Nepali translation, cross-cultural adaptation and measurement properties of the Shoulder Pain and Disability Index (SPADI).

BACKGROUND: The Shoulder Pain and Disability Index (SPADI) is a 13-item shoulder-specific patient-reported outcome measure (PROM). The English version is easy to use and has demonstrated excellent measurement properties for both clinical and research settings. The availability of the SPADI in Nepali would facilitate shoulder research and enhance management of patients with shoulder pain in Nepal. Therefore, the purpose of this study was to translate and cross-culturally adapt the SPADI into Nepali (SPADI-NP) and evaluate its measurement properties. METHODS: The translation and adaptation process followed international guidelines. Participants completed SPADI-NP on two assessments (N = 150 at initial and 119 at follow-up assessment). A Nepali version of the Global Rating of Change score was completed at follow-up. Assessment of measurement properties included analysis of internal consistency (Cronbach's α), minimal detectable change (MDC) with standard error of measurement (SEM), test-retest reliability (intraclass correlation coefficient; ICC), validity (factor structure, construct using Pearson's correlation with the Disability of Arm and Hand [DASH]) and responsiveness (area under the curve; AUC) with minimal important change (MIC). RESULTS: Minor changes were integrated in the adaptation process to improve cultural relevance such as dress items. Items were largely loaded under two factors (pain and disability), internal consistencies were good for the pain construct (α = 0.82) and disability (α = 0.88) and test-retest reliability was excellent (pain = 0.89, disability = 0.96). MDC was 5.7 (out of 100) with SEM = 2.1. Strong associations with the DASH (r = 0.63 pain, r = 0.81 disability) demonstrated its construct validity. The AUC was 0.68 and MIC was 12.3 (out of 100). CONCLUSION: The Nepali version of the SPADI demonstrated excellent reliability and validity. It can be used for the assessment of shoulder pain and disability in patients with shoulder pain in Nepal in both clinical practice and research.

Cross-cultural adaptation and measurement properties of the Nepali version of the DASH (disability of arm, shoulder and hand) in patients with shoulder pain.

BACKGROUND: Patient-reported outcome measures (PROMs) are important tools in both clinical practice and research. However, no upper extremity PROM to assess physical disability is available in Nepali. The most commonly used and recommended questionnaire for the shoulder is the Disability of Arm, Shoulder and Hand (DASH). Therefore, the aim of the study was to translate and cross-culturally adapt the DASH into Nepali and determine its measurement properties. METHODS: The translation and cultural adaptation process followed international standard procedures. The translated Nepali version of the questionnaire (DASH-NP) was completed by 156 patients with shoulder pain from three Nepali hospitals at an initial assessment and by 121 at follow-up. A Nepali version of Global Rating of Change (GROC-NP) was completed at follow-up to dichotomise improved and stable participants. Measurement properties testing included: internal consistency (Cronbach's alpha), test-retest reliability (Intraclass Correlation Coefficient, ICC), Minimal Detectable Change (MDC), construct validity - factor analysis, hypothesis testing with the Shoulder Pain and Disability Index (SPADI) (Pearson Correlation = r) and responsiveness - Area Under the Curve with minimal important change. RESULTS: Significant adaptations such as changing measurement units, activities and terminology were incorporated to improve cultural relevance. Internal consistency (α = 0.92) and test-retest reliability (ICC = 0.97, 95% CI: 0.94-0.98, p < 0.001) were excellent. The MDC was 11 out of 100 points. There were moderate-high positive correlations with the SPADI pain and disability items (rs = 0.63 and 0.81, P < 0.001). Four factor solution was retrieved for the DASH-NP. The Area Under the Curve was 0.69 (95% CI: 0.57 - 0.81, p < 0.001) with minimal important change of 11.2/100 points. CONCLUSIONS: The Nepali translation of the DASH is comprehensible, easy to administer via self-report or interview. It is found to be a reliable, valid, and responsive measure in patients with shoulder pain in Nepal. The DASH-NP can be used to assess shoulder pain related disability in Nepal for clinical practice or research.

An Arabic version of the effort-reward imbalance questionnaire: translation and validation study.

An Arabic version of the Effort-Reward Imbalance Questionnaire was developed and validated through a translation process with cross-cultural considerations. The translated questionnaire was evaluated for reliability and validity. A Principal Components Analysis was conducted following assessment of the suitability of data for factor analysis. Components with high eigenvalues were extracted, followed by Varimax rotation. Three components with eigenvalues greater than 1.0 (50% of variance) were indicated. The analysis showed Cronbach's alpha coefficients of .82 for the Effort scale, .88 for the Reward scale, and .74 for the Overcommitment scale. The test-retest reliability was high with intra-correlation coefficients of > or = .86. The Arabic version of the Effort-Reward Imbalance Questionnaire showed adequate reliability and validity and is a suitable instrument to assess work stress in Arabic-speaking people.

Associations among work-related stress, cortisol, inflammation, and metabolic syndrome.

This cross-sectional study examined the relationship between work-related stress, cortisol, and C-reactive protein (CRP) in predicting metabolic syndrome (MtS). Self-reported work stress measured by the effort reward imbalance ratio (ERI), anthropometric data, CRP, and saliva cortisol were collected from 204 healthy Jordanian male workers. ERI and cortisol were significantly associated with the presence of MtS (OR = 4.74, 95% CI: 2.13-10.55; OR = 3.03, 95% CI: 2.08-4.40; OR = 11.50, 95% CI: 2.16-59.14, respectively). The odds of MtS in men with high ERI and high cortisol were significantly higher than that of men with low ERI and low cortisol (OR = 11.50, 95% CI: 2.16-59.14). CRP was significantly associated with MtS (OR = 2.51, 95% CI: 1.50-4.20). The odds of MtS were significantly higher in centrally obese men with both high ERI and CRP level. Thus, high ERI along with high cortisol or high CRP increases the risk for MtS, especially among centrally obese men.

An Arabic version of the perceived stress scale: translation and validation study.

BACKGROUND: The Perceived Stress Scale has been designed to measure the degree to which situations in a person's life are perceived as stressful. OBJECTIVE: The paper describes the development of an Arabic version of the Perceived Stress Scale. DESIGN: A translation process with cross-cultural considerations was employed to produce an Arabic version of the Perceived Stress Scale. SETTINGS: Participants were asked to complete the Arabic version Perceived Stress Scale twice in their homes. PARTICIPANTS: The Jordanian study population for the Arabic version Perceived Stress Scale validation consisted of 126 volunteers (74 male, 52 female). Ninety participants completed the scale twice (55 male, 35 female), of whom 58 were high schools teachers and 32 technical workers. Arabic was the first language of all participants and all gave informed consent. RESULTS: The Arabic version Perceived Stress Scale reliability and validity were evaluated. Prior to an exploratory factor analysis, the suitability of data for factor analysis was assessed with acceptable results. The exploratory factor analysis showed two factors with eigenvalues greater than 1.0 (45.0% of variance). The Cronbach's alpha coefficients were 0.74 (Factor 1), 0.77 (Factor 2) and 0.80 for the Arabic version Perceived Stress Scale overall. The test-retest reliability had an intra-correlation coefficient of 0.90. CONCLUSIONS: The Arabic version Perceived Stress Scale showed an adequate reliability and validity. Therefore, the Arabic Perceived Stress Scale is considered a suitable instrument to assess perceived stress in Arabic people.

The association between work stress and inflammatory biomarkers in Jordanian male workers.

The study aimed to establish the association of work stress, expressed as effort-reward imbalance (ERI), and C-reactive protein (CRP) in 152 healthy Jordanian male employees. Self-report work stress, anthropometric data, and blood for CRP analysis were collected. A significant correlation between ERI and CRP (r = 0.29, p < .01), and between waist circumference with CRP (r = 0.44, p < .01) was found. Central obesity explained most of the variance in CRP after controlling for various covariates, and ERI was not a significant predictor of CRP (ΔR2 = 0.02; ß = 0.15, p = .052). However, when only the centrally obese group was considered, ERI accounted for 5.0% of the variability in the CRP (ß = 0.24, p < .05). Results of this study confirm previous findings that obesity is significantly associated with CRP, and support the notion that higher ERI amongst obese workers is one small but significant predictor of increased levels of CRP.