The data for this cross-sectional study was gathered over nearly two years (November 2020 to November 2021). The research was split into two parts: translation and cross-cultural adaptation, and RMDQ Urdu version psychometric testing. All of the procedures were carried out in accordance with the pre-determined guidelines Informed consent was obtained from all the participants before allowing them to enter the study.
Stage I: Translation and Cross-Cultural Adaptation Process:
The first step in adaptation is forward translation; two professional translators completed two forward translations of the questionnaire from the source language (English) to the target language (Urdu). One translator was aware of the context in the Ronald Morris Low Back Pain and Disability Questionnaire and provided clinical equivalency, whereas the other translator was unaware of the notions being quantified and had no clinical and medical background. Each translator submitted an audit document on the translation that they accomplished. Additional remarks were to given to draw attention to difficult words or uncertainty. The written statement also summarized their reasons for their selections.
SYNTHESIS OF THE TRANSLATION
The second step of translation was completed by working from the original RMDQ. A synthesis of the first translator's (T1) and second translator's (T2) versions of the questionnaire was first conducted, which resulted in one common translation T-12 in the form of a written report. The 2 interpreters and an audio spectator sat down to synthesis the translation results in a written statement that meticulously documented the method for the synthesis and addressed and resolved each of the issues.
The questionnaire was then translated back into its original language by a translator who worked from the T-12 version and was completely blind to the initial form. This is a validation procedure to ensure that the translated version contains the same item content as the original versions. Back translation is one sort of validity check that identifies major discrepancies or conceptual flaws in the translation. The back-translations (BT1 and BT2) were created by two people who were native speakers of the original language (English). The two translators were not aware of the topics being investigated and had no medical training. The team was strengthened by the addition of a third, unbiased member. That person's responsibility was to act as a mediator in conversations about translation difficulties, as well as to create written record of the process. The main motivations were to avoid knowledge bias and elicit unusual interpretations from the paraphrased questionnaire responses (T-12). Backward translation was used to create the B-12 questionnaire synthesis.
EXPERT COMMITTEE: Consent form were signed from each member of the committee. This committee's composition was critical to achieving cross-cultural equivalency. The basic things were made up by translators (both forward and back translators), language professionals and methodologists, health professionals who took part in the procedure up to this moment. During that stage of the process, the original questionnaire developers kept in close connection with the expert panel. The expert committee was charged with developing an initial version of the questionnaire for field testing. Committee decisions were made to achieve equivalence between the source and target versions in four areas: Conceptual equivalence, experiential equivalence, idiomatic equivalence, semantic equivalence are all examples of equivalence..
TEST OF THE PREFINAL VERSION
In the adaption process, the pretest was the final step. In this field test, the pre-final version of the new questionnaire was administered to individual from the target context. Thirty people were put through the wringer. Each respondent filled out the questionnaire and is then questioned to find out what he or she believed each questionnaire item and response signified. The items' and respondents' meanings were investigated. While this stage elaborates how the person clarify the questionnaire questions, it ignores construct reliability, validity and item response patterns, all of which are equally important in explaining effective cross-cultural adaptation. The explained procedure includes some quality assurance in terms of content validity.
SUBMISSION OF DOCUMENTATION FOR APPRAISAL
All reports and forms were submitted to the instrument's creator or the committee in charge of keeping track of the translated at the end of the adaptation process. It is a method review, with all procedures were taken as well as all required reports were completed. The Adapted Version was tested further to explain the process of translating and adapting self-report health metrics. Cultural adaptation attempts to maintain consistency in the content and face validity of a questionnaire across the source and target versions. As a consequence, if the original version was reliable and genuine, the consequent version should be as well. It is strongly advised that, following the translation and adaption procedure, investigators confirm that the latest edition has demonstrated the measurement qualities needed for the target purpose. Both item-level properties like internal consistency and item-to-scale correlations, as well as score-level properties like responsiveness, construct validity, and reliability, should be preserved in the new tool. (10)
Stage II: Psychometric testing
Total no of 150 participants were included in the study. The sample size was determined by kline method(11) The study recruited 57.3% of male and 42.7% of female participants. The data were collected after approval by the University of Lahore's Institutional Review Board. The data was gathered at the University of Lahore Teaching Hospital's Department of Physical Therapy. Before collecting data, patients were asked to provide informed written consent. Patients between age 18 to 50 (12) having pain for at least 6 weeks (13), those who are married, willing and able to understand Urdu language were recruited in the study. Individuals using walking aid devices, with diagnosed fibromalgia, any other systematic or muscular disorder were not included in the study. Patients having sciatica, malignant tumors, infectious and visceral diseases (14) were also excluded from the study.
Participants and Testing:
Visual analogue scale for pain, ODI Urdu for disability in addition to the Urdu Version of RMDQ were filled by 150 individuals having low back pain and fulfilling the sampling criteria.
RMDQ-Urdu was applied two times at two different occasions so that the test-retest reliability could be determined. To check intra-rater reliability, RMDQ-Urdu was reapplied 48 hours later. To minimize the clinical differences between the two assessments, no treatment was administered.
The correlation between RMDQ-Urdu VAS and ODI Urdu (15) was used to determine convergent validity.Pain intensity measured through visual analogue scale and RMDQ score have a strong positive relationship and so it can be documented that Urdu version of RMDQ scale has excellent convergent validity criterion validity. P value of < 0.001 confirms the statistical significance of the relationship.
Analysis was carried out on SPSS version 21. Quantitative variables were presented with mean ± SD and qualitative variables were presented with frequency and percentage. To determine reliability, measurement errors, internal consistency and test-retest reliability across repeated measures were used. The intra-class correlation coefficient (ICC) at 95 percent confidence intervals was used to determine test-retest reliability (CIs). Internal consistency was determined by Cronbach's alpha. To calculate measurement error, the standard error of measurement (SEM) and the smallest detectable change were used (SDC). SEM and SDC are calculated using the formulas SEM = SD 1 – ICC (16) and SDC = 1.96 2 SEM, (17) respectively. If the SEM value is lower, the instrument is considered more reliable. (18) SEM values of 2.15–6.5 (18–24) and SDC values of 6-13.7 (18, 25–27) are considered acceptable.
The study used RMDQ-Urdu was applied two times on two different occasions so that the test-retest reliability could be determined. To check intra-rater reliability, RMDQ-Urdu was reapplied 48 hours later. Between both of the assessments no treatment was provided to minimize the clinical differences. The study discovered that test-retest reliability was very good (ICC = 0.846 (0.808–0.880); CI = 95 percent). Cronbach's alpha was 0.860 (α = 860), indicating that RMQ had excellent internal consistency. Item total correlation value 0.23 which is also confirming that Urdu version of RMQ is internally consistent. SEM and SDC of RMQ was 4.58 and 12.69 respectively. Table 3
The validity of RMDQ Urdu with VAS and ODI Urdu was tested using Pearson's correlation. According to the findings, there was a p 0.001 correlation between RMDQ and VAS. The study also found overall strong correlation between RMDQ and ODI Urdu. Table 4