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Validation of the Spanish Version of the Roland-Morris Questionnaire

Kovacs, Francisco M., MD, PhD*; Llobera, Joan, MD, MPH; Gil del Real, María Teresa, MPH, PhD*; Abraira, Victor, PhD; Gestoso, Mario, MD*; Fernández, Carmen, MD§ Kovacs-Atención Primaria Group

Health Services Research
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Study Design. Validation of a translated, culturally adapted questionnaire.

Objectives. To translate and culturally adapt the Spanish version of the Roland-Morris Questionnaire (RMQ), and to validate its use for assessing disability in Spanish patients with low back pain (LBP).

Summary of Background Data. The RMQ is a reliable evaluation instrument for disability, but no validated Spanish version is available.

Methods. Translation/retranslation of the English version of the RMQ was done blindly and independently by four different individuals, and adapted by a team that included five primary care physicians, three back specialists, and two methodologists. The study was done in the primary care setting in Mallorca, with 195 patients who visited their physician for acute or chronic LBP: 50 in the pilot study and 145 in the validation study. Individuals were given the RMQ and three other scales (VAS, Oswestry, and EuroQol) on their first visit and 14 days later. For the pilot study, on the first visit, patients were also given a second RMQ with the questions in a different order and they were subsequently asked for comprehension of each item of the questionnaire.

Results. Only 2 questions were partially rephrased after the pilot study, and no request for aid in interpretation was made during the validation study. Scores of the two RMQs on day 1 were 10.04 (SD, 5.01) and 10.9 (SD, 4.8), with an intraclass correlation coefficient of 0.874. The 95% limits of agreement by the Bland-Altman method was 0.340 ± 4.81. Cronbach’s α was 0.8375 (day 1) and 0.9140 (day 15) in the validation. Concurrent validity, measured by comparing RMQ responses with the results of VAS, was r = 0.347 (P = 0.0000) for day 1,and r = 0.570 (P = 0.0000) for day 15. Construct validity, tested by determining the correlation between the Spanish RMQ and the Spanish adaptation of the Oswestry Questionnaire, yielded r = 0.197 (P = 0.0061) on day 1 and r = 0.341 (P = 0.0000) on day 15.

Conclusions. The Spanish version of the RMQ has good comprehensibility, internal consistency, and reliability, and is an adequate and useful instrument for the assessment of disability caused by LBP.

From the *Departamento Científico, Fundación Kovacs, Palma de Mallorca, Spain, the †Unidad de Investigación, Gerencia de Atención Primaria, Insalud Balears, Palma de Mallorca, Spain, the ‡Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, Madrid, Spain, and the §Centro de Salud de Valldargent, Palma de Mallorca, Spain.

This study was funded by the Kovacs Foundation.

Acknowledgment date: April 16, 2001.

First revision date: June 27, 2001.

Acceptance date: August 13, 2001.

Address reprint requests to

Francisco M. Kovacs,

Departamento Científico,

Fundación Kovacs,

Paseo Mallorca 36, 3° 1a,

07012 Palma de Mallorca,

Spain

E-mail: kovacs@kovacs.org

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

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Members of the Kovacs-Atención Primaria (KAP) group are José Ramón Bauza, MD, Kunibert Bauza, MD, Josep Coll, MD, Elena Duro, MD, Juan Gili, MD, Marina Gómez, MD, Juana González, MD, Patricia Ibañez, MD, Antoni Jover, MD, Pablo Lázaro, MD, MPH, Miguel Llinás, MD, Catalina Mateu, MD, Nicole Mufraggi, MD, Carmen Nicolau, MD, María Arrate Olivera, MD, Patricia Pascual, MD, Lourdes Perelló, MD, Fancisco Pozo, MD, MPH, Vicente Reyes, MD, Sebastián Ribot, MD, Jaime Ripoll, MD, Juana Ripoll, MD, and Elena Rodríguez, MD.

© 2002 Lippincott Williams & Wilkins, Inc.