The cross-cultural adaptation, validity, and reliability of the Spanish version of the Fremantle Back Awareness Questionnaire

Abstract

IntroductionIn chronic low back pain (CLBP), disturbed body image has been highlighted as a contributor to the condition and a potential target for treatment. The Fremantle Back Awareness Questionnaire (FreBAQ) allows its assessment. Following international guidelines for the cross-cultural translation of questionnaires, we aimed to translate the FreBAQ into Spanish (FreBAQ-S) and validate the new questionnaire in a sample of Spanish-speaking people with CLBP.MethodsTwo hundred and sixty-four adults with CLBP (91 males) and 128 healthy controls (34 males) completed an online form including the FreBAQ-S and questionnaires related to the pain experience. All participants were Spanish and no gender identities differing from biological sex were reported. A week later, 113 CLBP participants and 45 healthy controls (41 and 13 males, respectively), re-answered the FreBAQ-S to evaluate test–retest reliability. Confirmatory factor and multigroup analysis assessed the scale consistency on the patient sample. Discriminant and convergent validity were explored by between-group differences and the relationship with clinical characteristics. Reliability relied on Cronbach’s alpha estimates and test–retest (intraclass correlation coefficient, standard error of measurement, minimal detectable change).Results and discussionConfirmatory factor analysis showed a one-factor structure of the questionnaire, without supporting evidence for item deletion (CFI = 0.97; TLI = 0.96; RMSEA = 0.06; SRMR = 0.07; SRMRu = 0.064). Multigroup analyses do not support mean invariance between groups regarding health condition or sex. The FreBAQ-S demonstrated good discriminant and convergent validity, internal consistency (α = 0.82), and test–retest reliability (ICC = 0.78; SE = 3.41; MDC = 5.12). The FreBAQ-S is a valid and reliable tool to assess back awareness in clinical and non-clinical samples.

The Fremantle Back Awareness Questionnaire: cross-cultural adaptation, reliability, and validity of the Italian version in people with chronic low back pain

“…With respect to catastrophizing, we noted a similar correlation to what was reported in the original English version (0.36) [ 11 ]. Our results are also consistent with results obtained from the Japanese (0.38) [ 13 ], Turkish (0.41) [ 20 ], Spanish (0.46) [ 23 ] and Persian (0.60) [ 24 ] cross-cultural adaptation studies. These findings support the idea of a relationship between high levels of pain catastrophizing and disrupted body perception.…”

“…The internal consistency of the FreBAQ-I was good (0.82) and quite similar to that reported by the developers (0.80) [ 11 ]. Similar results were found in other versions of the questionnaires: Japanese 0.80 [ 13 ]; Dutch 0.82 [ 18 ]; German 0.91 [ 19 ]; Turkish 0.87 [ 20 ]; Chinese 0.83 [ 21 ], Indian 0.91 [ 22 ], Spanish 0.82 [ 23 ] and Persian 0.74 [ 24 ].…”

“…the Fear Avoidance Beliefs Questionnaire, physical activity subscale), which makes direct comparison difficult. Our results are somewhat in line with the Turkish and Spanish estimates (0.60 and 0.37) [ 20 , 23 ], while divergent from what was found in Japanese, Dutch and Persian samples (0.22, 0.10, and 0.17 respectively) [ 13 , 18 , 24 ], and, therefore, more analyses are recommended before firm conclusions can be drawn about the relationship between kinesiophobia and altered body perception.…”

“…Test–retest repeatability demonstrated an excellent level of agreement between the results on days 1 and 8 (ICC (2,1) = 0.88), a value higher than those reported in the original study (0.65) [ 10 ], while in the other validations, values were of 0.69 [ 18 ], 0.78 [ 23 ] and 0.90 [ 21 ]. The better reliability noted in this investigation may reflect the fact that no treatment was provided to participants between the two testing occasions, a control not enacted in the original study [ 10 ].…”

“…Japanese, Dutch, German, Turkish and Persian) [ 13 , 18 – 20 , 24 ], probably indicating disrupted body perception impacts more on the functional consequences of pain, rather than the experience of pain itself. A higher correlation with disability than pain was otherwise found in the Spanish sample (0.48 vs 0.38) [ 23 ]. Very low correlations with disability and pain were found in the Indian study [ 22 ].…”