.700) correlations with SF-12 domain and summary scores. EQ-5D-5L and SF-6D scores were correlated (0.625), with adequate construct validity as both utility scores conceptually measure the similar construct. Patients with no previous spine surgery nor disc degeneration had significantly higher EQ-5D-5L scores. Both EQ-5D-5L and SF-6D significantly correlated with back-specific questionnaires.

CONCLUSION

Both EQ-5D-5L and SF-6D appeared as applicable and valid measures in assessing HRQoL of LBP patients. Being the first study examining the differential psychometric properties and validation of the use of EQ-5D-5L and SF-6D in Chinese LBP population, this allows future exploration of the impact of utility score selection on assessing effectiveness of clinical intervention for LBP.

LEVEL OF EVIDENCE

2.

Cross-Cultural Adaptation, Reliability, and Validity of the Chinese Version of the Tampa Scale for Kinesiophobia-11 Among Patients Who Have Undergone Total Knee Arthroplasty

BACKGROUND

The shortened version of the Tampa Scale for Kinesiophobia (TSK-11) has been well characterized in the literature. However, to the best of our knowledge, no previous studies have evaluated the reliability and validity of the TSK-11 for Chinese-speaking patients who have undergone total knee arthroplasty (TKA). Thus, the objectives of this study were to translate and adapt the TSK-11 cross-culturally into Chinese and to evaluate its reliability and validity in a sample of Chinese TKA patients.

METHODS

The TSK-11 was translated and cross-culturally adapted into Chinese according to the international guidelines for the cross-cultural adaptation of self-report measures. The Chinese version of TSK-11 was administered to 254 patients following their TKA, along with the Fear-Avoidance Beliefs Questionnaire, Pain Catastrophizing Scale, Numerical Rating Scale, and 12-Item Short Form Health Survey. Psychometric testing included internal consistency, test-retest reliability, floor and ceiling effects, construct validity, and convergent validity.

RESULTS

A high completion rate of 95.8% with no floor or ceiling effects was noted in the Chinese version of the TSK-11. The questionnaire also showed good internal consistency (Cronbach's α = 0.883) and test-retest reliability (intraclass correlation coefficient = 0.798). Construct validity was assessed by exploratory factor analysis, and 3 factors were extracted that accounted for 65.2% of the variance. Convergent validity was confirmed by significant Pearson correlations between the Chinese version of the TSK-11 and the Pain Catastrophizing Scale (r = 0.751), Fear-Avoidance Beliefs Questionnaire (r = 0.719) and VAS (r = 0.450), as well as the 12-Item Short Form Health Survey subdomains Bodily Pain (r = -0.391), Mental Health (r = -0.356), Physical Functioning (r = -0.339), Role-Emotional (r = -0.317), and Role-Physical (r = -0.277).

CONCLUSION

The Chinese version of the TSK-11 demonstrated satisfactory acceptability, reliability, and validity; therefore, it can be used in clinical practice and research for assessing kinesiophobia in Chinese patients after TKA.

Psychometric validation of the adapted Traditional Chinese version of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ)

BACKGROUND

Low back pain is a common health problem encountered by various populations among different countries. This prospective study aimed to translate and cross-culturally adapt the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) into Traditional Chinese and to assess its validity, reliability and sensitivity in Chinese patients experiencing low back pain.

METHODS

Double forward and single back translation of the JOABPEQ was performed with cross-cultural adaptation. By convenience sampling, the final version of the translated JOABPEQ was administered to Chinese patients attending a specialty outpatient clinic with a history of back pain, followed by the traditional Chinese versions of Oswestry Disability Index (ODI) and Short Form-12 version 2 (SF-12v2). Construct validity of the domains were assessed using Spearman's correlation test. Internal consistency was assessed by Cronbach's alpha (α). Sensitivity of the adapted JOABPEQ was determined by known group comparisons.

RESULTS

A total of 100 patients were recruited. The translated JOABPEQ demonstrated excellent overall internal consistency (α: 0.912); and good internal consistency for the domains of Lumbar Function, Walking Ability, Social Life Function and Mental Health (α: 0.811, 0.808, 0.788, and 0.827 respectively). Scores of all domains of the translated JOABPEQ had significant correlations (p < 0.01) with ODI at all domains, as well as with almost all domains of SF-12v2 (p < 0.01-0.05). The translated JOABPEQ was sensitive in detecting differences in patients with/without a history of previous spine surgery, and also between patients with acute/acute on chronic versus chronic pain in specific domains.

CONCLUSIONS

The Traditional Chinese version of JOABPEQ has satisfactory psychometric properties in general, including adequate clinical and construct validity, and internal consistency in assessing Southern-Chinese patients with low back pain. It is demonstrated as a sensitive outcome measure. The translated JOABPEQ is verified for its use in the local clinical setting for patient assessment and future research.