Pokharel M1, Khatri CB1, Chandra A2, Panta B3, Sharma S4,5
1Annapurna Neurological Institute and Allied Sciences, Physiotherapy, Kathmandu, Nepal, 2Annapurna Neurological Institute and Allied Sciences, Department of Neurology, Kathmandu, Nepal, 3Annapurna Neurological Institute and Allied Sciences, Department of Neurosurgery, Kathmandu, Nepal, 4Kathmandu University School of Medical Sciences, Physiotherapy, Dhulikhel, Nepal, 5University of Otago, Department of Surgical Sciences, Dunedin, New Zealand
Background: Content validity is one of the most important type of validity but is often neglected. It is defined as the degree to which the content of an instrument is an adequate reflection of construct to be measured. The Tampa Scale for Kinesiophobia (TSK) is an important self-reported measure that assesses pain-related fear of movement in individuals with low back pain (LBP). Although the psychometric properties of the TSK has been widely studied, its content validity has not been studied or reported.
Purpose: The aim of our study was to evaluate the content validity (relevance, comprehensibility, and comprehensiveness) of the Nepali translation of the TSK.
Methods: We used newly developed COnsensus-based standards for the Selection of health Measurement Instruments (COSMIN) recommendations to evaluate the content validity of the Nepali version of TSK (TSK-NP). Based on COSMIN recommendations, we specifically asked: (1) whether all items referred to the construct of pain-related fear of movement; (2) if all items were relevant to the study population i.e. LBP; (3) whether all items were relevant to the purpose of measurement instrument; (4) did all items together comprehensively reflected the construct to be measured. Two rounds of cognitive interviewing were carried out on 30 patients with LBP at a neurosurgical hospital in Kathmandu, Nepal. After participants completed the questionnaires, we used verbal probing during a focused one-on-one in-depth qualitative interview. We recorded the interview, and noted the important comments related to content validity as a written verbatim. We stopped recruitment when data saturation was reached.
Results: Thirty individuals with LBP (mean age 34 yrs: 57% women; 43% acute, 23% sub acute, 33% chronic) participated in the study. In the first round of interview with 10 participants, 8 participants reported comprehensibility issues with item 2, 2 participants for item 10, and 1 participant for item 13. We used feedback from these participants to revise these three items, discussed in expert committee meeting, and tested all items on 5 participants with LBP. We found significant improvement in comprehensibility of the items. Items 6, 10, 13, 14 were reported as slightly unclear. In the similar fashion we made changes in wordings of these items and administered in another 10 participants until which we made minor changes. Instructions and response options required no change. Last five participants did not make many further suggestions and reported the final version as comprehensible, therefore, we stopped further recruitment based on our a priori criteria of saturation. There were no concerns or comments on relevance and comprehensiveness.
Conclusion(s): We conclude that TSK-NP demonstrated content validity to assess pain-related fear of movement in adult Nepalese with LBP.
Implications: As the first step in testing of psychometric properties of a patient-reported measures is completed for the TSK-NP in Nepalese with LBP, further psychometric testing should be continued. If shown to be a reliable and valid, the TSK-NP could be used in clinical practice and research in Nepal. Content validity of the other language versions of the TSK could be performed in similar fashion in future.
Keywords: Fear-avoidance, LBP, Validity
Funding acknowledgements: This study was funded from Research Grant provided by Annapurna Neurological Institute and Allied Sciences.
Purpose: The aim of our study was to evaluate the content validity (relevance, comprehensibility, and comprehensiveness) of the Nepali translation of the TSK.
Methods: We used newly developed COnsensus-based standards for the Selection of health Measurement Instruments (COSMIN) recommendations to evaluate the content validity of the Nepali version of TSK (TSK-NP). Based on COSMIN recommendations, we specifically asked: (1) whether all items referred to the construct of pain-related fear of movement; (2) if all items were relevant to the study population i.e. LBP; (3) whether all items were relevant to the purpose of measurement instrument; (4) did all items together comprehensively reflected the construct to be measured. Two rounds of cognitive interviewing were carried out on 30 patients with LBP at a neurosurgical hospital in Kathmandu, Nepal. After participants completed the questionnaires, we used verbal probing during a focused one-on-one in-depth qualitative interview. We recorded the interview, and noted the important comments related to content validity as a written verbatim. We stopped recruitment when data saturation was reached.
Results: Thirty individuals with LBP (mean age 34 yrs: 57% women; 43% acute, 23% sub acute, 33% chronic) participated in the study. In the first round of interview with 10 participants, 8 participants reported comprehensibility issues with item 2, 2 participants for item 10, and 1 participant for item 13. We used feedback from these participants to revise these three items, discussed in expert committee meeting, and tested all items on 5 participants with LBP. We found significant improvement in comprehensibility of the items. Items 6, 10, 13, 14 were reported as slightly unclear. In the similar fashion we made changes in wordings of these items and administered in another 10 participants until which we made minor changes. Instructions and response options required no change. Last five participants did not make many further suggestions and reported the final version as comprehensible, therefore, we stopped further recruitment based on our a priori criteria of saturation. There were no concerns or comments on relevance and comprehensiveness.
Conclusion(s): We conclude that TSK-NP demonstrated content validity to assess pain-related fear of movement in adult Nepalese with LBP.
Implications: As the first step in testing of psychometric properties of a patient-reported measures is completed for the TSK-NP in Nepalese with LBP, further psychometric testing should be continued. If shown to be a reliable and valid, the TSK-NP could be used in clinical practice and research in Nepal. Content validity of the other language versions of the TSK could be performed in similar fashion in future.
Keywords: Fear-avoidance, LBP, Validity
Funding acknowledgements: This study was funded from Research Grant provided by Annapurna Neurological Institute and Allied Sciences.
Topic: Musculoskeletal: spine
Ethics approval required: Yes
Institution: Nepal Health Research Council ( NHRC)
Ethics committee: Ethical Review M & E section.
Ethics number: Reference no. 2921
All authors, affiliations and abstracts have been published as submitted.
