Cross-cultural adaptation of The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire: A methodological systematic review

Abstract

Background

The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) is a reliable and sensitive measure of disability to determine functional status and evaluate curative effects in low back pain, it has now been cross-cultural translated into many other languages and adapted for use in different countries. We aim to evaluate the translation procedures and measurement properties of cross-cultural adaptations of the JOABPEQ.

Methods

Studies related to cross-cultural adaptation of the JOABPEQ in a specific language/culture were searched in PubMed, Embase, CINAHL, SciELO, PsycINFO, SinoMed, and Web of Science from their inception to March 2022. The Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures and the Consensus-based Standards for the Selection of Health Status Measurement Instruments guideline were used for evaluation.

Results

Nine different versions of cross-cultural JOABPEQ adaptations in 8 different languages/cultures were included. The adaptation process was not strictly performed, such as standard forward translation and expert committee review were rarely reported. Content validity (8/9), floor and ceiling effects (3/9), reliability (4/9), and interpretability (6/9) were assessed in most of the adaptations, while agreement (2/9), responsiveness (2/9), and the internal consistency (2/9) were not. JOABPEQ can replace functional and quality of life score to reduce the burden of scientific research.

Conclusion

We recommend Persian-Iranian, simplified Chinese–Chinese Mandarin, Thai and Gunaydin G's Turkish adaptations for application. The numerical pain rating scale/visual analogue scale in low back pain and lower extremities, as well as numbness in lower extremities could not be neglected in JOABPEQ adaptations.

Introduction

Low back pain (LBP) is complex with many etiologies and is often a mixture of various presentations with a dysfunction impact on quality of life [1]. It has become one of the top three leading causes of non-fatal health loss for nearly three decades [2]. The Oswestry Disability Index (ODI), Roland–Morris Disability Questionnaire (RMDQ) and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) are the valid evaluation methods to assess the LBP [[3], [4], [5], [6]]. Given that LBP are multifaceted, it is extremely important to have a reliable, and sensitive method to determine functional status and evaluate curative effects in LBP in multidimensional aspects. The ODI and RMDQ are highly recommended, but they only focus on the physical functioning outcome domain and the JOABPEQ is more comprehensive than RMDQ and ODI [7].

Considering the patient-perspective is essential for evaluating the results of interventions and making medical decisions. In 2007, the Japan Orthopaedic Association (JOA) revised the JOA score and created the JOABPEQ to assess the degree of LBP [[3], [4], [5],8]. The JOABPEQ provides specific, yet multidimensional, self-rating outcomes for patients with LBP, including the original physical components related to the disease, as well as psychological problems resulting from dysfunctions and disabilities [9,10]. As a multi-faceted measurement, JOABPEQ selected 25 items, including Q1 Low back pain with 4 items, Q2 Lumbar function with 6 items, Q3 Walking ability with 5 items, Q4 Social life function 4 items and Q5 Mental health with 7 items, as well as VAS score in low back and leg pain and lower limb numbness. The five functional scores are designed to be used independently, the score of each domain was ranged from 0 to 100 points, there is no total score, the higher scores, the better condition [8]. With factor analysis has confirmed the validity, the weighted kappa (Kw) values and the lower 95% confidence interval was performed to confirm the reliability, the MCID and AUC were assessed to determine the responsiveness, now JOABPEQ is a widely used objective evaluation for lumbar spine disorders [4,5,7,11,12].

The JOABPEQ had been cross-cultural translated into Arabic, Brazilian, Iranian, and other languages. Due to the cultural difference, a direct simple translation of the original questionnaire often can't guarantee similar measurement properties, and the rough translation may lead to bias to impact the validity of cross-cultural adaptation. Consequently, methodological considerations are important in cross-cultural comparisons, the process of cross-cultural adaptation should be followed, as well as the measurement properties should be used to assess. This study was to comprehensively evaluate the translation procedures and measurement properties of cross-cultural adaptations of JOABPEQ.