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
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.
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).
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
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.
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.
