Author: Ma, Hok Man
Title: Translation and validation of traditional Chinese version of a yellow flag assessment tool for patients with spinal pain
Advisors: Wong, Arnold (RS)
Pang, Marco (RS)
Degree: DHSc
Year: 2023
Subject: Backache
Neck pain
Spine -- Diseases
Pain -- Measurement
Translating and interpreting
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: xv, 190 pages : color illustrations
Language: English
Abstract: Background
Low back pain and neck pain in the chronic form are the most prevalent pain conditions affecting millions of people around the world. It was believed that chronic pain in the neck or lower back regions are multifaceted disorders resulting from the interactions between physiological, psychological and social factors, and has an important impact on extending and worsening the clinical presentation. Various psychological factors can negatively impact the chronic spinal pain condition and patients’ responses to treatment. Therefore, an improved understanding of the psychological condition of patients with chronic spinal pain is essential in tailor-made and comprehensive treatment strategies for these patients. The Optimal Screening for Prediction of Referral and Outcome Yellow Flag(OSPRO-YF) Assessment Tool is a newly established assessment tool for yellow flag screening in 2016. The OSPRO-YF Assessment Tool was deduced from a 136-item pool which was summarized from 10 validated questionnaires. Among those validated questionnaires, 11 psychological constructs were assessed. They include trait anxiety, depression, fear avoidance beliefs for physical activities, pain-related fear of movement fear avoidance beliefs for work, anger, pain self-efficacy, pain catastrophizing, pain-related anxiety and pain acceptance. However, no research was conducted to culturally adapted the OSPRO-YF Assessment Tool for assessing psychological conditions among Chinese patients with back or neck pain.
This study aimed to: (i) translate OSPRO Cohort Yellow Flag (OSPRO-YF) Assessment Tool into Traditional Chinese version; and (ii) evaluate the reliability and validity of the translated OSPRO-YF Assessment Tool among Chinese patients with spinal pain.
An established translation procedure was implemented to translate OSPRO-YF Assessment Tool. The procedure included forward and backward translation, as well as testing with cognitive debriefing interviews. Three panel members evaluated the semantic equivalence and the content equivalence.
The translated questionnaire was validated on 200 Chinese patients with spinal pain receiving physiotherapy service in a local public hospital. Confirmatory factor analysis (CFA) was adopted to evaluate the structural validity. The test-retest reliability and internal consistency were assessed by Wilcoxon signed-rank test and Spearman’s rho correlation coefficient. For the responsiveness analysis, the correlations between the changes of score in all factors and the corresponding changes in Numeric Pain Rating Scale (NPRS), Roland Morris Disability Questionnaire (RMDQ) scores and Northwick Park Questionnaire (NPQ) scores were examined by Spearman’s rho correlation coefficients. The convergent, discriminant validity and predictive validity were examined by evaluating the correlations between the items scores in each identified factor in the translated OSPRO-YF Assessment Tool and three representative questionnaires, including Tampa Scale of Kinesiophobia (TSK-11), Patient Health Questionnaire (PHQ-9), and Pain Self-Efficacy Questionnaire (PSEQ).
The semantic equivalence and the content equivalence of OSPRO-YF were 100%. Four factors including negative mood, pain catastrophizing, fear avoidance, and positive coping were identified. CFA indicated good fit for the four-factors model (CFI=0.974, RMSEA=0.066, p<0.001). Factors demonstrated moderate-to-good test-retest reliability (r=0.725 to 0.982, p>0.05). For the convergent validity, the pain catastrophizing factor revealed moderate correlations with TSK-11 (r=0.598) and PHQ­-9 (r=0.514) (p<0.001); the fear avoidance factor demonstrated moderate correlations (with TSK-11 (r=0.507; p<0.001); positive coping factor was moderately related to PSEQ (r=0.594; p<0.001); negative mood factor was weakly correlated with PHQ-9 (r=0.377; p<0.001). For the discriminant validity, pain catastrophizing factor demonstrated significant weak correlations with PSEQ (r= -0.341, p<0.001); fear avoidance factor was weak correlated with PHQ-9 (r=0.317) and PSEQ (r= -0.168). The positive coping factor displayed negligible correlation with TSK-11 (r= -0.112) and weak correlation with PHQ-9 (r=0.321), while the negative mood factor demonstrated negligible correlation with TSK-11 (r=0.154) and PSEQ (r= -0.125). Additionally, responsiveness analyses showed that changes in all these factors had negligible correlation with the corresponding change in NPRS, NGRCS, RMDQ or NPQ.
Our findings substantiated that traditional Chinese version of OSPRO-YF Assessment Tool was a reliable and valid instrument to assess psychosocial conditions among Chinese patients with spinal pain. This validated instrument can be used to monitor the temporal changes in health-related functioning of Chinese patients with spinal pain, although further research is warranted to evaluate the responsiveness of this questionnaire.
Rights: All rights reserved
Access: restricted access

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