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Validation of the Simplified Chinese Version of the Functional Rating Index for Patients With Low Back Pain

Wei, Xianzhao, MD; Chen, Zhi, MD; Bai, Yushu, MD; Zhu, Xiaodong, MD; Wu, Dajiang, MD; Liu, Xinwei, MD; Yi, Honglei, MD; Chen, Ziqiang, MD; Wang, Chuanfeng, MD; Zhao, Yingchuan, MD; Yang, Changwei, MD; Li, Jingfeng, MD; Li, Ming, MD

doi: 10.1097/BRS.0b013e318252ddd1
Health Services Research

Study Design. Cross-cultural translation and psychometric testing of the Functional Rating Index (FRI).

Objective. To evaluate the reliability and validity of the adapted simplified Chinese FRI (SC-FRI) for patients with low back pain (LBP).

Summary of Background Data. The FRI is a reliable and valid instrument to assess the perception of function and pain for patients with LBP. However, there is no culturally adapted, reliable, and validated FRI for use in mainland China.

Methods. The translation and cross-cultural adaptation were performed following international guidelines. The SC-FRI was administered to 115 patients with LBP along with the simplified Chinese version of the Oswestry Disability Index, 36-Item Short Form Health Survey, and the visual analogue scale. Psychometric testing included internal consistency, test-test reliability, concurrent criterion validity, and construct validity.

Results. A high completion rate of 96% and no floor or ceiling effects were noted for the SC-FRI. The internal consistency was good (i.e., Cronbach α = 0.897 for the overall SC-FRI; range, 0.851–0.890, if an item was deleted). Test-retest reliability was excellent, with an intraclass correlation coefficient of 0.948 (95% confidence interval, 0.917–0.968). Concurrent criterion validity assessment demonstrated that the SC-FRI significantly correlated with the visual analogue scale (r = 0.852, P < 0.0001) and the simplified Chinese version of the Oswestry Disability Index (r = 0.958, P < 0.0001). Construct validity was confirmed by the significant Pearson correlation between the SC-FRI and Physical Functioning (r = −0.802, P < 0.0001), Bodily Pain (r = −0.698, P < 0.0001), Social Functioning (r = −0.573, P < 0.0001), Role-Physical (r = −0.503, P < 0.0001), and General Health (r = −0.502, P < 0.0001) domains of the 36-Item Short Form Health Survey.

Conclusion. The SC-FRI showed excellent reliability and validity in the evaluation of pain and the functional health status of Chinese-speaking patients with LBP. It is simple and easy to use and can be recommended in clinical and research practice in mainland China.

The aim of this study was to cross-culturally adapt the Functional Rating Index (FRI) into simplified Chinese and to validate its use in mainland China for patients with low back pain (LBP). The simplified Chinese version of the FRI was proven reliable and valid when applied to patients with LBP.

From the Orthopedic Department of Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.

Address correspondence and reprint requests to Ming Li, MD, Orthopedic Department of Changhai Hospital, Second Military Medical University, No. 168, Changhai Rd., Shanghai, People's Republic of China, 200433; E-mail:

Acknowledgment date: August 10, 2011. First revision date: November 23, 2011. Second revision date: February 23, 2012. Acceptance date: February 26, 2012.

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

No funds were received in support of this work.

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.

© 2012 Lippincott Williams & Wilkins, Inc.