Sviluppo delle versioni Italiane del Örebro Musculoskeletal Pain Screening Questionnaire and Optimal Screening for Prediction of Referral and Outcome Yellow Flag: uno studio di affidabilità e validità

Development of the Italian versions of the Örebro Musculoskeletal Pain Screening Questionnaire and Optimal Screening for Prediction of Referral and Outcome Yellow Flag: reliability and validity study

Autori

Bonetti Francesca [University of Rome Tor Vergata, Rome, Italy; Physioup Physiotherapy Practice, Rome, Italy]

Angilecchia Domenico [Department of Medicine and Health Science “Vincenzio Tiberio”, University of Molise, Campobasso, Italy; Rehabilitation Service-ASL, Bari, Italy]

Agostini Alessandro [University of Rome Tor Vergata, Rome, Italy; Pain Unit. Santa Maria Maddalena Hospital. Advance Algology Research, Occhiobello (RO), Italy]

Marighetto Paolo [University of Rome Tor Vergata, Rome, Italy; Private Physiotherapy Practice, Castello di Godego (TV), Italy]

Minnucci Silvia [University of Rome Tor Vergata, Rome, Italy]

Giglioni Gloria [University of Rome Tor Vergata, Rome, Italy; Department of Rehabilitation, Asl Roma3, Rome, Italy]

Chiarotto Alessandro [Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands]

Pellicciari Leonardo [IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

Introduction

Low back pain (LBP) is the leading cause of disability worldwide with important social, healthcare and economic consequences. The early detection of prognostic factors using the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPQ-21) or the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) can predict improvement in pain and disability for patients with nonspecific LBP. The ÖMPQ-21 and the OSPRO-YF have been validated in several languages with moderate to good construct and predictive validity, and test-retest reliability. However, an Italian version of these instruments is not available, and this limits the use of these tools in clinical practice and in national and international studies.

Therefore, this study aims to translate and cross-culturally adapt the ÖMPQ-21 and the OSPRO-YF with their short versions into Italian,and to evaluate their measurement properties (i.e., reliability and validity) in patients with LBP.

Methods

The ÖMPQ-21 and the OSPRO-YF were translated into Italian following international guidelines, and final Italian versions were developed. Then, they were administered to adult patients with acute, subacute and chronic nonspecific LBP, together with a Numerical Rating Pain Scale (NPRS), the Oswestry Disability Index (ODI), the Pain Self-Efficacy Questionnaire (PSEQ), and the Pain Catastrophizing Scale (PCS). The following measurement properties of the full versions and their short forms were evaluated according to COSMIN recommendations: test-retest reliability (by means of Intraclass Correlation Coefficient [ICC]), measurement error (Standard Error of Measurement [SEM], Minimal Detectable Change [MDC]), and construct validity (hypotheses testing for correlations with other instruments).

Results

Eighty-three LBP patients (age=47.0±15.2 years; 56.6% female) were included. The translation processes were performed without any issue. Test-retest reliability of the ÖMPQ-21, OSPRO-YF, and their short forms (studied in 31 patients) were excellent and good, respectively (ICC:=0.82; 95%CI=0.65-0.91 for ÖMPQ-21; ICC=0.80, 95%CI, 0.63-0.90 for ÖMPQ short form; ICC=0.92; 95%CI=0.84-0.97 for OSPRO-YF; ICC=0.92, 95%CI=0.84-0.96 for OSPRO 10 items; ICC=0.92, 95%CI=0.92-0.98 for OSPRO 7 items). The measurement error analysis revealed a SEM of 2.3 points (2.8% of the scale range) and a MDC of 6.4 points (7.8%) for the OSPRO-YF, and a SEM of 6.7 points (3.2%) and a MDC of 18.6 points (8.9%) for the OMPQ-21. The construct validity of the ÖMPQ-21, its short version and OSPRO-YF was satisfactory and moderate, as 100% (4 out 4) and 50% (2 out 4) of the a-priori hypotheses were met, respectively. Overall, the OSPRO-YF performed slightly better than the OMPQ-21 on all three measurement properties

Discussion and Conclusion

The Italian versions of the ÖMPQ-21 and OSPRO-YF were developed. The OSPRO-YF showed excellent test-retest reliability in all versions (ICC>0.90), whereas the ÖMPQ-21 and ÖMPQ short forms reported good test-retest reliability (ICC>0.80). Measurement error was below 20% of the scale range for both instruments. Construct validity was satisfactory for the OSPRO-YF and its short versions, whereas it was moderate for the OMPQ-21 and its short forms.

ÖMPQ-21, OSPRO-YF and their short versions are quick to administer, and they are reliable and valid tools for identifying yellow flags in patients with LBP. The OSPRO-YF generally performs better than the OMPQ on all three assessed measurement properties, and therefore it could be clinically preferable. Future studies with a greater sample in different settings and musculoskeletal pathologies are needed to confirm the findings of the current study, and to compare head-to-head their prognostic ability to predict core outcomes in LBP patients.

REFERENCES

Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000 Dec 15;25(24):3186-91. doi: 10.1097/00007632-200012150-00014.

Gagnier JJ, Lai J, Mokkink LB, Terwee CB. COSMIN reporting guideline for studies on measurement properties of patient-reported outcome measures. Qual Life Res. 2021 Aug;30(8):2197-2218. doi: 10.1007/s11136-021-02822-4.

Profilo nazionale dei fisioterapisti con dottorato o dottorandi in Italia: uno studio trasversale basato su un sondaggio web

National profile of Physical Therapists with PhD or who are PhD students in Italy: A cross-sectional study based on a web-survey

Autori

Pellicciari Leonardo [IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy]

Ravizzotti Elisa [Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy]

Gianola Silvia [Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy]

Castellini Greta [Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy]

Putzolu Martina [Department of Experimental Medicine (DIMES), Section of Human Physiology, University of Genoa, Genoa, Italy]

Bertazzoni Luca [Vrije Universiteit Bruxelles (VUB), Brussels, Belgium; Painlab Studio Osteopatico, Milan, Italy]

Rossetto Gianluca [Department of Information Engineering, University of Brescia, Brescia, Italy]

Barbero Marco [Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland.]

Fabbri Alessia [AUSL della Romagna, Cesena, Italy]

Stefano Vercelli [Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland.] Paci Matteo [Department of Allied Health Professions, Azienda USL Toscana Centro, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy]

Introduction

In recent years, the physical therapist (PT) profession in Italy has grown culturally and scientifically. One of the contributing factors to this development has been the increasing number of PTs who have pursued a higher education program at universities, such as doctoral programmes (PhD).

In 2022, [1] we were able to identify 87 PTs who hold a PhD and 47 PhD students (PhDs). Their bibliometric indices were significantly higher than the national average of PTs who authored scientific articles (including academic ones), demonstrating that PhD programs effectively promote higher scientific achievements.

In the past two years, other colleagues were engaged in a doctoral program. Understanding the trajectories of doctoral programmes is the first essential step to promote the stable employment of PTs in academic and research environments in Italy and to foster the cultural growth of the profession. Therefore, the aim of this study was to update the profile of PTs with a PhD or who are PhDs.

Methods

This study was part of a broader national investigation promoted by the Italian Association of Physiotherapy (AIFI) and supported by the Italian Society of Physiotherapy (SIF).

An anonymous questionnaire investigating doctoral-related characteristics was administered online to PTs who were currently enrolled in, or completed a PhD program in September 2023. Physiotherapists were included in a database on the website of the SIF, updated in late August 2023 [2].

The purpose of the survey was to gather data about the attended PhD programs, research background, and employment history in addition to professional honors and recognition of participants. Two bibliometric indices were also extracted: the number of published articles was provided by the respondents, and their H-index was retrieved from the Scopus database.

Results

Out of 165 PTs listed in the SIF database, 101 (61.2%) responded to the questionnaire. Fifty-six (55.4%) of them declared that they obtained a PhD, while 45 (44.6%) were PhDs. About one third (N=42) of PTs with PhDs and two-third (N=29) of PhDs attended their program in Italy. Only 18 (32.1%) PTs with PhDs did their doctorate with a scholarship, while 27 (60.0%) of PhDs obtained a scholarship. Among PTs with PhD, the skills acquired during the PhD were very or somewhat useful for 44 (78.6%) of them, and 24 (42.9%) thought that obtaining a PhD was very important to find a work after the PhD. The tutor was a PT for 16 (28.6%) PT with PhD and for 23 (51.1%) for PhDs. Thirty-seven (82.2%) PhDs would choose to attend their PhD again. About two-third of PTs with PhD (N=37, 67.3%) currently hold an academic position in Italy or abroad. Finally, 15 (27.3%) PTs with PhD obtained the national scientific qualification.

Discussion and Conclusion

The number of PTs engaged in a PhD program has increased in recent years [3]. Unfortunately, about one-third of respondents had to emigrate to study because of the small number of PhD programs available in Italy and the lack of leadership of PhD programs in our profession. However, in 2023 the majority of PhDs have scholarship or funding (unlike PTs with PhD) that allow them to dedicate themselves to their research activity fully. PTs with PhD found their path useful, both in terms of skills acquired and professional impact. Furthermore, PhDs are satisfied with their path. Finally, in recent years, more PTs have filled the role of tutor; this means more PTs have acquired skills to fill this role. Therefore, the data collected by this study show a growing trend of Italian PTs engaged with PhD programmes, and a concomitant increase in the quality of their scientific production.

REFERENCES

[1] Pellicciari L, Vercelli S, Barbero M, Ravizzotti E, Corbetta D, Fabbri A, Pillastrini P. Italian physiotherapists who hold a PhD: ready for a new battle of Thermopylae? International Scientific Congress AIFI 2022. 28-29 October 2022.

[2] Italian Society of Physiotherapy internet site. Available at: https://www.sif-fisioterapia.it/risorse/fisioterapisti-e-dottorati-di-ricerca/ Accessed on August 20st, 2023.

[3] Vercelli S, Ravizzoti E, Paci M. Are they publishing? A descriptive cross-sectional profile and bibliometric analysis of the journal publication productivity of Italian physiotherapists. Arch Physiother. 2018;8:1.