Original ArticleCross-cultural adaptation of The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire: A methodological systematic review
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.
Section snippets
Study selection and eligibility criteria
In order to identify cross-cultural adaptations of the JOABPEQ translated for non-English languages/cultures, PubMed, Embase, CINAHL, SciELO, PsycINFO, SinoMed, Web of Science and Scopus were searched from their inceptions to March 2022, without language limitations. The keywords included (’‘Japanese Orthopaedic Association Back Pain Evaluation Questionnaire,’’ OR ‘‘JOABPEQ’‘) AND (“cross-cultur” OR “valid” OR “equivalence” OR “transl” OR “adaptation” OR “version” OR “cultur”). We also manually
Description of cross-cultural adaptation of the JOABPEQ
A total of 642 publications were identified by our search. We omitted 416 cases of duplication, 180 irrelevant studies, and 11 reviews. Finally, 38 full-text articles or abstracts assessed for eligibility. Then we excluded 14 publications that didn't conduct measurement property and 11 original studies. Ultimately, 13 publications met the inclusion criteria in this review (Fig. 1). There were 9 cross-cultural adaptations of the JOABPEQ for 8 different languages/cultures, including Arabic-Saudi [
Summary of the evidence
The objective of this review was to assess the cross-cultural adaptation process and the measurement properties of each JOABPEQ adaptation. Only 3/9 met the requirements for the test of the prefinal version, 5/9 of the adaptations failed to report the factor analysis, the expert committee were incompletely constituted, insufficient sample sizes were used for the test of the prefinal version and were performed in only some studies. These aspects were the major deficiencies impacting the quality
Conclusion
In the multiple adaptations for a specific language/culture, we recommend the Persian-Iranian, simplified Chinese–Chinese Mandarin, Thai, and Gunaydin G's Turkish versions for application. Not unexpectedly, the JOABPEQ scores may change by domain, age, gender, disease and treatments. So based on the process of cross-cultural adaptation and measurement properties, further studies are required to perform a comprehensive assessment, especially in the agreement and responsiveness. In addition,
Funding
We thank the National Natural Science Foundation of China (No. 82074454 for Xue-jun Cui, No. 81930116 for Yong-jun Wang, NO. 81929004 for Bing Shu, and No. 81873317 for Xue-jun Cui) and Shanghai Natural Science Foundation (No. 20ZR1459000 for Min Yao) for their financial support.
Conflict of interest
The authors report no conflicts of interest.
Acknowledgment
Not applicable.
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Zhuo-yao Li Contributed equally to this work and should be considered as co-first authors.