Challenges of Measuring Self-Reported Exposure to Occupational Biomechanical Risk Factors Amongst People with Low Literacy Engaged in Manual Labour: Findings from a Cross-Cultural Adaptation and Psychometric Investigation in an African Population with Chronic Low Back Pain.

PURPOSE: Occupational biomechanical factors are implicated in the aetiology and progression of low back pain (LBP). This study cross-culturally adapted and psychometrically investigated the Occupational Risk Factor Questionnaire (ORFQ) in a low literate Nigerian Igbo population with chronic LBP. METHODS: Forward and back translation of the original ORFQ by clinical and non-clinical translators was followed by an expert committee review. The adapted ORFQ was pre-tested amongst rural Nigerian adults with chronic LBP using cognitive think-aloud interviewing. Internal consistency (Cronbach's alpha) and test-retest reliability (unweighted and linear weighted k statistic for item-by-item agreement, and intra-class correlation coefficient-ICC) were investigated amongst 50 rural and urban Nigerian dwellers with chronic LBP. Spearman's correlation and regression analyses were conducted with the Igbo-ORFQ, and measures of disability [World Health Organisation Disability Assessment Schedule (WHODAS 2.0), Roland Morris Disability Questionnaire (RMDQ), Back performance scale (BPS)], pain intensity [Eleven-point box scale (BS-11)] and social support [Multidimensional Scale of Perceived Social Support (MSPSS)], to test construct validity with 200 rural Nigerian dwellers with chronic LBP. RESULTS: Cross-cultural adaptation highlighted difficulty conceptualising and concretising exposure to biomechanical risk factors. Item-by-item agreement, internal consistency (α = 0.84) and intraclass correlation coefficient (ICC = 0.83) were good. Some unexpected direction of associations between the biomechanical components of the Igbo-ORFQ, and disability, pain intensity, and social support prohibits establishment of construct validity. CONCLUSION: Prospective studies comparing the Igbo-ORFQ to other measures of exposure to occupational biomechanical risk factors are required to establish the construct validity of the Igbo-ORFQ.

Translation and Cross-Cultural Adaptation of the Exercise Adherence Rating Scale (EARS) into Danish.

The Exercise Adherence Rating Scale (EARS) is a self-administrated questionnaire designed to measure adherence to prescribed home-based exercises in a British population. In a Danish context, no reliable and valid questionnaires are available to measure exercise adherence. This study aimed to translate and cross-culturally adapt the EARS into Danish following international guidelines and to provide insights about construct validity in a Danish population with longstanding hip pain. The EARS was translated and cross-culturally adapted into Danish using a forward-backward method. The understanding and interpretability of the EARS were evaluated with semistructured interviews in 24 patients with longstanding hip pain due to hip dysplasia (22 females; median age 30 (IQR 24-37)). These patients were prescribed home-based exercises. Using Spearman's correlation, construct validity was evaluated by assessing if the Danish version of EARS was correlated with completed exercise sessions and self-reported pain and sport/recreation function. The EARS was translated and cross-culturally adapted into Danish following minor adjustments. The EARS was statistically significantly correlated to completed exercise sessions (p=0.005), self-reported pain (p=0.005), and sport/recreation function (p < 0.03). In patients with longstanding hip pain, the Danish EARS seems suitable to measure adherence to prescribed exercises; however, further evaluation of measurement properties may be needed.

Only two subscales of the Coping Strategies Questionnaire are culturally relevant for people with chronic low back pain in Nigerian Igbo populations: a cross-cultural adaptation and validation study.

BACKGROUND: Pain coping strategies are important in the chronicity of low back pain and the associated disability. However, their exact influence is unknown in many African contexts such as rural Nigeria due to lack of outcome instruments with which to measure them. This study aimed to cross-culturally adapt and psychometrically test the Coping Strategies Questionnaire (CSQ) in Igbo populations in Nigeria. METHODS: The CSQ was forward and back translated by clinical and non-clinical translators; evaluated by an expert review committee. The translated measure was piloted amongst twelve rural Nigerian dwellers with chronic low back pain (CLBP) using the think-aloud cognitive interviewing style. Internal consistency (Cronbach's alpha), test-retest reliability (intra-class correlation coefficient-ICC and Bland-Altman plot), and minimal detectable change were examined amongst 50 people with CLBP in rural and urban Nigerian populations. Construct validity was determined by assessing the correlations between the adapted CSQ and measures of disability, pain intensity, fear avoidance beliefs, and illness perceptions using Spearman's correlation analyses with 200 adults with CLBP in rural Nigeria. Exploratory factor analyses using Kaiser criterion (eigenvalue) and parallel analysis as methods for determining dimensionality were conducted with the same sample. RESULTS: Fourteen out of 42 items were routinely adopted in this population including all items of catastrophising subscale, and all but one item of praying and hoping subscale. Catastrophising and praying and hoping subscales had the highest Cronbach's alpha. All subscales had high ICCs with Bland-Altman plots that showed good agreement. All coping strategies were positively correlated with self-reported disability and pain intensity with catastrophising subscale having the highest values. Seven-factor and three-factor structures were produced with the Kaiser criterion and parallel analysis, with different items from the original CSQ, except for catastrophising. CONCLUSIONS: Catastrophising and praying and hoping may be the relevant coping strategies in this population. More culturally relevant measures of pain coping strategies that include adaptive coping strategies may need to be developed for African contexts such as rural Nigeria.

Detecting anxiety and depression among people with limited literacy living with chronic low back pain in Nigeria: adaptation and validation of the hospital anxiety and depression scale.

BACKGROUND: The Hospital Anxiety and Depression Scale (HADS) is one of the most popular measures of anxiety and depression. The original HADS is mostly used in Nigeria precluding people with limited literacy. This study aimed to cross-culturally adapt and psychometrically test the HADS for rural and urban Nigerian Igbo populations with chronic low back pain (CLBP) who have limited literacy. METHODS: The HADS was forward translated, back translated, and appraised. Face and content validity was ensured by pre-testing the translated measure among a convenience sample of twelve rural Nigerian dwellers with CLBP. Reliability utilising Cronbach's alpha, intraclass correlation coefficient, Bland-Altman plots and minimal detectable change were investigated amongst a convenience sample of 50 people living with CLBP in rural and urban Nigerian communities. Construct validity testing involving correlations between Igbo-HADS and Roland Morris Disability Questionnaire measuring self-reported back pain-specific disability, World Health Organisation Disability Assessment Schedule assessing generic self-reported disability, Fear Avoidance Beliefs Questionnaire measuring fear avoidance beliefs, and eleven-point box scale assessing pain intensity, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) among a random sample of 200 adults with CLBP in rural Nigerian communities were conducted. RESULTS: Idioms and colloquialisms were difficult to adapt. Internal consistency was good (α = 0.78) and acceptable (α = 0.67) for anxiety and depression subscales respectively. Intraclass correlation coefficients were very good (ICC ≃ 0.8) for both subscales. Minimal detectable change was 6.23 and 5.06 for anxiety and depression subscales respectively. The Igbo-HADS and the anxiety subscale had strong correlations (≃ 0.7) with generic self-reported disability; moderate correlations (≃ 0.5-0.6) with pain intensity, self-reported back pain-specific disability, and fear avoidance beliefs. The depression subscale had the lowest correlations (≃ 0.3-0.4) with these outcomes. The EFA produced a two-factor structure with cross-loading of items. The CFA showed poor fit indices for the EFA structure, the original two-factor structure, and one-factor structure. CONCLUSION: The HADS may not be suitable for assessing anxiety and depression, or emotional distress in this population due to difficulty achieving cross-cultural equivalence with western idioms; and the expression of emotional distress through somatisation in this culture.

World Health Organisation Disability Assessment Schedule (WHODAS 2.0): development and validation of the Nigerian Igbo version in patients with chronic low back pain.

BACKGROUND: Globally, the leading cause of years lived with disability is low back pain (LBP). Chronic low back pain (CLBP) is responsible for most of the cost and disability associated with LBP. This is more devastating in low income countries, particularly in rural Nigeria with one of the greatest global burdens of LBP. No Igbo back pain specific measure captures remunerative or non-remunerative work outcomes. Disability measurement using these tools may not fully explain work-related disability and community participation, a limitation not evident in the World Health Organisation Disability Assessment Schedule (WHODAS 2.0). This study aimed to cross-culturally adapt the WHODAS 2.0 and validate it in rural and urban Nigerian populations with CLBP. METHODS: Translation, cultural adaptation, test-retest, and cross-sectional psychometric testing was performed. WHODAS 2.0 was forward and back translated by clinical/non-clinical translators. Expert review committee evaluated the translations. Twelve people with CLBP in a rural Nigerian community piloted/pre-tested the questionnaire. Cronbach's alpha assessing internal consistency; intraclass correlation coefficient and Bland-Altman plots assessing test-retest reliability; and minimal detectable change were investigated in a convenience sample of 50 adults with CLBP in rural and urban Nigeria. Construct validity was examined using Spearman's correlation analyses with the back-performance scale, Igbo Roland Morris Disability Questionnaire and eleven-point box scale; and exploratory factor analysis in a random sample of 200 adults with CLBP in rural Nigeria. Ceiling and floor effects were investigated in both samples. RESULTS: Patient instructions were also translated. 'Waist pain/lower back pain' was added to 'illness(es)' to make the measure relevant for this study whilst allowing for future studies involving other conditions. The Igbo phrase for 'family and friends' was used to better represent 'people close to you' in item D4.3. The Igbo-WHODAS had good internal consistency (α = 0.75-0.97); intra class correlation coefficients (ICC = 0.81-0.93); standard error of measurements (5.05-11.10) and minimal detectable change (13.99-30.77). Igbo-WHODAS correlated moderately with performance-based disability, self-reported back pain-specific disability and pain intensity, with a seven-factor structure and no floor and ceiling effects. CONCLUSIONS: Igbo-WHODAS appears psychometrically sound. Its research and clinical utility require further testing.

Translation, cultural adaptation and psychometric testing of Igbo fear avoidance beliefs questionnaire in mixed rural and urban Nigerian populations with chronic low back pain.

INTRODUCTION: Low back pain (LBP) is highly prevalent in Nigeria and is more devastating in rural Nigeria due to adverse living and working conditions, reinforced by maladaptive illness beliefs. There is a need to develop measures for assessing such beliefs in this population. This study aimed to cross-culturally adapt the Fear Avoidance Beliefs Questionnaire (FABQ) and test its psychometric properties in mixed rural and urban Nigerian populations with chronic LBP. METHODS: Translation, cultural adaptation, test-retest, and cross-sectional psychometric testing. FABQ was forward and back translated by clinical/non-clinical translators. A review committee evaluated the translations. Twelve people with chronic LBP in a rural Nigerian community pre-tested the questionnaire. Cronbach's alpha assessing internal consistency; intra-class correlation coefficient and Bland-Altman plots assessing test-retest reliability; and minimal detectable change were investigated in a convenient sample of 50 chronic low back pain sufferers in rural and urban Nigeria. Construct validity was examined using Pearson's correlation analyses with the eleven-point box scale and Igbo Roland Morris Disability Questionnaire (Igbo-RMDQ), and exploratory factor analysis in a random sample of 200 adults with chronic low back pain in rural Nigeria. Ceiling and floor effects were investigated in all samples. RESULTS: Amendments allowed interviewer-administration. Item 8 was modified to 'I have a compensation or gains I get from having my pain' as there is no benefit system in Nigeria. Igbo phrase for 'physical activity' could also mean 'being active', 'moving the body' or 'moving about' and was used in the items with 'physical activity'. The Igbo-FABQ had good internal consistency (α = 0.80-0.86); intra class correlation coefficients (ICC = 0.71-0.72); standard error of measurements (3.21-7.40) and minimal detectable change (8.90-20.51). It correlated moderately with pain intensity and disability, with a two-factor structure and no floor and ceiling effects. CONCLUSIONS: Igbo-FABQ is valid, reliable, and can be used clinically and for research.

The DNA-Binding Domain of S. pombe Mrc1 (Claspin) Acts to Enhance Stalling at Replication Barriers.

During S-phase replication forks can stall at specific genetic loci. At some loci, the stalling events depend on the replisome components Schizosaccharomyces pombe Swi1 (Saccharomyces cerevisiae Tof1) and Swi3 (S. cerevisiae Csm3) as well as factors that bind DNA in a site-specific manner. Using a new genetic screen we identified Mrc1 (S. cerevisiae Mrc1/metazoan Claspin) as a replisome component involved in replication stalling. Mrc1 is known to form a sub-complex with Swi1 and Swi3 within the replisome and is required for the intra-S phase checkpoint activation. This discovery is surprising as several studies show that S. cerevisiae Mrc1 is not required for replication barrier activity. In contrast, we show that deletion of S. pombe mrc1 leads to an approximately three-fold reduction in barrier activity at several barriers and that Mrc1's role in replication fork stalling is independent of its role in checkpoint activation. Instead, S. pombe Mrc1 mediated fork stalling requires the presence of a functional copy of its phylogenetically conserved DNA binding domain. Interestingly, this domain is on the sequence level absent from S. cerevisiae Mrc1. Our study indicates that direct interactions between the eukaryotic replisome and the DNA are important for site-specific replication stalling.