|Year : 2019 | Volume
| Issue : 2 | Page : 76-81
Translation and validation of the roland–morris disability questionnaire in hausa-speaking patients with low back pain
Musa Sani Danazumi1, Shehu Usman Ibrahim2, Rufai Yusuf Ahmad2, Abdulsalam Mohammed Yakasai3
1 Department of Physiotherapy, Federal Medical Center, Nguru, Yobe State; Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
2 Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
3 Medical Rehabilitation Therapists (Reg.) Board of Nigeria, North-West Zonal Office, Kano, Nigeria; Department of Physiotherapy, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
|Date of Submission||09-Sep-2019|
|Date of Decision||11-Nov-2019|
|Date of Acceptance||19-Nov-2019|
|Date of Web Publication||02-Apr-2020|
Mr. Musa Sani Danazumi
Department of Physiotherapy, Federal Medical Center, Nguru, Yobe State; Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano
Source of Support: None, Conflict of Interest: None
Introduction: Measuring outcomes in the health-care system has been very well understood among health-care specialists for the past few decades and has been widely acknowledged by various authors. Roland–Morris Disability Questionnaire (RMDQ) is one of the most commonly used measures of disability in patients with low back pain (LBP) and has been translated and validated into many different languages around the world. However, Hausa version of the questionnaire is yet to be established. This study developed and assessed the validity of RMDQ in Hausa-speaking patients with LBP. Materials and Methods: Eligible participants (n = 375; age = 37.5; standard deviation = 7.48) with either acute or chronic LBP completed both the original version of the RMDQ (RMDQ-O) and the Hausa version of the RMDQ (RMDQ-H). In addition, other outcome measures including the Oswestry Disability Index and the Berg Balance Scale were also completed by the participants to enable equivalence of data. Pearson's product-moment correlation was used to establish the validity of the RMDQ-H. Results: The result of this study revealed that the concurrent validity of the RMDQ-H produced a significant value of 0.786 (n = 375; P= 0.001). The convergent validity and the divergent validity of the RMDQ-H were 0.692 (n = 375; P= 0.001) and 0.013 (n = 375; P= 0.671), respectively. Conclusion: The developed RMDQ-H is a valid outcome measure of disability among Hausa-speaking patients with LBP.
Keywords: Disability, Hausa language, low back pain, translation and validation
|How to cite this article:|
Danazumi MS, Ibrahim SU, Ahmad RY, Yakasai AM. Translation and validation of the roland–morris disability questionnaire in hausa-speaking patients with low back pain. Niger J Exp Clin Biosci 2019;7:76-81
|How to cite this URL:|
Danazumi MS, Ibrahim SU, Ahmad RY, Yakasai AM. Translation and validation of the roland–morris disability questionnaire in hausa-speaking patients with low back pain. Niger J Exp Clin Biosci [serial online] 2019 [cited 2020 Nov 25];7:76-81. Available from: https://www.njecbonline.org/text.asp?2019/7/2/76/281620
| Introduction|| |
Low back pain (LBP) is a very occurring medical condition with a great impact on health and social services and a patient's quality of life. It is a health problem that is present everywhere and is considered to be one of the leading causes of work absenteeism and disability worldwide. High expenses attributed to LBP and its socioeconomic effect have made this condition a significant health-care policy challenge not only in the industrialized world but also in the rural communities. LBP has negatively impacted the lives of many individuals, and its toll is getting worse.
Numerous interventions have been examined and applied with unsatisfactory success regarding the recurrence or persistence of LBP symptoms. These treatment setbacks have led to a larger view of LBP etiology and risk factors, incorporating psychological condition, and socioeconomic status which highlight the importance of measuring the outcome of health-care interventions used to ameliorate LBP. However, the utility of outcome measures in various countries and cultures must go in accordance with specific guidelines for translation and cross-cultural adaptation. The translation of such an instrument must be examined for its reliability and validity to be applied and to enable equivalence of data.
The Roland–Morris Disability Questionnaire (RMDQ) is one of the most commonly used outcome measures in patients with LBP and forms a good basis for comparative studies. In addition, a more recent finding indicated that RMDQ is a good measure of disability and recovery and is also very sensitive to change. However, as in most circumstances, this questionnaire was developed in English-speaking countries, and in spite of its context variations, RMDQ has been tested in its original version for its reliability, validity, and suitability. Furthermore, the questionnaire has been translated and validated into many different languages in the world,,,, but there has to date never been Hausa version of the questionnaire. For this reason, this study was conducted to develop and assess the validity of the 24-item RMDQ in Hausa-speaking patients with LBP. Thus, three major hypotheses were stated as follows: (1) Hausa version of the RMDQ (RMDQ-H) would correlate with the original version of the RMDQ (RMDQ-O), (2) RMDQ-H would correlate with other measures of disability (Oswestry Disability Index [ODI]), and (3) RMDQ-H would not correlate with other measures that measure a different characteristic or construct in participants with LBP.
| Materials and Methods|| |
Research design and setting
This was a cross-sectional study. Ethical approval to conduct this study was sought from the Health Research Ethics Committee of Federal Medical Centre (FMC), Nguru, Yobe State, Nigeria (File Reference Number: FMC/N/CL. SERV/355/VOL. IV/133).
Sample size and sampling technique
The sample size was estimated using the following formula: N = Z2 P (1 − P)/d2 (where, n = minimum sample size, Zα/2 set at 5% significant level = 1.96, P = Prevalence of LBP, which was examined to be 32.5% = 0.325, in a Nigerian population, and d = absolute error or precision [5%]). Adjustment for nonresponse rate (nr/r − 1) of 10% was also calculated, which gives a total sample size of 375 participants for this study. Based on the sample size estimation, a total of 375 LBP participants attending the outpatient physiotherapy clinic of FMC, Nguru, Yobe State, Nigeria, were recruited using a convenient sampling technique (participants who were readily available were included into the study).
Participants with LBP (acute or chronic) who use Hausa language as a mother tongue or as a second language and understand English were included in the study. Participants were excluded if; (1) cannot speak both Hausa and English languages, (2) presented with other types of conditions other than LBP, and (3) have red flags and/or comorbidities.
The Roland–Morris Disability Questionnaire
RMDQ is a self-administered measure of disability where greater levels of disability are reflected by higher numbers on a 24-point scale. Participants were asked to read the list of 24 sentences and placed a tick against appropriate questions based on how they feel each sentence described them that day. If the sentence does not describe their symptoms that day, participants were asked to leave the space blank and proceed to the next item. The questionnaire was scored by adding up the number of items the participants ticked. Scores can vary between 0 and 24. Greater levels of disability are reflected by higher scores.
Translation of the questionnaire
Hausa-speaking individuals in Nigeria are alike group with no great differences in the use of words for the description of a meaning. However, district differences exist, and an effort was made to use a standard Hausa language in the translation text, avoiding informal and idiomatic phrasing. A careful methodology of the translations was followed, to prevent language and cultural infiltration in the translation of the questionnaire that could produce a result with divergent psychometric properties. The first step of the translation was a forward translation of the RMDQ-H by two bilingual (Hausa and English) professional translators. One of the translators was an orthopedic physiotherapist who was very familiar with the concept of the RMDQ-O and was informed of the project. The other was a professional translator who was not familiar with the questionnaire and unaware of the project. The second step was comparison of the translations by the two translators to produce a synthesized version of the RMDQ-H after a consensus was met. A back translation (the 3rd step) was then conducted by two independent, bilingual (English and Hausa) translators, who were unaware of the original English version and application of the questionnaire (RMDQ-O). In addition, these translators were also not aware of the concept being examined. At the fourth step, the translators and the authors compared both translations and reached a consensus, after which a prefinal RMDQ-H was formed. The prefinal RMDQ-H was then pretested in a group of Hausa native speakers with LBP to obtain their responses about the questionnaire after which a peer debriefing was performed. The final RMDQ-H was then produced by the forward and back translators and by the authors to ensure that the original meaning was very well suited with the concept of the questionnaire while preventing language and cultural infiltrations.
Validation of the questionnaire
Face validity is concerned with whether a measurement seems to be assessing the intended parameters. In the current study, the translation of the questionnaire seemed to be valid, because it was very well accepted by the participants. In addition, the layout of the questionnaire and clear structure and clarity of the questions enhanced the face validity.
A measurement is considered to have content validity when it contains all the aspects of what needs to be measured. In the current study, the translation of the questionnaire was evaluated by orthopedic physiotherapists, and the questionnaire was found to sample all the components that are needed to measure the level of disability.
This is the case when a measurement correlates highly with a criterion test or with an assessment of a specialist in the field. To measure the concurrent validity in this study, all patients were asked to complete the RMDQ-O and the RMDQ-H at two separate hospital visits within the week and the scores were analyzed. The decision to complete the questionnaires at different times was made so that the scores of one questionnaire do not influence those of the other.
This validity establishes that a new measure correlates with another thought to measure a similar characteristic or concept. To measure the convergent validity, patients were asked to complete the RMDQ-H and the ODI at two different hospital visits and the scores were analyzed. This was necessary to obtain truthful outcomes.
Divergent validity establishes that a measure does not correlate with a measure thought to assess a distinctly different characteristic or concept. To assess this type of validity, patients were asked to complete the RMDQ-H and the Berg Balance Scale (BBS) at the same time and the scores were analyzed. This decision was made because the two questionnaires measure entirely different constructs and the scores cannot influence each other whatsoever.
Data obtained from this study were analyzed using SPSS 20.0 (SPSS Inc., Chicago, Illinois, USA). Descriptive statistics of means and standard deviations were used to summarize the demographic and clinical parameters of the participants. The normality of the data was assessed using the Shapiro–Wilk statistic. Pearson's product-moment correlation (PPMC) was used to determine the levels of correlation in the study. Statistical values were considered at 5% probability level (P<.05).
| Results|| |
A total of 375 participants (mean age = 37.54 ± 7.48) diagnosed with either acute or chronic LBP participated in the study. The study indicated that 234 (62.4%) participants out of 375 participants who participated in the study speak Hausa as their second language, while the remaining 141 (37.6%) speak Hausa as their first language.
[Table 1] showed the demographic and clinical parameters of the participants. The findings from this study indicated that the mean value of the RMDQ-O (15.4 ± 3.27) was slightly less scattered (indicated that the individual scores were not very wide apart) than that of the RMDQ-H (15.9 ± 4.56).
|Table 1: Demographics and clinical parameters of the participants (n=375)|
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[Table 2] indicated the PPMC coefficients of the validity tests. The concurrent validity of the RMDQ-O and RMDQ-H produced a significant positive value of 0.786 (n = 375; P = 0.001). The convergent validity of the RMDQ-H and ODI produced a significant positive value of 0.692 (n = 375; P = 0.001). The result of the divergent validity between the RMDQ-H and BBS produced a noncorrelating value of 0.0136 (n = 375; P = 0.671).
|Table 2: Pearsonfs product.moment correlation of the outcome measures (n=375)|
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Statement: The developed Hausa version of the RMDQ (RMDQ-H) would correlate with the RMDQ-O in participants with LBP.
Decision: the P value for the PPMC of the RMDQ-H and the RMDQ-O at 5% probability level and 95% confidence interval was 0.001, the stated hypothesis was retained [Table 2].
Statement: The developed RMDQ-H would correlate with the other measure of disability (ODI) in participants with LBP.
Decision: the P value for the PPMC of the RMDQ-H and the ODI at 5% probability level and 95% confidence interval was 0.001, the stated hypothesis was retained [Table 2].
Statement: The developed RMDQ-H would not correlate with the other measures that measure a different characteristic or construct (BBS) in participants with LBP.
Decision: the P value for the PPMC of the developed RMDQ-H, and the BBS at 5% probability level and 95% confidence interval was 0.671, the stated hypothesis was retained [Table 2].
| Discussion|| |
The sequential process of adaptation of outcome measures for use in different cultures is well documented.,,,, Condition-specific instruments capable of assessing disability and measuring the outcome of applied treatments are a necessary tool in patients with LBP. One of the most widely used questionnaires is the RMDQ, which is short, easily comprehended, and simple to complete. However, the LBP studies in the Hausa populace lacked reliable and valid assessment tools. This study developed and assessed the validity of the RMDQ-H in Hausa-speaking patients with LBP.
The Hausa language is one of the major three Nigerian languages (others being Yoruba and Igbo). It also has the largest spoken languages in the West Africa and overall Africa after Arabic, French, English, Portuguese, and Swahili. About 34 million people speak Hausa as their first language and 18 million more speak it as their second language. The current findings indicated that 234 (62.4%) participants out of 375 participants who were enrolled into the study speak Hausa as their second language, whereas the remaining 141 (37.6%) speak Hausa as their first language.
The findings from this study indicated that there was a highly significant correlation between the RMDQ-O and the RMDQ-H in Hausa-speaking participants with LBP. The hypothesis that the RMDQ-O would correlate with the RMDQ-H was retained, as the finding showed a significant correlation between the RMDQ-H developed and the RMDQ-O in the present study. The level of significant positive correlation obtained in this study was similar to those found in the previous studies., This significant correlation obtained may not be unrelated to the fact that RMDQ is a good measure of disability and recovery and is also very sensitive to change. In addition, it was also observed in this study that the mean value of the RMDQ-O was slightly less scattered (individual scores were not very wide apart) than that of the RMDQ-H. The findings of this study were similar to the reports of previous studies, which indicated that the mean values of the RMDQ-O were less scattered than that of the other versions of the developed RMDQ. The studies also indicated that these findings may be attributed to the higher sensitivity of the RMDQ-O in tracking change of care in patients with LBP who have minor level of disability.
The findings of this study also indicated that the RMDQ-H was very well correlated with the ODI indicating that both questionnaires measure the same or a similar characteristic/concept. The hypothesis that the RMDQ-H developed would correlate with other measures of disability (ODI) was retained as the findings of the study showed that the RMDQ-H correlated well with the ODI. The finding of this study was similar to the reports of previous studies, which indicated that the two questionnaires measure a similar construct or characteristic. In addition, a direct comparison of the RMDQ and the ODI by a previous systematic review indicated that there are no strong reasons to choose ODI over RMDQ (and vice versa) in the assessment of level of disability in participants with LBP, indicating that both questionnaires are a valid and reliable measure of LBP disability.
The findings of this study also indicated that RMDQ-H was not correlated with the BBS indicating that both questionnaires measure explicitly different constructs or characteristics. The hypothesis that the RMDQ-H developed would not correlate with other measures was retained as the finding showed that the RMDQ-H developed did not correlate with the BBS in the present study. This finding should not be surprising because a measure of disability should not correlate with a measure of balance. In addition, a previous study has also indicated that divergent validity (inability of a measure to correlate with another measure thought to assess a distinctly different characteristic or concept) is an important factor in the assessment of the validity of outcome measures and this further supported the finding of the present study.
Limitations of the study
Just like other studies, this study has some sort of limitations. Firstly, only one psychometric property of the RMDQ-H developed was assessed in this study, making the findings to be valid but not reliable or reproducible. Secondly, this study was not a multicenter cross-sectional study making the outcomes not to be fully generalizable.
| Conclusion|| |
The RMDQ-H developed is a valid outcome measure of disability in participants with LBP. It is recommended that similar studies may be conducted to assess other psychometric properties (reliability and responsiveness) of the questionnaire in a multicenter cross-sectional study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]