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Acharya R.1, Therese Tveter A.2, Grotle M.2, Eberhard-Gran M.3, Koju R.4, Stuge B.5
1Kathmandu University Dhulikhel Hospital, Physiotherapy, Kathmandu, Nepal, 2Institute of Physiotherapy,Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Oslo, Norway, 3University of Oslo, Institute of Clinical Medicine, Oslo, Norway, 4Kathmandu University Dhulikhel Hospital, Department of Medicine, Kathmandu, Nepal, 5Oslo University Hospital, Division of Orthopaedic Surgery, Oslo, Norway
Background: Pregnancy-related pelvic girdle pain (PGP) has been reported in developed and developing countries.Nepalese women perform both agricultural and household work that demands tedious, manual, monotonous and labour intensive work in awkward positions.Studies have reported that physical workload may have a negative impact on maternal health. No studies have assessed musculoskeletal pain such as PGP in Nepal. The Pelvic Girdle Questionnaire (PGQ) is a condition-specific measure developed for women with PGP. The PGQ includes items relating to activity/participation and bodily symptoms, has acceptably high reliability and validity, satisfactory discriminative validity, is simple to administer and feasible for use in research and in clinical practice.
Purpose: To cross culturally translate and assess the construct validity of the PGQ in pregnant Nepalese women.
Methods: The cross cultural adaptation process included: forward translation, backward translation expert committee review and pre-test of the pre-final version. A specific focus was made on achieving semantic, idiomatic, experimental and conceptual equivalence between original version and the translated Nepalese versions.The Nepali version PGQ was tested in 30 pregnant women with PGP attending antenatal clinic at Dhulikhel Hospital, Nepal. In-depth interview was also conducted to find misunderstandings and deviations in the translation for each items and responses.
For the validation study, a cross sectional study was conducted in pregnant women with clinically examined PGP at Dhulikhel hospital, Nepal. Together with sociodemographic variables the questionnaire included the PGQ, the Oswestry Disability Index (ODI), the patient specific functional scale (PSFS), the Edinburgh post natal depression scale -5 items (EPDS-5) and the numerical pain rating scale (NPRS). For assessment of construct validity, four a-priori hypotheses were formulated. We expected a positive moderate correlation (r>0.4) between the PGQ and the ODI (1) andthe PGQ and the NPRS (2). We expected a negative moderate correlation (r -0.4) betweenthe PGQ and the PSFS (3), while the correlation between the PGQ and the EPDS-5 were expected to be positive but low (r 0.4). Depending on distribution of scores, Pearsons or Spearmans correlation was used to assess the associations between the included questionnaires and the PGQ. For acceptable construct validity, 75% of the hypotheses had to be confirmed.
Results: The cross cultural adaptation resulted in modification of questions, such as climbing stairs, pushing a shopping cart and running.
Of the cohort of 646 pregnant women, atotal of 147 women were included in validation study. The women had a median age of 24 (17-42) years, and were between gestation week 5 and 42.
The correlations between the PGQ and the ODI, PSFS, NPRS and EPDS-5 were 0.53, -0.37, 0.49 and 0.12, respectively, indicating that 75% of the a-priori hypotheses were confirmed.
Conclusion(s): The Nepali version of the PGQ is a valid tool for assessing PGP in Nepalese women.
Implications: The Nepali version of the PGQ can be used to investigate the effectiveness of physiotherapy provided to women with PGP in Nepal.
Funding acknowledgements: Students Quota scheme,Norway
Topic: Research methodology & knowledge translation
Ethics approval: Ethics Committee of the Kathmandu University School of Medical Sciences, Nepal and REK, Norway
All authors, affiliations and abstracts have been published as submitted.
