Perceived Barriers to Breast Cancer Screening among Saudi Women at Primary Care Setting

Insights into the Refusal of Free Screening Mammograms: Exploring Contributing Factors

Background

Despite the availability of free screening mammograms (SMG) through the Breast Cancer Early Detection (BCED) Program in the Qassim region of Saudi Arabia, a notable gap exists between program implementation and the actual uptake of SMG. This study aims to assess the refusal rate, identify barriers to participation, and shed light on the factors influencing women's decisions regarding SMG.

Methods

A cross-sectional study was conducted among consecutive women aged 40-69 participating anonymously in the BCED program in September 2023. The participants were administered a validated Arabic language survey encompassing breast cancer screening backgrounds and knowledge, reasons for refusal, and factors influencing SMG reconsideration. Logistic regression was employed to identify factors linked with SMG refusal using SPSS version 28.

Results

Of the 2446 eligible women in the study, 576 (23.6%) declined to undergo SMG. The median age of participants was 49 years, primarily married (91.5%) and residing in central cities (60.3%). Previous mammogram history was reported by 21.4%, with only 12.9% performing regular SMGs every 1-2 years. Married women had a 31% lower refusal likelihood to SMG compared to widowed/divorced women (Adjusted Odds Ratio [aOR] = 0.69, p = 0.02). Women residing in peripheral areas showed approximately 1.45 times higher odds of refusal compared to those in central cities (aOR = 1.45, p < 0.001), and women without prior history of SMG had 2.13 times higher odds of refusal (aOR = 2.14, p < 0.001).

Conclusion

The refusal rate for SMG in the Qassim region aligns closely with rates observed in developed countries. Despite this progress, significant barriers to SMG uptake persist, and tailored interventions targeting specific demographic groups and addressing these barriers are essential to improving screening participation, promoting a culture of proactive screening behavior, and ensuring equitable access to screening services for all eligible women.

Barriers to Breast Cancer Screening in Saudi Arabia: A Systematic Review and Meta-Analysis

Breast cancer is a significant public health concern globally, and early detection through screening programs can improve treatment outcomes and reduce mortality rates. However, the uptake of breast cancer screening among women in Saudi Arabia is hindered by various barriers. This systematic review and meta-analysis aimed to elucidate the barriers to breast cancer screening among women in Saudi Arabia, providing insights into the multifaceted challenges hindering screening uptake and informing tailored interventions and policy recommendations. A comprehensive literature search was conducted across electronic databases and grey literature sources to identify relevant studies on barriers to breast cancer screening in Saudi Arabia. Studies conducted between 2017 and 2023, employing diverse settings and methodologies, were included in the analysis. Data on the prevalence of barriers, family history of breast cancer, and self-reported breast examination practices were extracted and synthesized. A total of 14 studies met the inclusion criteria, encompassing diverse populations and methodologies. The included studies predominantly employed cross-sectional survey designs and targeted various populations across different regions of Saudi Arabia. The barriers to breast cancer screening were investigated, revealing concerns such as fear of discovering cancer, embarrassment due to breast-related tests, fear of pain related to clinical examination, and lack of awareness. Additionally, a substantial proportion of participants reported a family history of breast cancer, indicating a significant risk factor for the disease. Self-reported breast examination practices varied among participants, with disparities in screening behaviors observed. Our review identified fear of diagnosis, embarrassment, and lack of awareness as key barriers to breast cancer screening in Saudi Arabia. Targeted interventions, including education and improved access, are essential to address these challenges and enhance early detection efforts, reducing the burden of breast cancer.

Perceptions and Behaviors Regarding Early Screening and Breast-Related Complaints Among Saudi Women

Background Breast cancer (BC) is a global public health issue, contributing to a significant death toll among women. Breast cancer is the most common type among Saudi women, accounting for over a quarter of all new cancer cases. The current approaches for detecting BC include mammography, clinical breast exams, and breast self-examination (BSE). Early diagnosis of BC is crucial for reducing mortality and morbidity. This study aims to investigate attitudes and behaviors regarding early screening and self-examination of breast cancer in Saudi Arabia. Materials and method This cross-sectional study was conducted over eight months. The sample size calculation with a 95% confidence interval and 0.05 precision rate is 600 of the total targeted group. The study included Saudi females aged 30 and above. Data were collected via an online questionnaire. The questionnaire evaluated various aspects, including information regarding sociodemographics, barriers, and attitudes toward breast cancer screening. Results The majority of participants were aged 41-50 (40.7%) and married (76.2%). Over a third (31.9%) had been diagnosed with benign breast tumors, with MRI being the most common examination method (39.2%). Regarding screening practices, 55.7% had been screened previously, with a high intention for future screening (76.8%). Attitudes toward screening were positive, with 83.4% willing to undergo testing if free, painless, and conducted by a female provider. Barriers to screening included fear of examination (30.2%) and shame about exposing the body (25.6%). Conclusion The study provides valuable insights into the demographic characteristics, prevalence of benign breast tumors, screening practices, and attitudes toward breast cancer screening among Saudi women aged 30 and above. Factors such as age, marital status, income, occupation, and geographical residency influence screening behavior and intentions. Efforts to promote awareness, reduce barriers, and improve access to screening services are essential for enhancing breast cancer detection and prevention within this population.

Breast Cancer and Screening Prevention Programmes: Perceptions of Women in a Multicultural Community in Southern Thailand

BACKGROUND

Breast cancer is a leading cause of morbidity and mortality among women worldwide and in Thailand.

OBJECTIVE

To explore perceptions of breast cancer and screening prevention programmes among a group of at-risk women in a multicultural setting in southern Thailand.

METHODS

Semi-structured in-depth interviews were used for data collection with 30 at-risk group women. Women from Muslim and Buddhist backgrounds were purposively included in this study. The thematic analysis method was used to analyse the data.

RESULTS

Four themes were identified from our data: perceptions of breast cancer, being diagnosed with breast cancer and anxiety, stigma: effects of breast cancer, and breast self-screening and prevention of breast cancer. The participants had some knowledge about the risk factors for breast cancer. However, participants perceived that breast cancer could occur to individual women at any time and that it was not possible to entirely prevent the disease, even when following a breast self-examination programme. However, most participants perceived that whether one would be afflicted by breast cancer depended also on Allah and their own karma. All participants were encouraged to attend breast self-screening training by healthcare providers of local health centres, but they had no confidence to perform self-screening soon after finishing the training programme. This became the reason for a lack of regular self-screening with responsibility left to health practitioners. Although participants were aware that breast self-screening should be their routine practice, there were multiple barriers to this, including accurate knowledge about breast cancer, belief, self-awareness, screening skills and healthcare facilities. Breast self-screening was recognised as an important means of early detection. However, most women did not perform this regularly, which could increase their risk of developing breast cancer.

CONCLUSIONS

Public health providers need to be more concerned about the perceptions, beliefs and practices regarding breast cancer and develop prevention practices that work better for women living in more diverse cultural locations so that they may be able to follow preventive practices and reduce their vulnerability to breast cancer.

Practices of Cancer Screening for Average-Risk Cancer Patients Among Primary Healthcare Center Physicians in Al-Qassim Region, Saudi Arabia

OBJECTIVE

Cancer screening programs exist in Saudi Arabia for some types of cancers. However, data on primary healthcare center (PHC) physicians' practices in referring patients for screening tests or procedures remain unclear.

METHODOLOGY

A cross-sectional study was conducted with a self-reported survey that included 141 PHC physicians affiliated with the Ministry of Health in the Al-Qassim region of Saudi Arabia. The primary outcome was the practice of recommending to average-risk patients screening tests for different types of cancers including breast, colorectal, cervical, prostate, and lung, and testing if sociodemographic, specialty, job level, years of experience, a family history of cancer, and patients encountered per day affect their decisions. Secondary outcomes were the barriers perceived by physicians to recommending a screening test. p-value <0.05 was considered significant.

RESULTS

The study included 141 respondents, of which 60.3% were males, and the mean age of the entire population was 35.7 ± 8.3 years. The rate of recommending cancer screening varied by the type of cancer, with screening for colorectal cancer being the most prominent (64.5%), followed by breast cancer (51.8%). Fear of finding cancer, poor patient compliance, and difficulty in scheduling the test were the most common patient, physician, and system-related barriers as perceived by PHC physicians. Male physicians were less likely to recommend patients for breast (0.10, 95%CI 0.04-0.23, p < 0.001) and cervical (0.26, 95%CI 0.08-0.78, p = 0.017) cancer screening. However, they were 3.74 times more likely to recommend prostate cancer screening (95%CI 1.20-11.68, p = 0.023) and 5.79 times more likely to request lung cancer screening (95%CI 1.27-26.39, p = 0.023).  Level of education, specialty, and being a senior physician were factors associated with cervical cancer screening. Physicians who work in non-general practice specialties were more likely to recommend cervical cancer screening than those who work in general practice (95%CI 0.04-0.48, p = 0.002). Senior physicians such as registrars/senior registrars and consultants were more likely to request or recommend a patient for breast cancer screening (2.85, 95%CI 1.11-7.35) and cervical cancer screening (6.35, 95%CI 2.10-019.19).

CONCLUSION

Screenings for colorectal and breast cancer were the commonly recommended screening tests. Patients' fear of finding cancer, poor patient compliance, and delays or difficulty in scheduling the procedures were the commonly identified barriers as perceived by physicians that influenced physician decisions in referring patients for cancer screening. Our findings suggest that cancer screening rates may be improved by educating individuals on the benefit of early detection of cancers and providing assurance for them with regard to the availability of effective treatments. More research is needed on ways to overcome the obstacles physicians encounter and the outcomes of these measures with regard to improved screening practices.

Evaluation of participation and performance indicators in a breast cancer screening program in Saudi Arabia

OBJECTIVES

To evaluate early performance indicators for breast cancer screening at the King Abdulaziz University Hospital in Saudi Arabia.

METHODS

This study retrospectively evaluated data from women who underwent their first breast cancer screening program in Jeddah, Saudi Arabia between 2012 and 2019. Data on screening results were used to estimate performance indicators and generate descriptive statistics.

RESULTS

Of the 16000 women invited from 2012 to 2019, a total of 1911 (11.9%) participated. The majority of women (68.8%) were between 40 and 55 years old. Based on the screening process results, 26.6%, 40.1%, 9.7%, 1.3%, 0.7%, and 5.2% of women had BI-RADS scores of R1, R2, R3, R4, R5, and R0 respectively. The remaining 16.3% did not have mammogram records. The recall rate, or the percentage of women who underwent further evaluation, was 19.9%; 18.9% underwent a biopsy procedure. In addition, 1.6% of women had cancer screen-detected, although only 0.7% were diagnosed with breast cancer.

CONCLUSION

In light of the low participation and high recall rates, it is essential that the screening program utilizes performance indicators to optimize resource utilization and ensure the quality of the service provided. Additionally, a national framework and standardized performance indicators could mitigate this problem for other cancer screening programs.

Evaluation of Arab Cultural Barriers That Influence Muslim Arab Iraqi Women's Breast Cancer Screening Behavior

OBJECTIVE

Little is known about Iraqi women's practice towards breast cancer screening (BCS), breast self-examination (BSE), clinical breast examination (CBE) and mammography, and the influence of Arab culture. The aim of this study was to assess women's behavior towards BCS, and to explain the influence of specific Arab culture barriers.

MATERIALS AND METHODS

This descriptive study was carried out with 1,066 women. Three structured questionnaires were used in the data collection. Descriptive statistics and multivariable logistic regression were used for data evaluation.

RESULTS

Many Iraqi women did not practice regular BSE, CBE, and mammography. The most common reason was "not having a breast complaint". Specific Arab cultural barriers such as exposure [odds ratio (OR) = 0.545; 95% confidence interval (CI) = 0.440 to 0.674; p<0.001], environment (OR = 0.571; 95% CI = 0.464 to 0.703; p<0.001) and uneasiness barriers (OR = 0.736; 95% CI = 0.557 to 0.974; p=0.032) were predictors for BSE while exposure (OR = 0.553; 95% CI = 0.447 to 0.684; p<0.001), and environment barriers (OR = 0.585; 95% CI = 0.474 to 0.772; p<0.001) was predictor for CBE. Additionally, exposure (OR = 0.324; 95% CI = 0.251 to 0.419; p<0.001), environment (OR = 0.636; 95% CI = 0.500 to 0.809; p<0.001), and uneasiness barriers (OR = 0.644; 95% CI = 0.464 to 0.893; p = 0.008) were predictors for mammography screening of Iraqi women.

CONCLUSION

Arab specific cultural barriers may be one of the key obstacles to BSC uptake in Iraq. Health education, including cultural education, may have the potential to increase BCS awareness and down-staging of the disease at presentation.

Breast Cancer in Asia: Incidence, Mortality, Early Detection, Mammography Programs, and Risk-Based Screening Initiatives

Simple Summary

Nearly all breast cancer patients survive for more than five years when the tumor is found early and in the localized stage. Regular clinical breast examinations, mammograms, and monthly self-exams of the breasts all contribute to early detection. However, late-stage breast cancers are common in many Asian countries. Low-income countries suffer from a lack of resources for breast cancer screening. High-income countries, on the other hand, are not benefiting fully from national breast screening programs due to an underutilization of the preventive healthcare services available. Existing reviews on Asian breast cancers are heavily focused on risk factors. The question of whether we should adopt or adapt the knowledge generated from non-Asian breast cancers would benefit from an extension into screening guidelines. In addition, several Asian countries are piloting studies that move away from the age-based screening paradigm.

Abstract

Close to half (45.4%) of the 2.3 million breast cancers (BC) diagnosed in 2020 were from Asia. While the burden of breast cancer has been examined at the level of broad geographic regions, literature on more in-depth coverage of the individual countries and subregions of the Asian continent is lacking. This narrative review examines the breast cancer burden in 47 Asian countries. Breast cancer screening guidelines and risk-based screening initiatives are discussed.

Predicting Rural Women's Breast Cancer Screening Intention in China: A PLS-SEM Approach Based on the Theory of Planned Behavior

Background

It was reported that the incidence of breast cancer (BC) was the highest among cancers worldwide. The breast cancer screening (BCS) program is regarded as an effective preventive measure. However, rural women's willingness to participate in the BCS program is relatively low. To provide measures to prevent BC, it is necessary for the government to identify the influencing factors of rural women's BCS intention.

Methods

A cross-sectional study was conducted among 3,011 rural women by a convenience sampling method through face-to-face interviews on a self-designed questionnaire based on the theory of planned behavior (TPB). The partial least square structural equation model (PLS-SEM) was conducted to determine the predictors of BCS intention, and a multi-group analysis (MGA) of age was performed to identify if there were differences in all hypotheses between different age groups.

Results

There were still rural women who have not been screened for BC in five years (41.7%). The research model of rural women's intention to accept this prevention against BC was rational. All of the hypotheses are supported. Especially, subjective norm (SN) (β = 0.345, p &lt; 0.001) is found to be the strongest predictor followed by the perceived behavioral control 1 (PBC 1) (personal factors, including distance, transportation, busyness, etc.) (β = 0.165, p &lt; 0.001), attitude (β = 0.152, p &lt; 0.001), past behavior (PB) (β = 0.150, p &lt; 0.001), knowledge (β = 0.121, p &lt; 0.001), and perceived behavioral control 2 (PBC 2) (pain and cultural-social factors including embarrassment from a physician, etc.) (β = 0.042, p &lt; 0.05). The advocacy and education (A&amp;E), medical level and service attitude (ML&amp;SA) of township health centers and village clinics can affect behavior intention (BI) via attitude, SN, and PBC. The results of MGA of age indicate that there are significant differences among rural women of different ages regarding the relationship between A&amp;E and PBC 2 (p &lt; 0.01) and the effect of PB on BI (p &lt; 0.001).

Conclusion

The TPB with the addition of PB, knowledge, ML&amp;SA, and A&amp;E can provide the theoretical basis for the policy intervention that aims to enhance the rural women's BCS willingness. MGA of age is conducive to promoting the implementation of the BCS policy. The findings are of great significance to improve rural women's health levels.

Determinants of Breast Cancer Screening Practice among Women in Indonesia: A Nationwide Study

Background:

Breast cancer remains the leading cause of death for women globally, including in Indonesia. Breast cancer screening plays a vital role in reducing deaths caused by breast cancer. However, breast cancer screening rate is still low and studies on determinants for breast cancer screening is limited in Indonesia. This study aimed to identify the determinants of breast cancer screening among women in Indonesia.

Methods:

This population-based study was conducted among 827 women who lived in either rural and urban areas, using a stratified sampling design where were based on province and locality combinations. Data were analysed using a binary logistic regression model to assess the associations between independent and dependent variables.

Results:

As many as 827 women with an average age of 29.91 (± 11.14) years old participated in this study. The overall breast cancer screening among women was 18.74%. Knowledge of breast cancer risk factors, signs, and symptoms (adj.OR = 1.75, 95%CI: 1.20 – 2.56), age of 35 to 39 years old (adj.OR. = 1.52, 95% CI: 1.02 – 2.26), and household income of ≥6,000,000 IDR (≥457 USD) (adj.OR. = 5.19, 95%CI: 1.43–18.84) were associated with breast cancer screening attendance. In contrast, Christian women had a significantly lower breast cancer screening rate that women from other religions (adj. OR. = 0.45, 95%CI: 0.24 – 0.85).

Conclusion:

The overall breast cancer screening attendance was poor among Indonesian women population. Age, household income, religion, and knowledge of breast cancer risk factors were identified as the determinant factors for breast cancer screening.

Husbands' Knowledge of Breast Cancer and Their Wives' Attitudes and Practices Related to Breast Cancer Screening in Saudi Arabia: Cross-sectional Online Survey

BACKGROUND

Despite Saudi Arabia's free and well-established cancer care program, breast cancer incidence and mortality are rising. Husbands' knowledge, and wives' attitudes and practices related to breast cancer screening are not well understood in Saudi Arabia.

OBJECTIVE

The aim of this study was to investigate husbands' knowledge, and wives' attitudes and practices related to breast cancer screening in Saudi Arabia.

METHODS

This cross-sectional study collected data from 403 husbands in the holy city of Makkah through an online self-reported questionnaire over a period of 2 months, from May 6 to July 7, 2020. Tabulation, bivariate, and multiple regression analyses were the major tools used for data analysis. Multivariate logistic regressions were used to examine the association between husbands' knowledge and wives' behavior regarding breast cancer screening methods.

RESULTS

Husbands' knowledge score (a 1-point increase) was significantly associated with the wives' utilization of mammograms (adjusted odds ratio [AOR] 1.089, 95% CI 1.024-1.159) and breast self-examination (AOR 1.177, 95% CI 1.105-1.255). Husbands' knowledge also influenced the wives' attitudes toward learning about breast self-examination (AOR 1.138, 95% CI 1.084-1.195). There was no significant association between husbands' knowledge and wives' utilization of clinical breast examination. However, richer husbands showed a socioeconomic gradient concerning their wives' utilization of clinical breast examinations (AOR 2.603, 95% CI 1.269-5.341).

CONCLUSIONS

Overall, husbands' knowledge of breast cancer influences wives' attitudes and practices related to breast cancer screening methods in Saudi Arabia. Thus, interventions delivered to husbands might increase breast cancer awareness and survival.

The Relationship between Risk Levels of Breast Cancer and Use of Early Diagnosis and Screening Services in Healthcare Workers in Turkey

BACKGROUND

This study aimed to determine the factors affecting early diagnosis and screening behaviors of healthcare workers concerning breast cancer and the breast cancer risk levels using the risk identification model and to evaluate the relationship between breast cancer risk levels and early diagnosis and screening behaviors.

METHODS

Overall, 466 healthcare workers from Balikesir Province, Turkey participated in this cross-sectional study. Data were collected thanks to a questionnaire prepared by the researchers. Cuzick-Tyrer model was utilized to determine breast cancer risk levels.

RESULTS

78.1% of the healthcare workers regularly perform breast self-examination (BSE), 11.6% had clinical breast examination (CBE), 7.7% had breast ultrasound scan and 4.5% had mammography. BSE behavior increased, as education level got higher. Mammography screening behavior increased in those aged 40 yr and older and those with breast or ovarian cancer history in their family. There was not any relationship between breast cancer risk levels and early diagnosis and screening behaviors.

CONCLUSION

Early diagnosis and screening behaviors of healthcare workers were low concerning breast cancer. Age, education level and family history are the most prominent factors affecting early diagnosis and screening behaviors of healthcare workers. Informing healthcare workers on breast cancer risk factors and screening can make positive contributions to them and the public through them.

A hospital based survey to evaluate knowledge, awareness and perceived barriers regarding breast cancer screening among females in Bangladesh

Background

Early diagnosis of breast cancer is essential for mitigating its related morbidity and mortality. Therefore, high awareness is required.

Objectives

We aimed to evaluate the knowledge, awareness and perceived barriers among females in Bangladesh regarding breast cancer.

Methods

A hospital-based survey was performed from April 2019 to June 2019. A total of 500 females aged >18 years were recruited to the study. The participants were selected by trained personnel and physicians via simple random sampling.

Results

The mean participant age was 37.13 ± 12.66 years. Among all the participants, 79% were married, 4% were single, 3% were divorced and 14% were widowed. We observed that 80.6% of respondents were housewives, 5% were students and 14.4% were working women. The participants had a severe lack of knowledge and awareness, and perceived barriers regarding breast cancer screening. Breast cancer was more linked to personal history, occupation and, marital status. Shyness, fear, lack of knowledge and deficient awareness programs were the major perceived barriers.

Conclusion

Educational interventions and proper, appropriate and socially acceptable awareness programs will help to ameliorate knowledge and awareness by addressing barriers regarding breast cancer among the females in Bangladesh.

Social Determinants of Breast Cancer Screening among Married Women: A Cross-Sectional Study

BACKGROUND

Regular cancer screening is the best way for early detection of breast cancer, but studies showed the low participation rates of screening in Iran. We aimed to determine breast cancer screening among married women and related factors in North of Iran.

STUDY DESIGN

A cross-sectional study.

METHODS

This cross-sectional study was carried out from Jan to Mar 2017 among 1472 married women in an urban population in Rasht City, North of Iran. Data were collected using a questionnaire included socio-demographic information and breast cancer screening behaviors. Descriptive statistics, chi-square and logistic regression were used for data analyzing with SPSS.

RESULTS

The mean age of women was 35.1 ±6.5 years. Majority of women never performed clinical breast examination (70.7%) and regular monthly breast self-examination (52.2%). Only women over 40 yr performed mammography. Mammography performance was associated with health insurance (OR=4.99; 95% CI: 1.10, 22.53) and family history (OR=1.60; 95% CI: 1.19, 2.19), clinical breast examination was associated with age of women (OR=2.87; 95% CI: 1.90, 4.32) and breast self-examination was associated with age and occupation of women [OR=1.67; 95 % CI: 1.16, 2.39, OR=1.65; 95% CI: 1.19, 2.29) respectively].

CONCLUSION

The rate of breast cancer screening was low among married women. Therefore considering the structural and cultural barriers, effective health education is essential to reduce inequality and increase the efficiency of screening programs.

Age distribution and outcomes in patients undergoing breast cancer resection in Saudi Arabia. A single-institute study

Objectives

In response to rising incidence and mortality we aimed to investigate the demographic characteristics of patients with operative breast cancer in our region.

Methods

We performed a retrospective study of 224 patients who underwent surgery for breast cancer at King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia between 2005 and 2012.

Results

We identified a young population overall with a mean age of 48.8±12.2 years (range: 26-93 years). Survival rate were however similar across all age groups with a 10-year overall survival of 87%.

Conclusion

Patients in our study were generally younger than those with breast cancer in Western nations. However, unlike Western countries, young age was not associated with worse outcomes.

Validation of the Japanese version of the Central Sensitization Inventory in patients with musculoskeletal disorders

Background

Many musculoskeletal pain conditions are characterized by hypersensitivity, which is induced by central sensitization (CS). A questionnaire, the Central Sensitization Inventory (CSI), was recently developed to help clinicians identify patients whose presenting symptoms may be related to central sensitivity syndrome (CSS). The aims of the present study were to examine criterion validity and construct validity of the Japanese version of the CSI (CSI-J), and to investigate prevalence rates of CS severity levels in patients with musculoskeletal disorders.

Methods

Translation of the CSI into Japanese was conducted using a forward-backward method. Two hundred and ninety patients with musculoskeletal pain disorders completed the resultant CSI-J. A subset of the patients (n = 158) completed the CSI-J again one week later. The relationships between CSI and clinical symptoms, EuroQol 5-dimension (EQ-5D) and Brief Pain Inventory (BPI), were examined for criterion validity. EQ-5D assesses Health-related QOL and BPI measures pain intensity and pain interference. The psychometric properties were evaluated with analyses of construct validity, factor structure and internal consistency, and subsequently investigate the prevalence rates of CS severity levels.

Results

The CSI-J demonstrated high internal consistency (Cronbach’s α = 0.89) and test-retest reliability was excellent value (ICC = 0.85). The CSI-J was significantly correlated with EQ-5D (r = −0.44), pain intensity (r = 0.42), and pain interference (r = 0.48) (p < 0.01 for all). Ten percent of the participants were above the cutoff “40”. The exploratory factor analysis resulted in 5-factor model.

Conclusions

This study reported that the CSI-J was a useful and psychometrically sound tool to assess CSS in Japanese patients with musculoskeletal disorders. The finding of the prevalence rates of CS severity levels in patients with musculoskeletal disorders may help clinicians to decide strategy of treatment.