To cross-culturally adapt the Core Outcome Measures Index for the back (COMI-back) for the Arabic language and to test its reliability and validity in Egyptian patients with non-specific low back pain (LBP).
COMI-back was translated and cross-culturally adapted into Arabic according to standard guidelines. Its construct validity was assessed in 85 patients with chronic LBP (mean (± SD) age, 41.1 (± 10.4) years and 65/85 (76.5%) female) who completed a booklet of questionnaires including the Arabic versions of COMI-back, Roland Morris disability questionnaire, Oswestry disability index, the short form health survey 36, and the visual analogue scale for back pain. Test–retest reliability was assessed in 52 participants who completed the booklet again within 7 days.
Floor effects (worst status; 1.2–10.6%) and ceiling effects (best status; 1.2–11.8%) for COMI-back were acceptable, except for symptom-specific well-being (18.8%, floor), leg pain (23.5%, ceiling), and work disability (31.8%, ceiling). The COMI item scores correlated with those of the reference questionnaires (ρ = 0.45–0.88) to the hypothesized extent, except for the COMI symptom-specific well-being (ρ = 0.16–0.17) and quality of life (ρ = 0.38). The intra-class correlation coefficient for the summary score was 0.90, whereas that of the individual items ranged from 0.71–0.92. The standard error of measurement and minimal detectable change for the summary score were 0.51 and 1.41 points, respectively. The predefined hypotheses for construct validity and reliability were largely confirmed.
The Arabic version of COMI-back represents a valid and reliable instrument for use in Arabic-speaking patients with non-specific LBP.
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Fairbank JCT, Davies JB, Couper J, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273
Roland M, Morris R (1983) A study of the natural history of back pain: part I: development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976) 8:141–144
Mannion A, Porchet F, Kleinstu F et al (2009) The quality of spine surgery from the patient’s perspective. Part 1: The Core Outcome Measures Index in clinical practice. Eur Spine J 18:367–373. https://doi.org/10.1007/s00586-009-0942-8
Röder C, Chavanne A, Mannion AF et al (2005) SSE Spine Tango—content, workflow, set-up. Eur Spine J 14:920–924. https://doi.org/10.1007/s00586-005-1023-2
Mannion AF, Elfering A, Staerkle R et al (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J 14:1014–1026. https://doi.org/10.1007/s00586-005-0911-9
Ferrer M, Pellisé F, Escudero O et al (2006) Validation of a minimum outcome core set in the evaluation of patients with back pain. Spine (Phila Pa 1976) 31:1372–1379. https://doi.org/10.1097/01.brs.0000218477.53318.bc
Matsudaira K, Oka H, Oshima Y et al (2018) Development of the Japanese Core Outcome Measures Index (COMI): cross-cultural adaptation and psychometric validation. BMC Musculoskelet Disord 19:71. https://doi.org/10.1186/s12891-018-1986-x
Kim H-J, Yeom JS, Nam Y et al (2018) Validation and cross-cultural adaptation of the Korean version of the Core Outcome Measures Index in patients with degenerative lumbar disease. Eur Spine J 27:2804–2813. https://doi.org/10.1007/s00586-018-5759-x
Cetin E, Celik EC, Acaroglu E, Berk H (2018) Reliability and validity of the cross-culturally adapted Turkish version of the Core Outcome Measures Index for low back pain. Eur Spine J 27:93–100. https://doi.org/10.1007/s00586-017-5329-7
Granstrom H, Langborg A, Mannion AF, Rasmussen-Barr E (2020) Cross-cultural adaption and validation of the Swedish version of the Core Outcome Measures Index for low-back pain. Eur Spine J. https://doi.org/10.1007/s00586-019-06271-z
Damasceno LHF, Rocha PAG, Barbosa ES et al (2012) Cross-cultural adaptation and assessment of the reliability and validity of the Core Outcome Measures Index (COMI) for the Brazilian–Portuguese language. Eur Spine J 21:1273–1282. https://doi.org/10.1007/s00586-011-2100-3
Genevay S, Cedraschi C, Marty M et al (2012) Reliability and validity of the cross-culturally adapted French version of the Core Outcome Measures Index (COMI) in patients with low back pain. Eur Spine J 21:130–137. https://doi.org/10.1007/s00586-011-1992-2
Mannion AF, Boneschi M, Teli M et al (2012) Reliability and validity of the cross-culturally adapted Italian version of the Core Outcome Measures Index. Eur Spine J 21:737–749. https://doi.org/10.1007/s00586-011-1741-6
Storheim K, Brox JI, Lochting I et al (2012) Cross-cultural adaptation and validation of the Norwegian version of the Core Outcome Measures Index for low back pain. Eur Spine J 21:2539–2549. https://doi.org/10.1007/s00586-012-2393-x
Qiao J, Zhu F, Zhu Z et al (2013) Validation of the simplified Chinese version of the Core Outcome Measures Index (COMI). Eur Spine J 22:2821–2826. https://doi.org/10.1007/s00586-013-2761-1
Miekisiak G, Kollataj M, Dobrogowski J et al (2013) Cross-cultural adaptation and validation of the Polish version of the Core Outcome Measures Index for low back pain. Eur Spine J 22:995–1001. https://doi.org/10.1007/s00586-012-2607-2
Klemencsics I, Lazary A, Valasek T et al (2016) Cross-cultural adaptation and validation of the Hungarian version of the Core Outcome Measures Index for the back (COMI Back). Eur Spine J 25:257–264. https://doi.org/10.1007/s00586-014-3750-8
Van Lerbeirghe J, Van Lerbeirghe J, Van Schaeybroeck P et al (2018) Cross-cultural adaptation and validation of the Dutch version of the Core Outcome Measures Index for low back pain. Eur Spine J 27:76–82. https://doi.org/10.1007/s00586-017-5255-8
Beaton DE, Bombardier C, Guillemin F, Ferraz MB (2000) Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976) 25:3186–3191
Terwee CB, Bot SDM, de Boer MR et al (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42. https://doi.org/10.1016/j.jclinepi.2006.03.012
Maki D, Rajab E, Watson PJ, Critchley DJ (2014) Cross-cultural translation, adaptation, and psychometric testing of the Roland–Morris disability questionnaire into modern standard Arabic. Spine (Phila Pa 1976) 39:E1537–E1544. https://doi.org/10.1097/BRS.0000000000000632
Algarni AS, Ghorbel S, Jones JG, Guermazi M (2014) Validation of an Arabic version of the Oswestry index in Saudi Arabia. Ann Phys Rehabil Med 57:653–663. https://doi.org/10.1016/j.rehab.2014.06.006
RAND Corporation (1997) 36-Item Short Form Survey from the RAND Medical Outcomes Study. RAND Corporation, Santa Monica
Hays RD, Morales LS (2001) The RAND-36 measure of health-related quality of life. Ann Med 33:350–357. https://doi.org/10.3109/07853890109002089
Laucis NC, Hays RD, Bhattacharyya T (2015) Scoring the SF-36 in orthopaedics: a brief guide. J Bone Jt Surg Am 97:1628–1634. https://doi.org/10.2106/JBJS.O.00030
Jaeschke R, Singer J, Guyatt GH (1989) Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 10:407–415. https://doi.org/10.1016/0197-2456(89)90005-6
Andresen EM (2000) Criteria for assessing the tools of disability outcomes research. Arch Phys Med Rehabil 81:S15–20
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Nevill AM, Lane AM, Kilgour LJ et al (2001) Stability of psychometric questionnaires. J Sports Sci 19:273–278. https://doi.org/10.1080/026404101750158358
Costa LOP, Maher CG, Latimer J (2007) Self-report outcome measures for low back pain: searching for international cross-cultural adaptations. Spine (Phila Pa 1976) 32:1028–1037. https://doi.org/10.1097/01.brs.0000261024.27926.0f
Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 41:582–592. https://doi.org/10.1097/01.MLR.0000062554.74615.4C
Post MWM (2014) Definitions of quality of life: what has happened and how to move on. Top Spinal Cord Inj Rehabil 20:167–180. https://doi.org/10.1310/sci2003-167
Ferrans CE (1990) Quality of life: conceptual issues. Semin Oncol Nurs 6:248–254. https://doi.org/10.1016/0749-2081(90)90026-2
Ferrans CE, Powers MJ (1985) Quality of life index: development and psychometric properties. ANS Adv Nurs Sci 8:15–24. https://doi.org/10.1097/00012272-198510000-00005
Ferrans CE, Powers MJ (1992) Psychometric assessment of the quality of life index. Res Nurs Health 15:29–38. https://doi.org/10.1002/nur.4770150106
Mannion AF, Porchet F, Kleinstuck FS et al (2009) The quality of spine surgery from the patient’s perspective part 2. Minimal clinically important difference for improvement and deterioration as measured with the Core Outcome Measures Index. Eur Spine J 18(Suppl 3):374–379. https://doi.org/10.1007/s00586-009-0931-y
Mr. Mohammed Gumaa, TRUST Research Center, for his help in statistical analysis. RAND healthcare for permitting the use of RAND 36-Item Health Survey 1.0 that was developed as part of the Medical Outcomes Study (MOS) (https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form/survey-instrument.html). The Arabic version of the Oswestry Disability Index [(ODI©), obtained by a permission from Mapi Research Trust, https://eprovide.mapi-trust.org), license 5533, August 2017).
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None of the authors has any potential conflict of interest.
The protocol for this study was approved by the institutional Ethics committee (P.T.REC/012/001677) and was registered at clinicaltrials.gov (NCT03328806).
All participants received a full verbal explanation of the study purpose and procedures and signed a written informed consent form.
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Abdeldaiem, A., Saweeres, E.S.B., Shehab-Eldien, AE.AE. et al. Cross-cultural adaptation and validation of the Arabic version of the Core Outcome Measures Index for the back (COMI-back) in patients with non-specific low back pain. Eur Spine J 29, 2413–2430 (2020). https://doi.org/10.1007/s00586-020-06530-4
- Low back pain
- Patient-reported outcome measures
- Psychometric properties