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Cross-cultural Adaptation, Reliability, and Validity of the Chinese Version of the STarT Back Screening Tool in Patients With Low Back Pain

Luan, Shuo MD*; Min, Yu MD; Li, Guoqi MD; Lin, Caina MD*; Li, Xiao MD*; Wu, Shaoling MD, PhD*; Ma, Chao MD, PhD*; Hill, Jonathan C. PhD§

doi: 10.1097/BRS.0000000000000413
Health Services Research
SLIDE

Study Design. Translation and psychometric testing.

Objective. The study aims to investigate the reliability and validity of the Chinese version of the STarT Back Screening Tool (STarT) in Chinese-speaking patients with low back pain (LBP) after translation and cultural adaptation.

Summary of Background Data. To date, no previous studies exist on the translation process and validation of the Chinese version of the STarT.

Methods. The procedure of translation, which included 6 stages, was performed according to the current recommended guidelines. Psychometric testing included face validity, test-retest reliability, and discriminant validity. A total of 307 patients completed a questionnaire booklet containing the Chinese version of the STarT, Roland-Morris Disability Questionnaire, Coping Strategies Questionnaire, Tampa Scale for Kinesiophobia-17, and Hospital Anxiety and Depression Scale. Seventy-four randomly selected patients were asked to finish the STarT a second time within 24 to 48 hours. The demographic characteristics and outcomes of psychometric testing were compared with the original English cohort.

Results. No items of the final version had reported ambiguity after the face validation and no floor or ceiling effects were noted. The intraclass correlation coefficient was 0.933 (95% confidence interval, 0.896–0.957), demonstrating very good reliability. Discriminant validity was established, with area under curve results in the range from 0.751 to 0.893 (95% confidence interval, 0.697–0.930) in the Chinese cohort compared with 0.840 to 0.925 (95% confidence interval, 0.772–0.948) in the original English cohort.

Conclusion. The results confirm the successful translation and adaptation of the STarT into Chinese, with appropriate reliability and validity. Therefore, this version can be recommended for clinical and research use for Chinese patients with LBP.

Level of Evidence: 4

This study demonstrated cultural-adaptation, reliability, and validity of the Chinese version of the STarT Back Screening Tool. The Chinese version showed good test-retest reliability, face validity, and discriminant validity. The results of this study suggest that the Chinese version is suitable for use in clinical and research applications.

*Pain Treatment Centre of Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China

Central Hospital of Panyu District, Guangzhou, Guangdong Province, China

Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China; and

§Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom.

Address correspondence and reprint requests to Chao Ma, MD, PhD, Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, 107 Yanjiang West Road, Guangzhou, Guangdong Province, China; E-mail: ma_chao99@126.com

Acknowledgment date: December 12, 2013. First revision date: March 28, 2014. Second revision date: April 22, 2014. Acceptance date: April 26, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

Shuo Luan and Yu Min contributed equally to this work.

© 2014 by Lippincott Williams & Wilkins