The aim of this study was to investigate the cross-culturally adapt the UWRI-Persian and to study its psychometric properties in patients with an RRI. The results indicate that the UWRI-Persian has good to excellent internal consistency, reliability, agreement, and construct validity. These results confirm the UWRI-Persian is an ideal instrument that could be feasible and suitable to assess change running ability after RRI. This index has similar properties to the original version [11, 27].
The UWRI incorporates physical and psychological factors to evaluate RRI symptoms and the impact on running. Within the running community, running distance is the principal assessment of training load [11, 27]. In this study, the validity of the different constructs of the UWRI-Persian was assessed by determining the correlation with the PSEQ, TSK, and VAS scores. Self-efficacy is recognized as one of the main psychological factors associated with return to sports [28, 29]. Woby et al. [30] found that self-efficacy beliefs mediated the impact of pain-related fear and both pain and disability outcomes. In instances where self-efficacy is low, elevated pain-related fear is likely to lead to greater pain and disability. The results of this study showed a moderate correlation between self-efficacy and the UWRI-Persian (r = 0.425). Alternatively, a decrease in the PSEQ score is associated with a low UWRI score and a decrease in the level of running ability after an RRI.
In individuals with chronic pain, confidence in the ability to perform specified activities correlated with the subsequent performance of those activities [31, 32]. Among runners, a common sentiment is that they fully regain their running ability once they regain the confidence to train without fear of re-injury. Maschke et al. [33] found that athletic fear-avoidance is associated with lower perceived running ability at the same time point or interval. However, one study found Kinesiophobia levels did not significantly change within anxiety levels during recovery [34]. The results obtained in this study differed from those of Madsen et al. [34] and maybe the reason for this difference is the type of study. It should not be overlooked that their study evaluated the impact of high anxiety levels on psychological state and gait performance during recovery, whereas the current study investigated the UWRI-Persian correlation with Kinesiophobia (r = 0.457). Also, our results showed a weak correlation between UWRI-Persian and VAS (r = 0. 187). This finding is consistent with a study conducted by Bunster et al. [13] who reported that a weak correlation was observed between the Spanish version of UWRI and the numeric pain rating scale. In fact, this weak correlation might be attributable to the time frame that each self-reported measure uses [13].
Test-retest reliability is comparable to three other translated versions and the UWRI-Persian version. The internal consistency of the UWRI-Persian is higher than that of the English [11], Spanish [13] and Turkish [14] versions, with a Cronbach’s α being 0.966 for the Persian version compared to 0.82, 0.87, and 0.84 for the other three translations, respectively. Although the internal consistency of all versions varied, all Cronbach’s α were within the recommended acceptable to excellent values [35], The Cronbach’s α of psychological response (0.92) in the Persian version was better than in the Spanish version (0.8) [13], whereas the Cronbach’s α of running progression in the Spanish version (0.95) [13] was better than in the Persian version (0.887).
From a clinical and theoretical perspective, it has been reported that psychological factors change in patients with RRI, and these factors should be considered in rehabilitation programs [3, 33], Therefore, a valid and reliable measure of running ability after RRI may be useful in the clinical setting as a guide for the appropriate management of injured runners, although it is crucial to conduct research in this context.
Study Limitations
This study is not without limitations. Only patients with RRI were included in this study, which may limit its generalizability to other injuries. For this purpose, more diverse injuries should be included in future studies. In addition, sensitivity to alternations, and responsiveness scores were not reported in this study, which would be helpful for clinical decision making. The UWRI-Persian was limited to individuals with RRI, so further testing is needed before it can be used in populations with acute injury or surgery. Furthermore, conducting longitudinal studies to investigate the instrument's sensitivity to changes over the recovery process would provide valuable insights into its responsiveness.