Reliability and validity study of the Gujarati version of the Oswestry Disability Index 2.1a

Cross-cultural adaptation and psychometric testing of the Arabic version of the Modified Oswestry Low Back Pain Disability Questionnaire

Background

The Modified Low Back Pain Disability Questionnaire (MLBPDQ) is used for evaluating the functional disability in patients with low back pain (LBP). However, the measurement characteristics of the MLBPDQ among Arab patients are unknown. In this study, we aimed to translate and cross-culturally adapt the MLBPDQ into Arabic and evaluate its psychometric properties.

Methods

An Arabic version of the MLBPDQ was developed through forward translation, translation synthesis, and backward translation. Sixty-eight patients (55 males and 13 females) with a mean age 37.01 ± 7.57 years were recruited to assess its psychometric properties. Reliability was evaluated using internal consistency (Cronbach’s α), test retest reliability (utilizing intraclass correlation coefficient [ICC]), standard error of measurement (SEM), minimal detectable change at 95% confidence level (MDC_95%), and 95% limits of agreement (LOA). The construct validity was investigated by correlating the new translation with four other measures of LBP (using Spearman’s rho). Finally, receiver operating characteristic curve was constructed to compute the sensitivity, using the area under the curve (AUC), and the minimum important change (MIC). An alpha level of 0.05 was set for statistical tests and all the psychometric values were tested against a priori hypotheses.

Results

The culturally aligned MLBPDQ showed good internal consistency (Cronbach’s α = 0.85). The ICC, SEM, MDC_95%, and LOA between baseline and two days later were 0.98, 1.60, 4.43, and -4.23 to 7.70, respectively, while the values between baseline and 14 days later were 0.94, 2.77, 7.67, and -6.59 to 13.53, respectively. The scale also demonstrated moderate to excellent correlation (rho = 0.54–0.86) with the other four questionnaires. The AUC value of the Arabic-MLBPDQ was 0.68, and the MIC was 3 points.

Conclusion

The Arabic version of the MLBPDQ demonstrates adequate psychometric properties and can be used to assess disability level in patients with LBP in Arabic-speaking communities.

Cross-cultural adaptation and psychometric evaluation of the Yoruba version of Oswestry disability index

INTRODUCTION

Low-Back Pain (LBP) is a common public health problem that is often worsened by maladaptive beliefs and disability. Thus, necessitating the need for availability of outcome measures to assess these sequelae among patients with chronic LBP. This study aimed to cross-culturally adapt and determine the psychometric properties of the Yoruba version of the ODI (ODI-Y).

METHODS

The ODI-Y was cross-culturally adapted following the process involving forward translation, synthesis, backward translation, expert review, and pilot testing. Internal consistency and test-retest reliability of the ODI-Y were determined using the Cronbach's alpha and intra-class correlation. Other psychometric properties explored included the factor structure, convergent validity, standard error of measurement and the minimal detectable change.

RESULTS

One hundred and thirty-six patients with chronic LBP took part in the validation of the ODI-Y; 86 of these individuals took part in the test-retest reliability (within 1-week interval) of the translated instrument. The mean age of the respondents was 50.5±10.6years. The ODI-Y showed a high internal consistency, with a Cronbach's alpha (α) of 0.81. Test-retest of the Yoruba version of the ODI within 1-week interval yielded an Intra-Class Correlation coefficient of 0.89. The ODI-Y yielded a three-factor structure which accounted for 61.56% of the variance. Correlation of ODI-Y with the visual analogue scale was moderate (r = 0.30; p = 0.001). The standard error of measurement and minimal detectable change of the ODI-Y were 2.0 and 5.5.

CONCLUSIONS

The ODI was adapted into the Yoruba language and proved to have good psychometric properties that replicated the results of other obtainable versions. We recommend it for use among Yoruba speaking patients with LBP.

Cross-cultural Adaptation and Validation of the Hausa Version of the Oswestry Disability Index 2.1a for Patients With Low Back Pain

STUDY DESIGN

Validation of a translated, culturally adapted questionnaire.

OBJECTIVE

To translate the Oswestry Disability Index (ODI) version 2.1a into Hausa Language and to validate its use in a cohort of patients with low back pain (LBP).

SUMMARY OF BACKGROUND DATA

The ODI is one of the most commonly used condition-specific questionnaires for assessing functional disability in patients with LBP, yet, no formal cross-culturally adapted and validated Hausa version exists.

METHODS

The Hausa version of the ODI 2.1a (ODI-H) was developed according to established guidelines. Validation was performed among 200 patients with LBP recruited from both rural and urban Nigeria. Reliability was assessed using internal consistency (Cronbach α), test-retest reliability by computing intraclass correlation coefficient, standard error of measurement, and minimal detectable change. Convergent validity was assessed by correlating the ODI-H with Visual Analogue Scale for pain, Fear-Avoidance Beliefs Questionnaire, and finger-floor distance test. Divergent validity was assessed by correlating the ODI-H with age, educational level, and occupational status. Exploratory factor analysis (EFA) and confirmatory factor analysis were also performed. Confirmatory factor analysis was performed with three models: 1) one-factor theory-driven model, 2) two-factor theory-driven model (dynamic and static factors), and 3) a model based on our EFA.

RESULTS

The ODI-H had high internal consistency (Cronbach α = 0.87) and excellent test-retest reliability (intraclass correlation coefficient  = 0.937) with standard error of measurement and minimal detectable change being 3.69 and 10.2 respectively. The construct validity (convergent and divergent validity) is supported as all (6:6, 100%) the a priori hypotheses were confirmed. The EFA yielded a two-factor model explaining 54.3% of the total variance but demonstrated poor fit. The one-factor and two-factor theory-driven model had acceptable fit but the one-factor theory-driven model was better.

CONCLUSION

The ODI-H version 2.1a was transculturally equivalent, reliable, and valid tool for assessing functional disability among Hausa-speaking patients with LBP. The use of this tool can be recommended for future clinical and research purposes.

LEVEL OF EVIDENCE

3.

Clinical application of the pedicle in vitro restorer in percutaneous kyphoplasty

Background

Percutaneous kyphoplasty (PKP) is widely applied for the treatment of osteoporotic vertebral compression fractures (OVCFs) and has achieved satisfactory clinical results. With the accumulation of clinical cases and prolonged follow-up times, the inability to reconstruct vertebral height defects has attracted more and more attention. A comparison of clinical effects was retrospectively reviewed in 72 patients who underwent simple PKP or pedicle in vitro restorer (PIVR) combined with PKP to discuss the clinical application of self-developed PIVR used in PKP.

Methods

From August 2013 to August 2016, 72 patients with OVCFs were treated surgically, with 30 patients undergoing PKP (group A) and 42 undergoing PIVR combined with PKP (group B). Operation-related situations, radiological data, and related scores were compared between the two groups by corresponding statistical methods.

Results

Bone cement was successfully injected into 72 vertebral bodies. Sixty-three cases were followed up for an average of 14 months. There were significant differences between the two groups in the improvement of the height of the vertebral body, sagittal Cobb angle, and visual analogue scale (VAS) 1 week after the operation (P < 0.05), and the improvements of group B were better than those in group A. The cement leakage ratio was significantly different between the two groups (P < 0.05). The Oswestry Disability Index (ODI) at last follow-up was significantly different between the two groups (P < 0.05). There was no significant difference in the incidence of recurrent vertebral fractures between the two groups at the last follow-up (P > 0.05).

Conclusion

PIVR combined with PKP can overcome the limitations of PKP alone, that is, hardly restoring vertebral height and height being easily lost again with balloon removal. The combined method can also restore the vertebral fractures to a satisfactory height and effectively maintain the stability of the spine, which improves the long-term quality of life of patients. Thus, PIVR combined with PKP is a better choice for patients with OVCFs.