Next Article in Journal
Do Gastric Signet Ring Cell Carcinomas and ECL-Cell Neuroendocrine Tumours Have a Common Origin?
Previous Article in Journal
Morphologic Evaluation of Dentoalveolar Structures after Corticotomy-Assisted Orthodontic Treatment in Romanian Adult Patients
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Medicina
Volume 58
Issue 4
10.3390/medicina58040469
medicina-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Brief Report

Translation and Adaptation of the French Version of the Risk Stratification Index, a Tool for Stratified Care in Chronic Low Back Pain: A Pilot Study

by
Alexandra Naïr
1,
Chiao-I Lin
1 and
Pia-Maria Wippert
1,2,*
1
Medical Sociology and Psychobiology, Department of Physical Activity and Health, University of Potsdam, Am Neuen Palais 10, 14469 Potsdam, Germany
2
Faculty of Health Sciences Brandenburg (Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg University of Technology Cottbus–Senftenberg), University of Potsdam, Am Neuen Palais 10, 14469 Potsdam, Germany
*
Author to whom correspondence should be addressed.
Medicina 2022, 58(4), 469; https://doi.org/10.3390/medicina58040469
Submission received: 28 January 2022 / Revised: 16 March 2022 / Accepted: 18 March 2022 / Published: 23 March 2022
Review Reports Versions Notes

Abstract

:
Background and Objectives: Low back pain is a worldwide health problem. An early diagnosis is required to develop personalized treatment strategies. The Risk Stratification Index (RSI) was developed to serve the purpose. The aim of this pilot study is to cross-culturally translate the RSI to a French version (RSI-F) and evaluate the test-retest reliability of RSI-F using a French active population. Materials and Methods: The RSI was translated from German to French (RSI-F) based on the guidelines of cross-cultural adaptation of self-report measures. A total of 42 French recreational athletes (age 18–63 years) with non-specific low back pain were recruited and filled in the RSI-F twice. The test-retest reliability was examined using intraclass correlation coefficient (ICC1,2) and Pearson correlation coefficient. Results: Finally, 33 questionnaires were analyzed (14 males and 19 females, age 31 ± 10 years, 9.5 ± 3.2 h/week of training). The test-retest of RSI-F CPI and DISS were excellent (CPI: ICC1,2 = 0.989, p < 0.001; r = 0.989, p < 0.001; DISS: ICC1,2 = 0.991, p < 0.001; r = 0.991, p < 0.001), as well as Korff pain intensity (ICC1,2 = 0.995, p < 0.001; r = 0.995, p < 0.001) and disability (ICC1,2 = 0.998, p < 0.001; r = 0.998, p < 0.001). Conclusion: The RSI-F is linguistically accurate and reliable for use by a French-speaking active population with non-specific low back pain. The RSI-F is considered a tool to examine the evolution of psychosocial factors and therefore the risk of chronicity and the prognostic of pain. Further evaluations, such as internal, external validity, and responsiveness should be evaluated in a larger population.

1. Introduction

Low back pain (LBP) is a common health problem all around the world and 50–80% of adults experience LBP at some point in their lifetime [1]. LBP is defined as pain, muscle tension, or stiffness that is localized below the costal margin (inferior rib cage), above the inferior gluteal folds, and might occur with or without leg pain (sciatica) [2]. In Western and Central Europe, LBP is the leading cause of years lived with disability (years of life lived in unhealthy conditions) and may lead to long-term disability associated with recurrent use of health services, activity limitation, or work absence [3,4,5,6,7]. The prevalence of LBP is 84% and the prevalence of chronic low back pain (CLBP) is approximately 23%. In France, the prevalence of LBP was 15% whereas in Germany it was 17% [8,9]. LBP appears not only in the general population but also among athletes, notably in Martial Arts such as Judo (between 34.5% and 40.9% depending on the weight categories) or Kyokushin Karate (55%) [10,11].
LBP is a global health issue and the most expensive musculoskeletal problem in modern societies. However, specific treatments for LPB are missing, causing frequent recurrent LBP or transition to CLBP for many patients [5,6,7,8]. For that reason, detecting patients’ risk of LBP chronicity at an initial stage is essential. Various back pain screening tools (i.e., the STarT Back screening tool) were developed to specify if a unimodal or multimodal program is needed [12].
Moreover, patient-based biopsychosocial indicators (also known as yellow flags factors) are the best way to evaluate patients with LBP and at least five areas should be assessed: social disability, pain symptoms, work disability, well-being, and LBP-specific function [13,14,15,16,17]. Therefore, the Risk Stratification Index (RSI) was developed, a bio-psychosocial screening tool for risk estimation of low back pain chronicity, extended absenteeism, and disability after a low back pain episode [18].
This brief questionnaire covers a multiple spectrum of biopsychosocial risk factors: yellow flags (e.g., fear-avoidance, depression), orange flags (e.g., lifestyle factors, life events, and chronic stress), blue flags (e.g., social status, position, and economy), and black flags (e.g., unemployment rate, workplace environment). It also includes the measurement for pain persistence and pain intensity. The RSI was developed in German and validated using the general population, athletes, and patients from rehabilitation centers. The RSI was also translated and validated in English [19,20,21].
The advantage of the RSI compared to other back pain screeners is that the RSI assesses whether individuals at higher risk can respond to an exercise therapy or whether moderating factors would interfere with this [22]. On this basis, assignment to a unimodal or multimodal therapy is made. Furthermore, the RSI is used in combination with a prevention screener (RPI-S) to give information about an optimized individualized therapy management for each psychosocial risk area [23]. Both screeners allow an individualized therapy management in functional and psychosocial areas [18]. Another advantage of the RSI is that it can provide a high prediction accuracy even at a lower pain level, which is why it is more sensitive than other screeners such as the STarT Back [24,25,26,27].
In France, the High Authority of Health (HAS) usually uses three questionnaires for detecting psychosocial risk factors: the STarT Back screening tool (SBST), which offers a stratified risk management approach to unimodal or multimodal treatment, the short version of the Örebro Questionnaire (ÖMPSQ), which is predictive of absenteeism, and the Roland-Morris Questionnaire (RMDQ) for the indication of acute LBP [28,29].
However, except for SBST, no other tool can stratify patients’ risk of back pain chronification and suggest corresponding treatment (exercise only or exercise with behavior intervention) based on psychosocial factors. The RSI provides another possibility for physicians to assess the risk for CLBP because it includes the Fear Avoidance Beliefs Questionnaire (FABQ) and Depression Scale (HADS), which assesses the level of fear, apprehensions, and avoidance related to low back pain, and the level of anxiety and depression, respectively [30,31]. Therefore, the objective of this pilot study is to cross-culturally adapt and translate the RSI into French and to examine the test-retest reliability.

2. Materials and Methods

The current study was a cross-sectional study of a cross-cultural adaptation validation of a self-report questionnaire and was conducted between November and December 2020. Two methodological steps were carried out: the first step was a cross-cultural translation of the RSI from German to French by four translators and the second step was the evaluation of the test-retest reliability of the RSI-F.
The German version (original) of the RSI was adapted to French according to the guidelines for the process of cross-cultural adaptation of self-report measures [32]. Six steps were applied:
Step I: Initial translation (German to French): Two bilingual translators, a medical doctor and a non-medical background translator, translated the RSI from German to French.
Step II: Synthesis of the translation: Translations differences from the two translators were synthesized in the consensus meeting, resulting in the first version of the translated questionnaire.
Step III: Back translation: The first version of RSI-F was translated back to German by two German native speakers without any medical background. The translators were unknown to the original German RSI.
Step IV: Expert committee review: The expert committee included two methodologists, a health professional, a French language professional, and the translators (forward and back translators). They discussed and compared the backward translations with each other and with the original questionnaire to secure the pre-final version of RSI-F.
Step V: Test of the pre-final version: Participants filled up the pre-final version of RSI-F to check the meaning and the comprehension of the subjects of each item included in the questionnaire. Any issues that occurred in the process of filling up the questionnaire were reported and adjusted to the final version of RSI-F.
Step VI: Submission of documentation and coordination committee for appraisal of the adaptation process: The final version of RSI-F was given to the developer of the instrument who reviewed it.
To evaluate the psychometric properties of RSI-F, n = 42 participants who train regularly, from a private physiotherapy clinic and two sport clubs (Krav Maga team), were contacted.
Candidates were eligible for inclusion if they were 18 years old or older with at least one episode of non-specific LBP (≥days) in the past 12 months and native French speakers [33]. The main exclusion criteria were pregnancy, specific low back pain (i.e., fracture, cancer, infection, or inflammatory disease), non-active participants (<3 h training/week), and an inability to fill out questionnaires independently. All participants signed up for the study after receiving both written and oral information. Each participant completed the RSI-F and was questioned about any difficulties encountered in completing the questionnaire or understanding the purpose or meaning of each question. This study was approved by the Ethics Committee of the University of Potsdam within a pain network study (47/2016).
The Risk Stratification Index: RSI aims to evaluate the estimation of prognostic of pain (disability and intensity) and risk of CLBP development. This tool contains four psychological risk variables: pain, distress, medical care-environment, and social environment. RSI was developed for the general population and further validated for athletes. RSI includes 28 items. A total of 7 items evaluates pain intensity (CPI) and disability (DISS) related to the Chronic Pain Grade questionnaire (CPG); 14 items evaluate distress; 4 items evaluate medical care-environment; and 6 items evaluate social environment [34]. Patients are classified as “low risk” of developing CLBP if RSI = 0–29, “medium risk” if RSI = 29–49, “high risk” if RSI = 50–69, and “very high risk” if RSI = 70–100 [18,19].
For the psychometric properties’ exploration, the test-retest reliability was analyzed. All the participants filled out the questionnaire twice, with a week period in between testing. The test-retest reliability of each item was examined by the intraclass correlation coefficient (ICC1,2) for the scale items and by Cohen’s kappa for nominal and ordinal (weighted kappa value) items. For the total score, the test-retest reliability was evaluated by ICC1,2 and Pearson correlation coefficient (r).
ICC1,2 and kappa values were interpreted as follows: poor <0.40, fair 0.40–0.59, good 0.60–0.74, and excellent 0.75–1.00 [35,36]. The Pearson correlation coefficient was indicated as: very high correlated 0.90–1.00, high correlated 0.70–0.90, moderate correlated 0.50–0.70, low correlated 0.30–0.50, and negligible correlated 0.00–0.30 [37].
All data analysis was performed using IBM SPSS 25.0 (Chicago, IL, USA). Test-retest reliability for each item was examined by intraclass correlation coefficient (ICC1,2) and by kappa values; the total score was evaluated by Pearson correlation coefficient (r) and ICC1,2 with 95% Confidence Interval (CI). Level of significance was set at <0.05.

3. Results

3.1. Participants

After excluding participants who did not meet the inclusion criteria, 33 questionnaires could be accepted for analysis. In total, 14 males and 19 females with a mean age of 31.8 (±10.1) from recreational athletes (3–10 h training/week) to regular athletes were recruited. Among them, 28 participants were suffering from LBP at the time of the study (see Table 1).

3.2. Validation of the Cross-Cultural Translation

The German version of RSI was adapted to French based on the guidelines. During phase II of cross-cultural translation, two versions of forward translation were difficult to synthesize because the German and French education systems are different. Therefore, the educational-related questions were adapted to the French education system. No other specific problem of experiential, idiomatic, semantic, or conceptual equivalence was relevant during the translation process.

3.3. Psychometric Properties

Test-retest reliability: The RSI-F CPI/DISS and the French version of the CPG (CPG-F) CPI/DISS were measured at baseline and one week later showing excellent total scores. The results are shown in Table 2. For each item, test-retest reliability was good to excellent (ICC1,2 values ranged from 0.921 to 1.00 with p < 0.001 and kappa values from 0.812 to 1.00). Results for each item are shown in Table 3.

4. Discussion

In this pilot study, a bio-psychosocial screening tool, the Risk Stratification Index was translated and cross-culturally adapted from German to French and the test-retest reliability within an active population with low back pain was evaluated. Results showed an overall excellent test-retest reliability, meaning that the RSI-F can be used in clinical practice for persons suffering from low back pain.
The test-retest reliability from the RSI-F (ICC1,2 = 0.989–0.991) is in line with the German version which showed a good overall reliability (RSI-DISS: ICC1,2 = 0.74; RSI-CPI: ICC1,2 = 0.721, unpublished data). The RSI translation performs very well in comparison with the French version of the ÖMPSQ (ICC1,2 = 0.89 (95% CI: 0.79–0.95)), the Finnish ÖMPSQ (ICC1,2 ranged from 0.59 to 0.96), the Brazilian ÖMPSQ (ICC1,2 = 0.76 (95% CI: 0.28–0.89), and the Persian version of ÖMPSQ (ICC1,2 ranged from 0.49 to 0.87; ICC1,2 = 0.82) [38,39,40]. Moreover, it is in line with translated versions of other back pain related questionnaires such as the French version of the SBST (ICC1,2 = 0.90 (95% CI: 0.81–0.95)), and the RMDQ (ICC1,2 = 0.89 (95% CI: 0.83–0.93)) [41,42,43].
Although the CPG is a part of the RSI (see Table 2 CPG-F and Table 3 items Korff 2–7), it was of further interest how the translation of the CPG performs: the presented data show a very good test-retest reliability of CPG-F which is comparable to the Spanish CPG version (ICC1,2 = 0.81 (95% CI: 0.684–0.891)) and the Turkish CPG version (ICC1,2 = 0.972 (95% CI: 0.94–0.98)) [44,45].
The current pilot study applied the common one-week interval to examine the overall test-retest reliability. Previous studies also applied the same time frame: this was the case for the translation of the French version of the Keele STarT MSK Tool (ICC1,2 = 0.97), the Brazilian version of the ÖMPSQ (ICC1,2 = 0.76 (95% CI: 0.28–0.89), and the French version of the RMDQ (ICC1,2 = 0.89 (95% CI: 0.83–0.93) [41,42,46].
The original version of the RSI progressed from 205 predictors and showed a precise estimation of the expected individual CPG-CPI and DISS values. The original RSI showed an excellent strength (Area Under the Curve (AUC) = 0.81, 95% CI: 0.76–0.86) to discriminate patients at a risk of developing greater score of CPI and an acceptable strength (AUC = 0.74, 95% CI: 0.63–0.85) to discriminate patients at a risk to develop a greater score of DISS. In contrast, PickUp (predicting pain intensity) evolved from 20 predictors and showed an acceptable performance (AUC = 0.66), the SBST contained 9 predictors for pain disability with an excellent performance (AUC = 0.92), and the ÖMPSQ contained 24 predictors for disability and return to work [18].
Screening of patients’ psychosocial risk factors and stratified allocation to treatment are needed since different types of treatment for low back pain are recommended. In addition to the traditional neuromuscular training, prevention guidelines for non-specific LBP indicate that biopsychosocial factors and psychological treatment options should be considered [47]. Multimodal treatments including psychosocial interventions are favored over unimodal approaches because they address factors including distress, social environment, or subjective pain [47]. Consequently, available tools for screening and stratifying patients’ psychosocial risk are important [48,49,50].
A few back specific instruments have been cross culturally adapted to French (i.e., the ÖMPSQ, the SBST, and the RMDQ) but no “gold standard” questionnaire exist to measure the biopsychosocial factors, and therefore the risk of chronicity in low back pain [35,38,39]. Thus, RSI-F showed to be a good new tool to assess the chronicity of low back pain.
The strength of the current study is the use of two different fighting clubs and one private physiotherapist clinic, allowing the recruitment of a broad spread of patients with LBP with a fair representation of both sexes. Moreover, the main scales of CPG included in the RSI were also translated and evaluated. This questionnaire is one of the most important measurements worldwide and from what is known, no French version has previously been translated and validated. The main limitation of this study was the small sample size, but the statistical precision of the study was good: the lower end of the confidence interval of the ICC is above the minimum accepted level for reliability of 0.7 [51]. Additional testing of the psychometric properties of the French version of the RSI questionnaire is needed to assess the predictive validity (cut off scores for risk groups); it still needs to be confirmed in a broader French population and sample size.

5. Conclusions

In conclusion, the French version of the RSI questionnaire is reliable, linguistically accurate, and acceptable for use by French-speaking patients. The next step will be to assess other psychometric properties (e.g., cutoff score and responsiveness) of RSI-F to effectively examine the evolution of psychosocial factors, the risk of chronicity, and the prognostic of pain in clinical standard routines in a larger sample.

Author Contributions

A.N.: conception, drafting the original manuscript, collecting data, formal analysis, and statistics; C.-I.L.: visualization, reviewing, and editing the manuscript; and P.-M.W.: supervision, reviewing, and editing the manuscript. All authors revised the final manuscript version critically. All authors have read and agreed to the published version of the manuscript.

Funding

The publication was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)—Projektnummer 491466077.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board (or Ethics Committee) of the University of Potsdam (number: 36/2011 and number: 47/2016).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Not applicable.

Acknowledgments

The authors thank the translators who took the time to get involved in this study. The authors acknowledge Niklas Pragsten for his proofreading. The authors are also thankful to the athletes and the coaches from the Bug Concept Krav Maga Association and the Krav Maga Marseille Association who kindly agreed to participate in this study.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Hoy, D.; March, L.; Brooks, P.; Blyth, F.; Woolf, A.; Bain, C.; Williams, G.; Smith, E.; Vos, T.; Barendregt, J.; et al. The global burden of low back pain: Estimates from the Global Burden of Disease 2010 study. Ann. Rheum. Dis. 2014, 73, 968–974. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  2. Duffy, R.L. Low back pain: An approach to diagnosis and management. Prim. Care 2010, 37, 729–741. [Google Scholar] [CrossRef] [PubMed]
  3. Hoy, D.G.; March, L.; Brooks, P.; Woolf, A.; Blyth, F.; Vos, T.; Buchbinder, R. Measuring the global burden of low back pain. Best. Pract. Res. Clin. Rheumatol. 2010, 24, 155–165. [Google Scholar] [CrossRef] [PubMed]
  4. Rapoport, J.; Jacobs, P.; Bell, N.R.; Klarenbach, S. Refining the measurement of the economic burden of chronic diseases in Canada. Chronic Dis. Can. 2004, 25, 13–21. [Google Scholar] [PubMed]
  5. Kent, P.M.; Keating, J.L. The epidemiology of low back pain in primary care. Chiropr. Osteopat 2005, 13, 13. [Google Scholar] [CrossRef] [Green Version]
  6. Hoy, D.; Bain, C.; Williams, G.; March, L.; Brooks, P.; Blyth, F.; Woolf, A.; Vos, T.; Buchbinder, R. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012, 64, 2028–2037. [Google Scholar] [CrossRef]
  7. Macias-Toronjo, I.; Sanchez-Ramos, J.L.; Rojas-Ocana, M.J.; Garcia-Navarro, E.B. Fear-avoidance Behavior and Sickness Absence in patients with Work-related musculoskeletal disorders. Medicina 2020, 56, 646. [Google Scholar] [CrossRef]
  8. Breivik, H.; Collett, B.; Ventafridda, V.; Cohen, R.; Gallacher, D. Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. Eur. J. Pain 2006, 10, 287–333. [Google Scholar] [CrossRef]
  9. Neuhauser, H.; Ellert, U.; Ziese, T. Chronic back pain in the general population in Germany 2002/2003: Prevalence and highly affected population groups. Gesundheitswesen 2005, 67, 685–693. [Google Scholar] [CrossRef]
  10. Okada, T.; Nakazato, K.; Iwai, K. Body Mass, Nonspecific Low Back Pain and Anatomical Changes in the Lumbar Spine in Judo Athletes. J. Orthop. Sports Phys. Ther. 2007, 37, 688–693. [Google Scholar] [CrossRef]
  11. Blach, W.; Klimek, B.; Rydzik, L.; Ruzbarsky, P.; Czarny, W.; Ras, I.; Ambrozy, T. Nonspecific low back pain among Kyokushin karate practitioners. Medicina 2021, 57, 27. [Google Scholar] [CrossRef] [PubMed]
  12. Chew-Graham, C.; May, C. Chronic low back pain in general practice: The challenge of the consultation. FAM Pract. 1999, 16, 46–49. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  13. Hill, J.C.; Dunn, K.M.; Lewis, M.; Mullis, R.; Main, C.J.; Foster, N.E.; Hay, E.M. A primary care back pain screening tool: Identifying patient subgroups for initial treatment. Arthritis Rheum. 2008, 59, 632–641. [Google Scholar] [CrossRef] [PubMed]
  14. Burton, A.K.; Tillotson, K.M.; Main, C.J.; Hollis, S. Psychosocial predictors of outcome in acute and subchronic low back trouble. Spine 1995, 20, 722–728. [Google Scholar] [CrossRef]
  15. Truchon, M. Determinants of chronic disability related to low back pain: Towards an integrative biopsychosocial model. Disabil. Rehabil. 2001, 23, 758–767. [Google Scholar] [CrossRef]
  16. Deyo, R.A.; Battie, M.; Beurskens, A.J.; Bombardier, C.; Croft, P.; Koes, B.; Malmivaara, A.; Roland, M.; Korff, M.; Waddell, G. Outcome measures for low back pain research. A proposal for standardized use. Spine 1998, 23, 2003–2013. [Google Scholar] [CrossRef]
  17. Nieto-Garcia, J.; Suso-Marti, L.; La Touche, R.; Grande-Alonso, M. Somatosensory and Motor Differences between Physically Active Patients with chronic low back pain and asymptomatic individuals. Medicina 2019, 55, 524. [Google Scholar] [CrossRef] [Green Version]
  18. Wippert, P.-M.; Puschmann, A.-K.; Drießlein, D.; Arampatzis, A.; Banzer, W.; Beck, H.; Schiltenwolf, M.; Schmidt, H.; Schneider, C.; Mayer, F. Development of a risk stratification and prevention index for stratified care in chronic low back pain. Focus: Yellow flags (MiSpEx network). Pain Rep. 2017, 2, e623. [Google Scholar] [CrossRef]
  19. Wippert, P.-M.; Puschmann, A.-K.; Drießlein, D.; Banzer, W.; Beck, H.; Schiltenwolf, M.; Schneider, C.; Mayer, F. Personalized Treatment Suggestions: The validity and Applicability of the Risk-Prevention-Index Social in low back pain exercise treatments. J. Clin. Med. 2020, 9, 1197. [Google Scholar] [CrossRef]
  20. Wippert, P.-M.; Puschmann, A.-K.; Arampatzis, A.; Schiltenwolf, M.; Mayer, F. Diagnosis of psychosocial risk factors in prevention of back pain in athletes (MiSpEx Network). BMJ Open Sports Exerc. Med. 2017, 3, e000295. [Google Scholar] [CrossRef] [Green Version]
  21. Puerto Valencia, L.; Arampatzis, D.; Beck, H.; Dreinhöfer, K.; Drießlein, D.; Mau, W.; Zimmer, J.-M.; Schäfer, M.; Steinfeldt, F.; Wippert, P.-M. RENaBack: Study Protocol for a Multicenter, Randomized Controlled Trial for low back pain patients in rehabilitation. Trials 2021, 22, 932. [Google Scholar] [CrossRef] [PubMed]
  22. Wippert, P.-M.; Drießlein, D.; Beck, H.; Schneider, C.; Puschmann, A.-K.; Banzer, W.; Schiltenwolf, M. The Feasibility and Effectiveness of a New Practical Multidisciplinary Treatment for Low-Back Pain: A Randomized Controlled Trial. J. Clin. Med. 2020, 9, 115. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  23. Wippert, P.-M.; Niederer, D.; Drießlein, D.; Beck, H.; Banzer, W.; Schneider, C.; Schiltenwolf, M.; Mayer, F. Moderators and Mediators of sensorimotor exercise in low back pain: A Randomized Controlled Trial. Front. Psychiatry Psychosom. Med. 2021, 12, 1034. [Google Scholar] [CrossRef]
  24. Wippert, P.-M.; Mekle, R.; de Witt Huberts, J.; Motter, S.; Schulze, S.; Brenner, G.; Hornbacher, A.; Figura, A.; Krause, T.; Villringer, K.; et al. Dosis-Wirkungs-Beziehung verschiedener Verhaltenstherapie-Module auf die Schmerzwahrnehmung und -verarbeitung. In MiSpEx—National Research Network for Medicine in Spine & Exercise (Hrsg). Das MiSpEx-Parallelstudienbuch; Köln/Bonn. BISp.: Haus, Germany, 2019. [Google Scholar]
  25. Kongsted, A.; Andersen, C.H.; Hansen, M.M.; Hestbaek, L. Prediction of outcome in patients with low back pain—A prospective cohort study comparing clinicians predictions with those of the StarT Back Tool. Man. Ther. 2016, 21, 120–127. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  26. Karran, E.L.; McAuley, J.H.; Traeger, A.C.; Hillier, S.L.; Grabherr, L.; Russek, L.N.; Moseley, G.L. Can screening instruments accurately determine poor outcome risk in adults with recent onset low back pain? BMC Med. 2017, 15, 13–21. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  27. Karran, E.L.; Traeger, A.C.; McAuley, J.H.; Hillier, S.L.; Yau, Y.-H.; Moseley, G.L. The Value of Prognostic Screening for Patients with Low Back Pain in Secondary Care. J. Pain 2017, 18, 673–686. [Google Scholar] [CrossRef] [PubMed]
  28. Linton, S.J.; Hallden, K. Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Clin. J. Pain. 1998, 14, 209–215. [Google Scholar] [CrossRef]
  29. Roland, M.; Morris, R. A study of the natural history of back pain. Part I: Development of a reliable and sensitive measure of disability in low back pain. Spine 1938, 8, 635–643. [Google Scholar] [CrossRef]
  30. Waddell, G.; Newton, M.; Henderson, I.; Somerville, D.; Main, C.J. A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993, 52, 157–168. [Google Scholar] [CrossRef]
  31. Zigmond, A.S.; Snaith, R.P. The Hospital Anxiety and Depression Scale. Acta. Psychiatr. Scand. 1983, 67, 361–370. [Google Scholar] [CrossRef] [Green Version]
  32. Beaton, D.E.; Bombardier, C.; Guillemin, F.; Ferraz, M.B. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. Spine 2000, 25, 3186–3191. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  33. Balagué, F.; Mannion, A.F.; Pellisé, F.; Cedraschi, C. Non-specific low back pain. Lancet 2012, 379, 482–491. [Google Scholar] [CrossRef] [Green Version]
  34. Von Korff, M.; Ormel, J.; Keefe, F.J.; Dworkin, S.F. Grading the severity of chronic pain. Pain 1992, 50, 133–149. [Google Scholar] [CrossRef]
  35. Cicchetti, D.; Bronen, R.; Spencer, S.; Haut, S.; Berg, A.; Oliver, P.; Tyrer, P. Rating scales, scales of measurement, issues of reliability: Resolving some critical issues for clinicians and researchers. J. Nerv. Ment. Dis. 2006, 194, 557–564. [Google Scholar] [CrossRef] [PubMed]
  36. Shrout, P.E.; Fleiss, J.L. Intraclass correlations: Uses in assessing rater reliability. Psychol. Bull. 1979, 86, 420–428. [Google Scholar] [CrossRef]
  37. Hinkle, D.E.; Wiersma, W.; Jurs, S.G. Applied Statistics for the Behavioral Sciences, 5th ed.; Houghton Mifflin: Boston, MA, USA, 2003. [Google Scholar]
  38. Opsommer, E.; Hilfiker, R.; Raval-Roland, B.; Crombez, G.; Rivier, G. Test-retest reliability of the Örebro Musculoskeletal Pain Screening Questionnaire and the Situational Pain Scale in patients with chronic low back pain. Swiss Med. Wkly. 2013, 143, w13903. [Google Scholar] [CrossRef]
  39. Fagundes, F.R.C.; Costa, L.O.P.; Fuhro, F.F.; Manzoni, A.C.T.; de Oliveira, N.T.B.; Cabral, C.M.N. Örebro Questionnaire: Short and long forms of the Brazilian-Portuguese version. Qual. Life Res. 2015, 24, 2777–2788. [Google Scholar] [CrossRef]
  40. Ruokolainen, O.; Haapea, M.; Linton, S.; Korniloff, K.; Häkkinen, A.; Paananen, M.; Karppinen, J. Construct validity and reliability of Finnish version of ÖrebroMusculoskeletal Pain Screening Questionnaire. Scand. J. Pain 2016, 6, 2. [Google Scholar] [CrossRef]
  41. Bruyère, O.; Demoulin, M.; Beaudart, C.; Hill, J.C.; Maquet, D.; Genevay, S.; Mahieu, G.; Reginster, J.-Y.; Crielaard, J.-M.; Demoulin, C. Validity and reliability of the French version of the Start Back screening tool for patients with low back pain. Spine 2014, 39, e123–e128. [Google Scholar] [CrossRef]
  42. Zerkak, D.; Métivier, J.-C.; Fouquet, B.; Beaudreuil, J. Validation of a French version of Roland–Morris questionnaire in chronic low back pain patients. Ann. Phys. Rehabil. Med. 2013, 56, 613–620. [Google Scholar] [CrossRef] [Green Version]
  43. Sharafi, E.S.; Hafizi, S.; Shahi, M.H.P.; Kordi, R.; Noorbala, A.A.; Arbabi, M.; Nejatisafa, A.-A. The Persian Version of Örebro Musculoskeletal Pain Screening Questionnaire: Translation and Evaluation of its Psychometric Properties. Int. J. Prev. Med. 2017, 8, 14. [Google Scholar] [CrossRef] [PubMed]
  44. Ferrer-Pena, R.; Gil-Martinez, A.; Pardo-Montero, J.; Jiménez-Penick, V.; Gallego-Izquierdo, T.; La Touche, R. Adaptation and validation of the Spanish Version of the Graded Chronic Pain Scale. Reumatol. Clínica 2015, 12, 130–138. [Google Scholar] [CrossRef]
  45. Özden, F.; Özkeskin, M.; Bakırhan, S.; Karaman, O.N.; Aydoğmuş, H. The reliability and validity of the Turkish version of the graded chronic pain scale in patients with chronic low back pain. Eur. Spine J. 2021, 30, 2955–2961. [Google Scholar] [CrossRef] [PubMed]
  46. Beaudart, C.; Criscenzo, L.; Bornheim, S.; Van Beveren, J.; Demoulin, C.; Kaux, J.-F. French translation and validation of the Keele Start MSK Tool. Eur. Rehab. J. 2021, 1, 1–7. [Google Scholar] [CrossRef]
  47. Van Tulder, M.W.; Becker, A.; Bekkering, T.; Breen, A.; del Real, M.T.; Hutchinson, A. European Guidelines for the management of acute nonspecific low back pain in primary care (chapter 3). Eur. J. Spine 2006, 15, 169–191. [Google Scholar] [CrossRef] [Green Version]
  48. National Association of Statutory Health Insurance Physicians; Association of the Scientific Medical Societies in Germany. Nationale Versorgungsleitlinie Nicht-Spezifischer Kreuzschmerz—Langfassung. National Therapy Guideline for Non-Specific Low Back Pain; National Association of Statutory Health Insurance Physicians; Association of the Scientific Medical Societies in Germany: Berlin, Germany, 2016. [Google Scholar]
  49. Nicholas, M.K.; Linton, S.J.; Watson, P.J.; Main, C.J. Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: A reappraisal. Phys. Ther. 2011, 96, 1–17. [Google Scholar] [CrossRef]
  50. Maher, C.; Underwood, M.; Buchbinder, R. Non-specific low back pain. Lancet 2017, 389, 736–747. [Google Scholar] [CrossRef] [Green Version]
  51. Terwee, C.B.; Bot, S.D.M.; de Boer, M.R.; van der Windt, D.A.W.M.; Knol, D.L.; Dekker, J.; Bouter, M.; de Vet, H.C.W. Quality criteria were proposed for measurement properties of health status questionnaires. J. Clin. Epidemiol. 2007, 60, 34–42. [Google Scholar] [CrossRef] [Green Version]
Table
Table 1. Baseline characteristics of the study population.
Table 1. Baseline characteristics of the study population.
SociodemographyBaseline Characteristics
n (men/women)33 (14/19)
Age (years, M ± SD)31.8 ± 10.1
Training (hours per week, M ± SD)9.5 ± 3.2
Regular athletes (n (%))15 (45)
Recreational athletes (n (%))18 (55)
LBP at the time of the study (n (%))28 (85)
Risk Stratification Index CPI (n (%))
Low risk13 (40%)
Medium risk16 (48%)
High risk4 (12%)
Risk Stratification Index DISS (n (%))
Low risk30 (90%)
Medium risk3 (10%)
n, sample size; M mean; SD, standard deviation; h, hours; LBP, low back pain; CPI, characteristic pain intensity, scale of Chronic Pain Grade questionnaire; DISS, subjective pain disability, scale of Chronic Pain Grade questionnaire.
Table
Table 2. Descriptive statistics of RSI-F CPI/DISS and CPG-F CPI/DISS at baseline and retest.
Table 2. Descriptive statistics of RSI-F CPI/DISS and CPG-F CPI/DISS at baseline and retest.
ItemsBaselineRetestICC1,295% CIrp-Values
RSI-FCPI31.3 ± 14.231.6 ± 13.80.9890.977–0.9940.989<0.001
DISS16.0 ± 9.815.9 ± 9.90.9910.982–0.9960.991<0.001
CPG-FCPI31.0 ± 21.730.8 ± 21.40.9950.990–0.9970.995<0.001
DISS18.7 ± 21.718.6 ± 21.70.9980.996–0.9990.998<0.001
ICC: intraclass correlation coefficient; CI: confidence interval; RSI-F: French version of the Risk Stratification Index; CPG-F: French version of the Chronic Pain Grade; CPI: characteristic pain intensity, scale of Chronic Pain Grade questionnaire; DISS: subjective pain disability, scale of Chronic Pain Grade questionnaire; r, Pearson correlation coefficient.
Table
Table 3. Test-retest reliability for each item.
Table 3. Test-retest reliability for each item.
CategoryItemsBaselineRetestType of DataReliability Test ICC (95% CI); Kappa
Mean ± SDMean ± SD
PainKorff 21.79 ± 2.201.88 ± 2.12scaleICC0.989 (0.994–0.997) ***
Korff 34.33 ± 2.784.24 ± 2.840.997 (0.997–0.999) ***
Korff 43.18 ± 2.133.12 ± 2.130.997 (0.993–0.998) ***
Korff 51.36 ± 1.921.39 ± 1.920.998 (0.996–0.999) ***
Korff 61.97 ± 2.301.94 ± 2.290.999 (0.997–0.999) ***
Korff 72.27 ± 2.712.24 ± 2.700.999 (0.998–0.999) ***
DistressRSI 80.36 ± 0.650.45 ± 0.67scaleICC0.948 (0.887–0.973) ***
RSI 92.76 ± 0.502.70 ± 0.530.940 (0.879–0.970) ***
RSI 102.85 ± 0.712.85 ± 0.670.967 (0.933–0.984) ***
RSI 112.64 ± 1.542.64 ± 1.520.993 (0.987–0.997) ***
RSI 123.82 ± 1.813.76 ± 1.820.995 (0.991–0.998) ***
RSI 132.12 ± 2.192.15 ± 2.210.995 (0.990–0.998) ***
RSI 141.85 ± 1.151.82 ± 1.160.983 (0.965–0.991) ***
RSI 14a1.73 ± 1.211.73 ± 1.210.968 (0.934–0.984) ***
RSI 151.45 ± 0.971.42 ± 0.970.975 (0.950–0.988) ***
RSI 161.70 ± 0.921.67 ± 0.990.974 (0.948–0.987) ***
RSI 171.24 ± 0.971.21 ± 0.960.992 (0.984–0.996) ***
RSI 181.33 ± 1.081.27 ± 1.070.987 (0.973–0.993) ***
RSI 18a1.18 ± 0.731.12 ± 0.700.969 (0.938–0.985) ***
RSI 191.24 ± 0.791.27 ± 0.760.921 (0.921–0.981) ***
Medical care-environmentRSI 61.61 ± 0.501.61 ± 0.50nominalKappa1.00 ***
RSI 6a0.30 ± 0.470.30 ± 0.471.00 ***
RSI 6b0.09 ± 0.290.09 ± 0.291.00 ***
RSI 6c0.33 ± 0.480.33 ± 0.481.00 ***
Social environmentRSI 37.52 ± 1.127.52 ± 1.12ordinalWeighted kappa1.00 ***
RSI 44.94 ± 3.124.94 ± 3.12nominalKappa1.00 ***
RSI 57.55 ± 1.567.45 ± 1.58scaleICC0.991 (0.981–0.995) ***
RSI 71.21 ± 0.991.15 ± 1.00nominalKappa0.812 (0.721–0.949) ***
SD: Standard deviation; ICC: intraclass correlation coefficient; CI: confidence interval; RSI-F: French Risk Stratification Index; ***: p < 0.001.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Naïr, A.; Lin, C.-I.; Wippert, P.-M. Translation and Adaptation of the French Version of the Risk Stratification Index, a Tool for Stratified Care in Chronic Low Back Pain: A Pilot Study. Medicina 2022, 58, 469. https://doi.org/10.3390/medicina58040469

AMA Style

Naïr A, Lin C-I, Wippert P-M. Translation and Adaptation of the French Version of the Risk Stratification Index, a Tool for Stratified Care in Chronic Low Back Pain: A Pilot Study. Medicina. 2022; 58(4):469. https://doi.org/10.3390/medicina58040469

Chicago/Turabian Style

Naïr, Alexandra, Chiao-I Lin, and Pia-Maria Wippert. 2022. "Translation and Adaptation of the French Version of the Risk Stratification Index, a Tool for Stratified Care in Chronic Low Back Pain: A Pilot Study" Medicina 58, no. 4: 469. https://doi.org/10.3390/medicina58040469

Article Metrics

Back to TopTop