The cross-cultural adaptation, validity, and reliability of the Spanish version of the Fremantle Back Awareness Questionnaire

The Fremantle Back Awareness Questionnaire: Cross-cultural adaptation, validity and reliability of the Polish version

BACKGROUND

Body image disturbance is observed in individuals with chronic low back pain (CLBP) and is a potential treatment target. The Fremantle Back Awareness Questionnaire (FreBAQ) is designed to identify disrupted body image specific to the low back. This study aimed to develop and assess the measurement properties of a Polish language version of this questionnaire (FreBAQ-PL).

METHODS

Following the translation process, cognitive interviews were carried out as a qualitative assessment of content validity. Subsequently a quantitative assessment of content validity was undertaken among in a study sample with CLBP and experts. Measurement properties were assessed in 114 participants with CLBP and 53 pain-free participants. The CLBP sample repeated the FreBAQ-PL assessment within 14-days. The measurement properties assessed in this study were content validity, internal consistency, frequency of responses, known-groups validity, convergent validity and test-retest reliability.

RESULTS

Content validity was supported, affirming relevance and comprehensiveness. Known-groups validity was confirmed by significant differences in FreBAQ-PL scores between participants with CLBP and pain-free participants (p < 0.05). Convergent validity was established through moderate associations between FreBAQ-PL scores and pain variables (intensity and duration) (ρ's = 0.24-0.27, p's < 0.01), disability (ρ = 0.34, p < 0.01), kinesiophobia (ρ = 0.37, p < 0.01), depression (ρ = 0.30, p < 0.01) and anxiety (ρ = 0.24, p < 0.01). The scale was internally consistent (Cronbach's alpha 0.81). Test-retest reliability was good (ICC 0.90).

CONCLUSIONS

The FreBAQ-PL is a reliable, internally consistent, and valid measure that can be used in clinical and research settings to assess the presence of body image disturbance in Polish-speaking individuals with CLBP.

Body perception outcome measures in chronic non-specific low back pain: A systematic review of measurement properties using the COSMIN approach

Chronic low back pain (CLBP) is a highly prevalent health problem. Recent research has suggested that disruption of body perception might contribute to the problem and represent a target for treatment. Valid and reliable outcome measures are required to understand the relationship between disrupted body perception and clinical status. This systematic review aimed to identify patient reported outcome measures (PROMs) used to assess body perception disruption in people with CLBP and evaluate their psychometric properties. Five databases were searched for studies investigating the psychometric properties of PROMs designed to assess body perception in people with CLBP. The appraisal of the methodological quality and measurement properties adhered to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Sixteen studies were included, evaluating two PROMs: the Fremantle Back Awareness Questionnaire (FreBAQ) and the Body Awareness Rating Questionnaire (BARQ). The studies included data from 2545 participants, comprising 1694 individuals with CLBP. The following measurement properties were investigated: content validity; structural validity; internal consistency; cross-cultural validity; test-retest reliability; measurement error and construct validity. While there is evidence for test-retest reliability and construct validity, neither questionnaire demonstrated adequate content validity and there was a low level of evidence for sufficient internal consistency. Consequently, both the FreBAQ and BARQ were classified as 'B', indicating their potential for recommendation, contingent upon further research to evaluate their quality. Future research should address identified limitations of the questionnaires, particularly content validity. This will lead to the development of more useful tools to measure body perception in the CLBP population. Perspective This article presents an evaluation of the psychometric properties of patient reported outcome measures used to assess body perception in individuals with chronic low back pain. These tools could potentially help clinicians identify and address body perception distortions in people with chronic low back pain, leading to effective management strategies.

Validation of the French version of the Fremantle Back Awareness Questionnaire in patients with chronic low back pain

BACKGROUND

Impaired body perception could contribute to the pain experience and be a possible treatment target. The Fremantle Back Awareness Questionnaire (FreBAQ) is the only self-report questionnaire to assess back-specific self-perception.

AIM

The aim of this study was to develop a French version of the FreBAQ (FreBAQ-FR) and to evaluate its psychometric properties.

DESIGN

Observational study.

SETTING

Department of Physical Medicine and Rehabilitation at University Hospital.

POPULATION

One hundred eighteen patients with chronic low back pain (cLBP) and 30 healthy participants were included.

METHODS

A forward-backward method was used to translate the FreBAQ into French. Unidimensionality was assessed by exploratory factor analysis, and internal consistency was quantified by Cronbach's alpha coefficient. Known-groups validity was assessed by comparing results between cLBP patients and healthy participants. Temporal stability was assessed in participants who completed the FreBAQ-FR 7 days later using the intraclass correlation coefficient (ICC). Patients' FreBAQ-FR scores were correlated with functional questionnaires and two-point discrimination thresholds (TPD) for tactile acuity.

RESULTS

The FreBAQ-FR showed good internal consistency with a Cronbach's alpha coefficient of 0.78 and can be considered unidimensional. The cLBP group scored significantly higher than the control group (11 [6 ; 17] vs. 0.5 [0 ; 5], P<0.0001). The temporal stability of the FreBAQ-FR was acceptable, with an ICC of 0.84 (95% CI: 0.77 to 0.89) and an estimated bias of -0.71±4.2 (95% CI: -1.61 to 0.18, P=0.12). In the cLBP group, FreBAQ-FR total scores correlated moderately with the Oswestry Disability Index (r=0.53, 95% CI: 0.39 to 0.65) and the Pain Catastrophizing Scale total score (r=0.53, 95% CI: 0.38 to 0.65). TPD results did not correlate with FreBAQ-FR scores (r=0.06, 95% CI: -0.12 to 0.24).

CONCLUSIONS

The FreBAQ-FR showed acceptable psychometric properties and is suitable to assess back-specific body perception in the French-speaking population with cLBP.

CLINICAL REHABILITATION IMPACT

This questionnaire may help researchers and clinicians to assess disrupted self-perception of the back, improve our understanding of the multifaceted experience of cLBP, and potentially offer better tailored treatment to patients.

Self-reported questionnaires assessing body perception disturbances in adults with chronic non-cancer pain: a scoping review

Introduction

Body perception disturbances (BPD) are well documented in certain chronic pain populations [e.g., complex regional pain syndrome (CRPS)], while being far less studied in chronic pain as a general condition. The aims of this scoping review are to identify the self-reported questionnaires used to assess BPD in individuals with chronic non-cancer pain and to refine the definition of the BPD construct as used in these questionnaires.

Methods

A search strategy focusing on the concepts of "chronic pain", "body perception" and "questionnaire" was used across four databases. Each record was screened for eligibility by two independent reviewers, and data extraction was performed by one reviewer and validated by a second reviewer.

Results

Eighty-seven studies were included, comprising 18 different questionnaires-either directly related to BPD or containing relevant items. The three most commonly used questionnaires were the Bath Body Perception Disturbance Scale, the Fremantle Back Awareness Questionnaire, and the Neurobehavioral Questionnaire. Appraisal of the construct derived from the questionnaire items identified five main facets: size, shape, cognitive neglect-like symptoms, proprioceptive awareness, and agency, along with 11 other less frequently addressed facets. The most represented clinical populations were CRPS (40 studies) and chronic low-back pain (20 studies).

Discussion

A variety of self-reported questionnaires are available to assess BPD, but most are diagnosis- or body-region specific. To better assess BPD in individuals with chronic non-cancer pain, a consensus on the general definition and the key facets of the construct is needed.

Body Image Measured via the Fremantle Awareness Questionnaire in Individuals With and Without Pain: A Systematic Review and Meta-Analysis

Research suggests that pain negatively affects body image, and body image may also influence reported pain levels. This review aims to summarize the literature on differences in body image distortion between individuals with pain compared to pain-free individuals. The review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 statement and an a priori preregistered protocol. The literature was searched using 5 electronic databases. Studies assessing body image with the Fremantle Awareness Questionnaire (FAQ) in individuals with and without pain were eligible for inclusion. Screening and selection of eligible studies were performed by independent reviewers. Methodological quality was assessed with the Joanna Briggs Institute critical appraisal tool. Meta-analyses, meta-correlations, and metamean analyses were performed using random-effect models. The primary outcome was the FAQ score; secondary outcomes were reported pain variables. Data from individuals with pain (n = 2277) and without pain (n = 615) were summarized. Significant body image distortions were found in individuals with pain compared to individuals without pain. Compared to pain-free individuals, the pain group rated significantly higher in the FAQ when experiencing back pain (standardized mean differences=1.33, 95% confidence interval=.88-1.77) or other body parts (standardized mean differences=1.25, 95% confidence interval=.51-1.99). The results of meta-correlation analyses confirmed the positive relationship between body image distortion and pain intensity (r = .31), pain at rest (r = .31), or pain during movement (r = .36), but not for pain duration. A difference in mean FAQ results was observed between individuals with pain in different areas (knee and back). PERSPECTIVE: This review confirms differences in body image distortion between pain and pain-free individuals. Pain intensity was correlated with altered body perception, but not pain duration. A moderate correlation was observed between body image distortion and reported pain variables. Body image was more impaired by knee pain than back pain. REGISTERED PROTOCOL AT PROSPERO: CRD42022309937; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022309937.

Unraveling the Left-Right Judgment Task in Chronic Low Back Pain: Insights Through Behavioral, Electrophysiological, Motor Imagery, and Bodily Disruption Perspectives

Bodily disruptions have been consistently demonstrated in individuals with chronic low back pain. The performance on the left-right judgment task has been purposed as an indirect measure of the cortical proprioceptive representation of the body. It has been suggested to be dependent on implicit motor imagery, although the available evidence is conflicting. Hence, the aim of this case-control observational study was to examine the performance (accuracy and reaction times) and event-related potentials while performing the left-right judgment task for back and hand images in individuals with chronic low back pain versus healthy controls, along with its relationship with self-reported measurements and quantitative sensory testing. While self-reported data suggested bodily disruptions in the chronic low back pain sample, this was not supported by quantitative sensory testing. Although both groups displayed the same performance, our results suggested an increased attentional load on participants with chronic low back pain to achieve equal performance, measured by a higher N1 peak amplitude in occipital electrodes, especially when the effect of contextual images arises. The absence of differences in the reaction times for the left-right judgment task between both groups, along with inconsistencies in self-reported and quantitative sensory testing data, could question the involvement of implicit motor imagery in solving the task. In conclusion, our results suggest disrupted attentional processing in participants with chronic low back pain to solve the left-right judgment task. PERSPECTIVE: Although there are no differences in the performance of the left-right judgment task (hits, reaction times) between chronic low back pain patients and controls, the analysis of event-related potentials revealed that patients require a higher cognitive load, measured by N1 peak amplitude.

The Fremantle Back Awareness Questionnaire: cross-cultural adaptation, reliability, and validity of the Italian version in people with chronic low back pain

BACKGROUND AND AIM

There is evidence to suggest that assessing back-specific altered self-perception may be useful when seeking to understand and manage low back pain (LBP). The Fremantle Back Awareness Questionnaire (FreBAQ) is a patient-reported measure of back-specific body perception that has never been adapted and psychometrically analysed in Italian. Hence, the objectives of this research were to cross-culturally adapt and validate the Italian version of this outcome measure (namely, the FreBAQ-I), to make it available for use with Italians suffering from chronic LBP.

METHODS

The FreBAQ-I was developed by forward and backward translation, review by a committee skilled in patient-reported measures and test of the pre-final version to assess its clarity, acceptability, and relevance. The statistical analyses examined: structural validity based on Rasch analysis; hypotheses testing by investigating correlations of the FreBAQ-I with the Roland Morris Disability Questionnaire (RMDQ), a pain intensity numerical rating scale (PI-NRS), the Pain Catastrophising Scale (PCS), and the Tampa Scale of Kinesiophobia (TSK) (Pearson's correlations); reliability by internal consistency (Cronbach's alpha) and test-retest repeatability (intraclass correlation coefficient, ICC (2,1)); and measurement error by determining the minimum detectable change (MDC). After the development of a consensus-based translation of the FreBAQ-I, the new outcome measure was delivered to 100 people with chronic LBP.

RESULTS

Rasch analysis confirmed the substantial unidimensionality and the structural validity of the FreBAQ-I. Hypothesis testing was considered good as at least 75% of the hypotheses were confirmed; correlations: RMDQ (r = 0.35), PI-NRS (r = 0.25), PCS (r = 0.41) and TSK (r = 0.38). Internal consistency was acceptable (alpha = 0.82) and test-retest repeatability was excellent (ICC (2,1) = 0.88, 95% CI: 0.83, 0.92). The MDC95 corresponded to 6.7 scale points.

CONCLUSION

The FreBAQ-I was found to be a unidimensional, valid, and reliable outcome measure in Italians with chronic LBP. Its application is advised for clinical and research use within the Italian speaking community.

Proprioceptive acuity is core for back awareness in chronic low back pain: Further analysis of the content validity of the Spanish version of the Fremantle Back Awareness Questionnaire

Treatments aimed at increasing self-perception may improve chronic low back pain (CLBP) symptomatology and present novel management approaches. Consequently, it is important to have valid, complete, and reliable tools for its assessment, and to understand which variables influence altered back awareness. We aimed to evaluate the face/content validity of the Spanish version of the Fremantle Back Awareness Questionnaire (FreBAQ-S) among people with and without CLBP, and to explore additional variables suggested to be involved in back awareness. A total of 264 individuals with CLBP and 128 healthy controls (HC) answered an online survey, including the FreBAQ-S, and questions regarding the completeness, comprehensibility, time-to-complete adequacy, and time spent completing it. If participants declared a lack of completeness, they had to report which aspects would be incorporated into the questionnaire to explore additional back-awareness-related variables. A statistically significant difference in completeness emerged between groups (p < 0.01). The questionnaire was comprehensible for more than 85% of participants, regardless of the group (p = 0.45). CLBP participants spent significantly more time in completing the questionnaire than controls (p < 0.01), but no differences were found between groups regarding the time-to-complete adequacy (p = 0.49). Regarding the back-awareness-related variables, 77 suggestions from CLBP group and seven from the HC were received. Most of them were related to proprioceptive acuity such as posture, weight, or movement patterns, among others. The FreBAQ-S demonstrated adequate face/content validity, completeness, comprehensibility, and adequate time of response. The feedback provided will help improve currently available assessment tools.