Cross-cultural adaptation and validation of the Amharic version of Roland Morris Disability Questionnaire in people with low back pain in Ethiopia

Abstract

Purpose

Cross-culturally translate, adapt, and validate Roland Morris Disability Questionnaire (RMDQ) in Amharic language in Ethiopia.

Methods

The English version RMDQ was translated into Amharic and back-translated into English. An expert review committee reviewed the translations and created Amharic version of the RMDQ (RMDQ-Am). Pilot testing and cognitive debriefing of the RMDQ-Am were conducted with a sample of 20 individuals with LBP. The RMDQ-Am was administered to 240 individuals with LBP from three rehabilitation centers to determine its psychometric properties. Internal consistency of the tool was determined by Cronbach’s alpha. Test-retest reliability was determined by the Intraclass correlation coefficient. The Standard Error of Measurement (SEM), Minimum Detectable Change (MDC), and the Bland Altman Limit of Agreement (LOA) was also determined. The Short-Form Health Survey (SF-36) Bodily Pain and Physical Functioning subscales were used to assess convergent validity. Exploratory Factor Analysis (EFA) was used to determine the dimensionality of the tool.

Results

RMDQ-Am demonstrated good internal consistency (α = 0.88), excellent test-retest reliability (ICC = 0.91), SEM (1.64), MDC (3.55), and good LOA. There is a significant moderate correlation between RMDQ-Am and the Physical Functioning (Rho = −0.62, p < 0.01) and Bodily Pain (BP) (Rho = −0.41, p < 0.01) subscales of the SF-36. Exploratory Factor Analysis demonstrates that the Amharic version of RMDQ is a primary one and secondary four-factor model [The Kaiser Meyer Olkin = 0.877, X² (df) =1413.278/190, p < 0.001].

Conclusion

RMDQ-Am is a reliable and valid tool that can be used in both clinical practice and research with the Ethiopian LBP population.

IMPLICATION FOR REHABILITATION

• Despite LBP being a concern in Ethiopia, the magnitude of disability related to this phenomenon is not studied in the country, mainly due to the absence of validated LBP specific patient-reported outcome measures such as the Roland Morris Disability Questionnaire (RMDQ).

• The RMDQ was successfully translated, adapted, and validated into the Amharic language and the Ethiopian context (RMDQ-Am).

• The RMDQ-Am is a reliable outcome measure among the Ethiopian population with LBP, as demonstrated by the good internal consistency (α = 0.88) and excellent test-retest reliability (ICC = 0.91).

• There is a moderate negative correlation between the RMDQ-Am and the Physical Functioning (Rho = −0.62, p < 0.01) and Bodily Pain (Rho = −0.41, p < 0.01) subscales of the SF-36.

• The RMDQ-Am can be used in clinical and research settings to measure LBP-related disability and its impact among individuals living with LBP in Ethiopia.

Keywords:

• Cross-cultural translation and adaptation
• Ethiopia
• low back pain
• Roland Morris Disability Questionnaire
• reliability
• validity

Acknowledgments

We acknowledge the following individuals for their help during the cross-cultural translation and adaptation of this tool: Dr. Esayas Adefris (a neurosurgeon at the University of Gondar), Solomon Fasika (a Physiotherapist at the University of Gondar), Abey Bekele Abebe (Ph.D. candidate at the School of Rehabilitation Therapy, Queen’s University, Canada), Tewodros Leulseged Mamo (a professor of Teaching English as a Foreign Language at the University of Gondar), Dr. Tadesse Awoke Ayele (Biostatistician and research methodologist at the University of Gondar), Samuel Malede (Communications officer, public and international relations director at the University of Gondar). We also acknowledge the physiotherapists who helped in the data collection for this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was funded by the MasterCard Foundation Scholarship Program and Queen’s University graduate dean’s travel grant. Both funding organizations had no influence on designing this research, data collection, write-up, submission, and publication of the manuscript.