Skip to main content
SpringerLink
Log in

The Italian version of the Quebec Back Pain Disability Scale: cross-cultural adaptation, reliability and validity in patients with chronic low back pain

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Background and aim

Growing attention is being given to physical functioning measures to assess interventions for low back pain (LBP). The Quebec Back Pain Disability Questionnaire (QBPDS) has never been validated in Italian patients, and the aim of the study was culturally adapting and validating the Italian version of the QBPDS (QBPDS-I), to allow its use with Italian-speaking patients with chronic LBP.

Methods

The QBPDS-I was developed by means of forward–backward translation, a final review by an expert committee and a test of the prefinal version to evaluate its comprehensibility. The psychometric testing included structural validity by exploratory factor analysis (EFA), reliability by internal consistency (Cronbach’s alpha) and test–retest reliability (intraclass correlation coefficient, ICC 2.1), measurement error by calculating the minimum detectable change (MDC), construct validity by assessing hypotheses of QBPDS correlations with the Roland Morris Disability Scale (RMDQ), the Oswestry Disability Questionnaire (ODI) and a pain numerical rating scale (NRS) (Spearman’s correlations).

Results

It took one month to develop a consensus-based version of the QBPDS-I. The questionnaire was administered to 201 subjects with chronic LBP and was well accepted. EFA suggested a one-factor 20-item solution (first factor variance explained = 54.7%). Internal consistency (α = 0.95) and test–retest reliability (ICC = 0.90) were excellent. The MDC was 12 scale points. Construct validity was good as all of the hypotheses were met; correlations: RMDQ (r = 0.40), ODI (r = 0.48) and NRS (r = 0.44).

Conclusions

The QBPDS-I is unidimensional, reliable and valid in patients with chronic LBP. Its use is recommended for clinical and research purposes.

Graphic abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Deyo RA, Weinstein JN (2001) Low back pain. Reply N Engl J Med 344:1644–1645

    Article  Google Scholar 

  2. Andersson GB (1999) Epidemiological features of chronic low-back pain. The Lancet 354:581–585

    Article  CAS  Google Scholar 

  3. Balagué F, Mannion AF, Pellisé F, Cedraschi C (2012) Non-specific low back pain. The Lancet 379:482–491

    Article  Google Scholar 

  4. Bombardier C (2000) Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. Spine 25:3100–3103

    Article  CAS  Google Scholar 

  5. Chiarotto A, Deyo RA, Terwee CB et al (2015) Core outcome domains for clinical trials in non-specific low back pain. Eur Spine J 24:1127–1142

    Article  Google Scholar 

  6. Wong AY, Lauridsen HH, Samartzis D et al (2019) Global consensus from clinicians regarding low back pain outcome indicators for older adults: pairwise wiki survey using crowdsourcing. JMIR Rehabil Assist Technol 6:e11127

    Article  Google Scholar 

  7. Chapman JR, Norvell DC, Hermsmeyer JT et al (2011) Evaluating common outcomes for measuring treatment success for chronic low back pain. Spine 36:S54–S68

    Article  Google Scholar 

  8. Chiarotto A, Boers M, Deyo RA et al (2018) Core outcome measurement instruments for clinical trials in nonspecific low back pain. Pain 159:481

    Article  Google Scholar 

  9. Padua R, Padua L, Ceccarelli E et al (2002) Italian version of the Roland Disability Questionnaire, specific for low back pain: cross-cultural adaptation and validation. Eur Spine J 11:126–129

    Article  CAS  Google Scholar 

  10. Monticone M, Baiardi P, Ferrari S et al (2009) Development of the Italian version of the Oswestry Disability Index (ODI-I): a cross-cultural adaptation, reliability, and validity study. Spine 34:2090–2095

    Article  Google Scholar 

  11. Grotle M, Brox JI, Vøllestad NK (2005) Functional status and disability questionnaires: what do they assess?: a systematic review of back-specific outcome questionnaires. Spine 30:130–140

    Article  Google Scholar 

  12. Kopec JA, Esdaile JM, Abrahamowicz M et al (1995) The Quebec back pain disability scale. Meas Prop Spine 20:341–352

    Article  CAS  Google Scholar 

  13. Kopec JA, Esdaile JM, Abrahamowicz M et al (1996) The Quebec back pain disability scale: conceptualization and development. J Clin Epidemiol 49:151–161

    Article  CAS  Google Scholar 

  14. Davidson M, Keating JL (2002) A comparison of five low back disability questionnaires: reliability and responsiveness. Phys Ther 82:8–24

    Article  Google Scholar 

  15. Chiarotto A, Ostelo RW, Boers M, Terwee CB (2018) A systematic review highlights the need to investigate the content validity of patient-reported outcome measures for physical functioning in patients with low back pain. J Clin Epidemiol 95:73–93

    Article  Google Scholar 

  16. Schoppink LE, van Tulder MW, Koes BW et al (1996) Reliability and validity of the Dutch adaptation of the Quebec back pain disability scale. Phys Ther 76:268–275

    Article  CAS  Google Scholar 

  17. Yvanes-Thomas M, Calmels P, Béthoux F et al (2002) Validity of the French-language version of the Quebec back pain disability scale in low back pain patients in France. Joint Bone Spine 69:397–405

    Article  Google Scholar 

  18. Mousavi SJ, Parnianpour M, Mehdian H et al (2006) The Oswestry disability index, the Roland-Morris disability questionnaire, and the Quebec back pain disability scale: translation and validation studies of the Iranian versions. Spine 31:E454–E459

    Article  Google Scholar 

  19. Melikoglu MA, Kocabas H, Sezer I et al (2009) Validation of the Turkish version of the Quebec back pain disability scale for patients with low back pain. Spine 34:E219–E224

    Article  Google Scholar 

  20. Rodrigues MF, Michel-Crosato E, Cardoso JR, Traebert J (2009) Psychometric properties and cross-cultural adaptation of the Brazilian Quebec back pain disability scale questionnaire. Spine 34:E459–E464

    Article  Google Scholar 

  21. Christakou A, Andriopoulou M, Asimakopoulos P (2011) Validity and reliability of the Greek version of the Quebec back pain disability scale. J Back Musculoskelet Rehabil 24:145–154

    Article  Google Scholar 

  22. Misterska E, Jankowski R, Glowacki M (2011) Quebec back pain disability scale, low back outcome score and revised Oswestry low back pain disability scale for patients with low back pain due to degenerative disc disease: evaluation of Polish versions. Spine 36:E1722–E1729

    Article  Google Scholar 

  23. Alnahhal A, May S (2012) Validation of the Arabic version of the Quebec back pain disability scale. Spine 37:E1645–E1650

    Article  Google Scholar 

  24. Suh KT, Kim JI, Lim JM et al (2012) Validation of the Korean version of the Quebec back pain disability scale. Clin Spine Surg 25:447–450

    Google Scholar 

  25. Cruz EB, Fernandes R, Carnide F et al (2013) Cross-cultural adaptation and validation of the Quebec back pain disability scale to European Portuguese language. Spine 38:E1491–E1497

    Article  Google Scholar 

  26. Wei X, Yi H, Wu B et al (2012) A valid cross-culturally adapted simplified Chinese version of the Quebec back pain disability scale. J Clin Epidemiol 65:1321–1328

    Article  Google Scholar 

  27. Zaidi S, Verma S, Moiz JA, Hussain ME (2018) Transcultural adaptation and validation of Hindi version of Quebec back pain disability scale. Disabil Rehabil 40:2938–2945

    Article  Google Scholar 

  28. Riecke J, Holzapfel S, Rief W et al (2016) Cross-cultural adaption of the German Quebec back pain disability scale: an exposure-specific measurement for back pain patients. J Pain Res 9:9

    Article  Google Scholar 

  29. Bendeddouche I, Rostom S, Bahiri R et al (2012) Translation, adaptation and validation of the Moroccan version of the Quebec back pain disability scale. Clin Rheumatol 31:943–949

    Article  Google Scholar 

  30. De Beer N, Stewart A, Becker P (2010) Validation of the Tswana versions of the Roland-Morris disability questionnaire, Quebec disability scale and Waddell disability index. S Afr J Physiotherapy 64:23–30

    Google Scholar 

  31. Speksnijder CM, Koppenaal T, Knottnerus JA et al (2016) Measurement properties of the Quebec back pain disability scale in patients with nonspecific low back pain: systematic review. Phys Ther 96:1816–1831

    Article  Google Scholar 

  32. Beaton DE, Bombardier C, Guillemin F, Ferraz MB (2000) Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 25:3186–3191

    Article  CAS  Google Scholar 

  33. Wild D, Grove A, Martin M et al (2005) Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value Health 8:94–104

    Article  Google Scholar 

  34. Terwee CB, Bot SD, de Boer MR et al (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42

    Article  Google Scholar 

  35. Mokkink LB, Terwee CB, Knol DL et al (2010) The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol 10:22

    Article  Google Scholar 

  36. Huskisson EC (1974) Measurement of pain. The Lancet 304:1127–1131

    Article  Google Scholar 

  37. Maughan EF, Lewis JS (2010) Outcome measures in chronic low back pain. Eur Spine J 19:1484–1494

    Article  Google Scholar 

  38. R Core Team (2015) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  39. Terwee CB, Prinsen CAC, Chiarotto A, Westerman MJ, Patrick DL, Alonso J, Bouter LM, de Vet HCW, Mokkink LB (2018) COSMIN methodology for evaluating the content validity of patient-reported outcome measures: a Delphi study. Qual Life Res 27(5):1159–1170

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to thank all of the subjects who got involved into the study. The research activities of Frigau Luca described in this paper have been conducted within the R&D Project Cagliari2020, partially funded by the Italian University and Research Ministry (Grant No. MIUR PON04a2 00381).

Author information

Authors and Affiliations

  1. Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria, Strada Statale, 554 - Monserrato, Cagliari, Italy

    Marco Monticone

  2. Department of Neuroscience and Rehabilitation, Neurorehabilitation Unit, G. Brotzu Hospital, Cagliari, Italy

    Marco Monticone

  3. Department of Economics and Business Science, University of Cagliari, Cagliari, Italy

    Luca Frigau & Francesco Mola

  4. ICS Maugeri, IRCCS, Lissone, Italy

    Barbara Rocca

  5. ICS Maugeri, IRCCS, Pavia, Italy

    Franco Franchignoni

  6. Department of Scienze Anatomiche, Istologiche, Medico-Legali E Dell’Apparato Locomotore, University of Roma La Sapienza, Rome, Italy

    Salvatore Simone Vullo

  7. Physical and Rehabilitation Medicine, University of Rome Tor Vergata, Rome, Italy

    Calogero Foti

  8. Department of Health Sciences, Amsterdam Movement Sciences Institute, VU University, Amsterdam, The Netherlands

    Alessandro Chiarotto

  9. Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

    Alessandro Chiarotto

Authors
  1. Marco Monticone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luca Frigau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesco Mola
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Barbara Rocca
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Franco Franchignoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Salvatore Simone Vullo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Calogero Foti
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alessandro Chiarotto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Monticone.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

IRB approval

The study was approved by our hospital’s Institutional Review Board and was conducted in accordance with ethical and humane principles of research.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file 1 (PPT 191 kb)

Appendix: Quebec Back Pain Disability Scale

Appendix: Quebec Back Pain Disability Scale

Il presente questionario intende valutare in che modo il mal di schiena influenza la tua vita quotidiana. Soggetti con problemi alla schiena possono trovare difficoltà a svolgere alcune attività di ogni giorno. Pertanto, vorremmo sapere se a causa della tua schiena hai difficoltà a svolgere alcune delle attività descritte di seguito. Per ogni attività è possibile rispondere da 0 a 5. Per cortesia, scegli una risposta per ogni attività (senza saltarne nessuna) cerchiando il numero corrispondente.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Monticone, M., Frigau, L., Mola, F. et al. The Italian version of the Quebec Back Pain Disability Scale: cross-cultural adaptation, reliability and validity in patients with chronic low back pain. Eur Spine J 29, 530–539 (2020). https://doi.org/10.1007/s00586-019-06153-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-019-06153-4

Keywords

Search

Navigation