The development of a physiotherapist-led pain management programme for low back pain in Bahrain

Study Design. Cross-cultural translation, adaptation, and psychometric testing. Objective. To cross-culturally translate and adapt the Roland-Morris Disability Questionnaire (RMDQ) into Modern Standard Arabic and examine its validity with Arabic-speaking patients with low back pain (LBP). Summary of Background Data. The English RMDQ is valid, reliable, and commonly used to assess LBP disability in clinical practice and research. There is no valid and reliable version of the RMDQ in Modern Standard Arabic. Methods. The RMDQ was forward translated and back translated. An expert committee of musculoskeletal physiotherapists reviewed the translation. Eight patients with LBP evaluated item-by-item comprehensibility. Ten patients piloted the RMDQ for overall comprehensibility and acceptability. Seventeen bilingual patients tested the agreement of the Arabic and English RMDQs. Two-hundred one patients completed the RMDQ and the visual analogue scale. Sixty-four patients were followed-up for test-retest reliability. Results. Translation of most items was uncontroversial. The expert committee found the Arabic RMDQ clinically and culturally appropriate. They reviewed item 11, addressing bending and kneeling, because this has a clinical significance and cultural/religious implication regarding prayer positions. All patients reported that it was easy to understand and complete. The Arabic RMDQ had high overall agreement with the English RMDQ for the global score (intraclass correlation coefficient [ICC] = 0.925; 0.811–0.972). Kappa statistics showed good item-by-item agreement (none <=0.30). Mean (SD) RMDQ and visual analog scale scores of 201 patients were 10.53 (4.80) and 5.11 (2.28), respectively. The RMDQ had a low correlation against pain intensity (r = 0.259; P < 0.01). A Cronbach [alpha] of 0.729 showed high internal consistency. Test-retest reliability of the Arabic RMDQ was good (ICC = 0.900; 95% confidence interval, 0.753–0.951). Kappa statistics were high for 18 items and fair for 6. Conclusion. The Arabic version of the RMDQ has good comprehensibility and acceptability, high internal consistency and reliability, low correlation against pain intensity, and good agreement with the English RMDQ. We recommend its use with Arabic-speaking patients with LBP. Level of Evidence: 3 Low back pain (LBP) is a common source of musculoskeletal pain and disability. About 10% of patients with LBP experience activity limitations or restricted participation in daily life.1,2 The Roland-Morris Disability Questionnaire (RMDQ) is a condition-specific, patient-reported outcome commonly used to measure LBP disability in research and clinical practice.3–5 It was developed from the Sickness Impact Profile. Statements were chosen to cover multiple aspects of daily living and the phrase “because of my back” was added to each statement to specify that the limitation described was due to back problems.6 The English RMDQ (EnRMDQ) has adequate reliability, validity, and responsiveness.6–8 In addition, it is simple to understand and complete; therefore, guidelines have recommended its use with patients with LBP.9,10