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L. Elsabbagh1, T. Al-Atwi2, D. Aldossary2, A.M. Alshami3, J.C. Hill4, W. Abu-Ras5, H.A.-S. Huijer6, D. Brooks7
1Johns Hopkins Aramco Healthcare, Rehabilitation Service Division, Dhahran, Saudi Arabia, 2King Fahad Specialist Hospital Dammam, Physical Therapy Department, Dammam, Saudi Arabia, 3Imam Abdulrahman Bin Faisal University, College of Applied Medical Sciences, Dammam, Saudi Arabia, 4Keele University, Research Institute for Primary Care and Health Sciences, Staffordshire, United Kingdom, 5Adelphi University, School of Social Work, New York, United States, 6American University of Beirut, Hariri School of Nursing, Beirut, Lebanon, 7University of Toronto, Physical Therapy Department, Faculty of Medicine, Toronto, Canada
Background: Low back pain (LBP) is the most common cause of activity limitation and absence from work throughout the world. Consequently, it imposes a high economic burden on individuals, families, societies and governments. It is a recurring condition with 60-80% of patients in the United Kingdom consulting their physician a year later for the same problem. STarT Back Tool (Subgrouping for Targeted Treatment; SBT) was developed and validated in the United Kingdom for adults with non-specific low back pain (LBP) to provide risk stratification groups. An Arabic version has not yet been developed.
Purpose: Our objectives were: First, to cross-culturally adapt the SBT for use in Arabic speaking adults (SBT-Ar) with LBP. Second, to assess the face, content and construct validity of SBT-Ar against relevant reference standards.
Methods: This was a prospective, cross-sectional study carried out in the outpatient department in a tertiary care hospital. A total of 59 participants (aged 18-60) with LBP able to read Arabic completed the questionnaire. SBT cross-cultural adaptation was performed according to published guidelines. Face and content validity were explored by individual interviews. Construct validity was assessed using pre-hypothesized correlations with relevant reference standards.
Results: Following 48 individual interviews the SBT final version was reached and demonstrated face and content validity. The SBT-Ar total score and psychosocial sub-scale had acceptable internal consistency and no redundancy (Cronbach alpha= 0.7). Moderate Spearman's correlations were found between the SBT- Ar total score and reference standards (Arabic Pain Numeric Rating Scale NRS-Ar r=0.50 and Arabic Oswestry Disability Index ODI-ar r= 0.51). As expected the SBT-Ar psychosocial subscale had medium to high correlations with the psychosocial reference measures (Arabic Fear-Avoidance Beliefs Questionnaire Physical Activity FABQPA-Ar r= 0.41, Arabic Hospital Anxiety and Depression Scale-Anxiety HADSA-Ar r=0.58, Arabic Hospital Anxiety and Depression Scale-Depression HADSD-Ar r= 0.45 and Arabic Pain Catastrophizing Scale PCS-Ar r=0.69).The SBT-Ar showed no significant floor or ceiling effects.
Conclusion(s): This study culturally adapted and preliminary validated SBT into Arabic.
Implications: The current study found that the SBT-Ar demonstrated good face, content and construct validity. Clinicians working with Arabic speaking individuals with LBP are now able to use the SBT-Ar in their practice. Future multicenter (primary, secondary and tertiary) studies are needed to further investigate the psychometric properties of the SBT-Ar including predictive validity and reliability.
Funding, acknowledgements: The authors declare no conflict of interest and no funds were received in support of this work.
Keywords: Low back pain, Psychometric Properties, Measurement
Topic: Musculoskeletal: spine
Did this work require ethics approval? Yes
Institution: University of Toronto, Fahad Specialist Hospital Dammam
Committee: The Research Ethics Board (REB) / The International Review Board (IRB)
Ethics number: MED0317 / 32784
All authors, affiliations and abstracts have been published as submitted.
