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

Abstract

AbstractPurpose Occupational biomechanical factors have been implicated in the aetiology and progression of low back pain (LBP). This study aimed to cross-culturally adapt and psychometrically investigate the occupational risk factor questionnaire (ORFQ) in a low literate Nigerian 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. Correlations between the adapted CSQ 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)], were used to test construct validity employing Spearman’s correlation analyses with 200 rural Nigerian dwellers with chronic LBP. Results Igbo-ORFQ was challenging to cross-culturally adapt due to 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 mostly good. Unexpected direction of correlations with disability, pain intensity, and social support prohibits establishment of construct validity of the biomechanical component of the Igbo-ORFQ. Conclusions The biomechanical component of the Igbo-ORFQ may have limited applicability to low literate populations self-employed in informal manual jobs.