Brazilian version of the Neck Bournemouth Questionnaire does not have a well-defined internal structure in patients with chronic neck pain

Tampa Scale for Kinesiophobia in chronic neck pain patients (TSK-neck): structural and construct validity and reliability in a Brazilian population

BACKGROUND

To date, there are no studies in the literature that define the internal structure of the Tampa Scale for Kinesiophobia (TSK) in patients with chronic neck pain based on factorial analysis. As such, we aimed to verify and identify the best structure of the Brazilian version of the TSK in patients with chronic neck pain.

METHODS

We included Brazilian participants aged ≥18 years, both sexes, with self-reported neck pain for more than 3 months and pain intensity ≥3 on the Numerical Pain Rating Scale (NPRS). Dimensionality and number of TSK items were assessed using confirmatory factor analysis (CFA). We tested the following internal structures: structure 1 (1 domain and 17 items), structure 2 (1 domain and 11 items), structure 3 (2 domains and 11 items), and structure 4 (2 domains and 9 items). We used the Pain-Related Catastrophizing Thoughts Scale (PCTS) and the NPRS for construct validity. In addition, we assessed test-retest reliability for the seven-day interval using intraclass correlation coefficient (ICC2,1), Cronbach's alpha to assess internal consistency, and ceiling and floor effects.

RESULTS

The study sample included of 335 patients. Most were women (77.6%), young adults (~ 34 years), single (48.4%), with complete primary education (57.3%), physically inactive (66.6%), with a mean pain duration of 46 months and a mean pain intensity of ~ 5 points on the NPRS. Redundancy was found in the following items: item 1 with item 2 (modification indices = 21.419) and item 13 with item 15 (modification indices = 13.641). Subsequently, based on these paired analyses, the items with the lowest factor loadings (items 2 and 15) were excluded. As such, TSK structure 4 was composed of two domains ("somatic focus" and "activity avoidance") and 9 items, which showed adequate fit indices and lower AIC and SABIC values. We observed significant values (p < 0.05) with a correlation magnitude greater than 0.142 to 0.657 between the two domains of the TSK-neck and the other instruments (PCTS and NPRS). We found excellent reliability (ICC2,1 ≥ 0.96) and adequate internal consistency (Cronbach's alpha ≥0.98) of the TSK-neck. Finally, ceiling and floor effects were not observed.

CONCLUSION

The TSK-neck structure with two domains (somatic focus and activity avoidance) and nine items is the most appropriate for patients with chronic neck pain.

Anterior Knee Pain Scale (AKPS): structural and criterion validity in Brazilian population with patellofemoral pain

PURPOSE

To identify the best internal structure of the Brazilian version of the Anterior Knee Pain Scale (AKPS), comparing different instrument structures (structural validity) and correlating the scores of the versions (criterion validity).

METHODS

We included Brazilian volunteers, aged ≥ 18 years, with patellofemoral pain (PFP) for at least 3 months. We used the confirmatory factor analysis and considered the following fit indices: chi-square/degrees of freedom (DF), comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA). We considered the structure with the lowest values of the Akaike information criterion (AIC), sample size adjusted Bayesian information criterion (SABIC), and assessed criterion validity using Pearson correlation coefficient (r) to correlate the long and short versions.

RESULTS

The study included 101 participants, mostly women (65.3%), young adults (~ 31 years old), overweight (BMI > 25 kg/m2), incomplete higher education (37.6%), and physically active (64.4%). The original 1-domain, 13-item structure showed adequate fit indices (chi-square/GL < 3.00, TLI and CFI > 0.90, and RMSEA < 0, 08). However, items 11 and 12 had a factorial load of less than 0.23. Therefore, we excluded items 11 and 12 and found adequate fit indices (chi-square/GL < 3.00, TLI and CFI > 0.90, and RMSEA < 0, 08) and lower AIC and SABIC values. We observed a correlation coefficient above the acceptable cutoff of 0.70 (r = 0.966, p-value < 0.001) between the versions.

CONCLUSION

The 11-item AKPS (without items 11 and 12) is the version with the most adequate internal structure and correlates satisfactorily with the long version of the instrument.

The best structure of the Tampa Scale for Kinesiophobia for patients with chronic low back pain has two domains and nine items

PURPOSE

To identify the best internal structure of the Tampa Scale for Kinesiophobia in chronic low back pain patients.

DESIGN

Questionnaire validation study was designed for this study.

SETTING

This study was conducted in physical therapy facility.

SUBJECTS

Respondents reporting chronic low back pain (≥3 points on the 11-point Numerical Pain Rating Scale).

MAIN MEASURES

We included participants of both sexes, with a self-report of low back pain ≥3 months and with pain intensity ≥3 on the 11-point Numerical Pain Rating Scale; participants also answered the Roland-Morris Disability Questionnaire and the Pain-Related Catastrophizing Thoughts Scale for low back pain disability and catastrophizing, respectively. The dimensionality and number of items of the Tampa Scale for Kinesiophobia were evaluated using the confirmatory factor analysis. Criterion validity was assessed using Spearman's correlation coefficient using the original version of the 17-item Tampa Scale for Kinesiophobia as the gold standard.

RESULTS

A total of 122 participants were included, with mean values of low back pain duration ≥48 months, pain intensity >5 and disability >8. Tampa Scale for Kinesiophobia structure with two domains and nine items was the most suitable, with adequate values in all fit indices (Chi-square/degree of freedom <3, Comparative Fit Index and Tucker-Lewis Index >0.90, and root mean square error of approximation <0.08) and lower Akaike information criterion and Bayesian information criterion values. We observed a high correlation between the 17-item Tampa Scale for Kinesiophobia and the activity avoidance domain (rho = 0.850, P < 0.001) and somatic focus domain (rho = 0.792, P < 0.001) of the nine-item Tampa Scale for Kinesiophobia.

CONCLUSION

Tampa Scale for Kinesiophobia structure with two domains (activity avoidance and somatic focus) and nine items is the most suitable for patients with chronic low back pain.

Ten-Item Lower Extremity Functional Scale (LEFS-10): Instrument Reduction Based on Brazilian Patients With Lower Limb Dysfunction

OBJECTIVE

To propose a short version of the lower extremity functional scale (LEFS), to compare our short version with the different structures proposed for the LEFS by the specialized literature, and to verify the criterion validity of the best structure of the LEFS identified in our study.

DESIGN

Cross-sectional observational study.

SETTING

Physiotherapy clinics.

PARTICIPANTS

We included 140 patients with lower limb dysfunction (N=140).

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

We used confirmatory factor analysis (CFA), χ²/degree of freedom (DF), comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), standardized root mean squared residual (SRMR), Akaike information criterion (AIC), and Bayesian information criterion (BIC). The method of reducing the number of items of the LEFS considered the modification indices and factor loadings.

RESULTS

The body site most affected by pain was the knee (71.4%), and the most common diagnoses were knee osteoarthritis (55%) and anterior knee pain (11.4%). LEFS reduction generated a 1-dimensional structure of the LEFS with 10 items (LEFS-10). When compared with other structures, the LEFS-10 presented the best fit indices (χ²/DF=1.88, CFI=0.975, TLI=0.968, RMSEA=0.079, and SRMR=0.058) and the lowest values of AIC (3287.063) and BIC (3345.896). LEFS-10 presents a high correlation (Spearman's correlation coefficient [ρ]=0.911, P<.001) with the 20-item LEFS.

CONCLUSION

LEFS-10 is the proposal for a short version of the instrument with the most adequate internal structure, in addition to being satisfactorily correlated with the longer version of the instrument.

15-item Roland-Morris Disability Questionnaire (RMDQ-15): structural and criterion validity on patients with chronic low back pain

Background

The Roland-Morris Disability Questionnaire (RMDQ) is one of the most used instruments to measure self-reported disability in patients with low back pain, however, the uncertainty on which version to use may lead to inadequate disability measurement and consequently, improper management of patients with chronic low back pain.

Objective

To propose a short version of the RMDQ, compare it with the other short versions presented by the specialized literature, and identify the best internal structure of the RMDQ for the Brazilian population.

Methods

This is a cross-sectional study in which we used confirmatory factor analysis to identify the best structure of the RMDQ. We assessed 545 participants, most of which were women, aged ≥ 30 years old, single, with mean low back pain intensity ~ 5 points, and mean pain chronicity ~ 72 months. We used lavaan and semPlot packages, with implementation of a tetrachoric matrix and the robust diagonally weighted least squares extraction method. We also used fit indices chi-square/degree of freedom, comparative fit index, Tucker-Lewis index, root mean square error of approximation, and standardized root mean squared residual. For the comparison between models, we considered the structure with the lowest values of the Akaike information criterion and Bayesian information criterion. In addition, we assessed criterion validity via Spearman’s correlation coefficient to correlate the long and short versions. In this study, the 15-item structure was created through the use of modification indices to identify redundant items (9 items were excluded).

Results

RMDQ structure with one domain and 15 items and the structure with two domains and 16 items showed all fit indices with adequate values, but the one-dimensional version showed the lowest Akaike information criterion and Bayesian information criterion values. Regarding criterion validity, correlation between the RMDQ with 24 items and 15 items is adequate (rho = 0.954, p < 0.001).

Conclusion

The RMDQ-15 is a short version of the RMDQ instrument with the most adequate internal structure and satisfactorily correlated with the long version of the instrument.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05953-y.

The internal structure of Brazilian versions of disability questionnaires in patients with chronic low back pain: A cross-sectional study

BACKGROUND

Structural validity refers to the degree to which the scores of a questionnaire or scale are an adequate reflection of the construct to be measured. The aim of this study was to perform the analysis of the structural validity of the Roland-Morris Disability Questionnaire (RMDQ), Oswestry Disability Index (ODI), Quebec Back Pain Disability Scale (QBPDS), and Bournemouth Questionnaire (BQ) in Brazilian respondents with chronic low back pain.

METHODS

A cross-sectional study was conducted. The sample was composed by respondents with non-specific chronic low back pain (score ≥3 points on the 11-point Numerical Pain Rating Scale). The internal structure (number of domains and items) of the Brazilian versions of the RMDQ, the ODI, the QBPDS, and the BQ were analyzed by the confirmatory factor analysis.

RESULTS

Two hundred and twenty-two patients were included. Most of the sample consisted of women and overweight. The RMDQ and ODI have a one-dimensional structure and acceptable values for all confirmatory factor analysis fit indices. The QBPDS with 4 domains and 20 items showed the best values of the fit indices. In addition, we did not identify an internal structure for the BQ supported by the confirmatory factor analysis.

CONCLUSION

The ODI and RMDQ present valid internal structure with 1 domain (disability). The QBPDS has a valid internal structure with 4 domains (rest, prolonged postures, ambulation/reach, and bending/carrying). The BQ does not have a well-defined internal structure.

Psychometric properties of the Brazilian short-version of the Northwick Park Neck Pain Questionnaire

OBJECTIVE

To translate, cross-culturally adapt and assess measurement properties of the translated version of the Northwick Park Neck Pain Questionnaire into Brazilian Portuguese.

DESIGN

Cross-sectional study.

SETTINGS

University healthcare facility and online.

PARTICIPANTS

People with chronic neck pain (n = 178).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants answered the translated version of Northwick Park Neck Pain Questionnaire, the Neck Disability Index, the Numerical Rating Scale for pain, the Tampa Scale for Kinesiophobia and the Pain Catastrophizing Scale. Seven to ten days after that, a subset of 84 participants answered the Northwick Park Neck Pain Questionnaire again. The structural (exploratory and confirmatory factor analyses) and construct validities, internal consistency, reliability and concordance were assessed. Level of significance was set at 5%.

RESULTS

Participants' (35.6 ± 13.5 years old) with symptoms duration of 54.4 ± 60.4 months scored 25.5 ± 14.0 on the Brazilian Northwick Park Neck Pain Questionnaire and 11.9 ± 5.8 on the Neck Disability Index. The structural analysis showed that the short version of the Northwick Park Neck Pain Questionnaire has an adequate structure to measure disability due to neck pain. Correlations with other questionnaires were between 0.268 and 0.678, Cronbach's alfa was 0.76, intraclass correlation coefficient was 0.96, standard error of measurement was 2.74 and minimal detectable change was 7.60.

CONCLUSION

The short version of the Northwick Park Neck Pain Questionnaire is valid and reliable to be used in patients with chronic neck pain, as it presented adequate measurement properties of structural and construct validity, reliability and concordance.