This study translated the ÖMPQ into Arabic and tested its reliability and validity. The translation of the ÖMPQ was appropriate as the expert committee ensured that the items are reader-friendly and close to Saudi Arabian culture and dialect. The Arabic ÖMPQ was understood well by patients in primary care clinics and we did not have any issues with items comprehension.
For the construct validation, it was important that the Arabic ÖMPQ can distinguish between patients with LBP who have low, medium, or high psychosocial status. We did not use receiver operating curve because we did not want to dichotomize the scores. To that end, this study showed that for each increase in psychosocial risk status on the Arabic ÖMPQ, there was an associated increase in the outcome measures of pain, disability, fear-avoidance and catastrophizing. This suggested that the Arabic ÖMPQ had good discriminant validity between low, medium and high risk groups.
Since the ÖMPQ had multiple constructs such as pain, disability, fear-avoidance, and catastrophizing, we investigated if these constructs are correlated with their respective outcome measures. Similar to correlations found in other studies (12–15), the constructs within the Arabic ÖMPQ showed significant moderate to high correlations with their respective outcome measures. The correlations were as expected a priori and suggest that the Arabic ÖMPQ is capable of capturing various levels of psychological factors.
There were 3 items in the Arabic ÖMPQ that correlated different than what was set a priori: item 8 (perception of work demands), item 12 (pain control), and item 20 (fear-avoidance of work). Item 8 was expected to have low correlation (r < .3) with FABQ-W but it was found to have high correlation (r ≥ .5), suggesting better than expected correlation between perception of work demands and fear-avoidance of work. Item 12 was expected to have at least moderate correlation with pain catastrophizing but the correlation was low, suggesting that item 12 should be considered in light of other pain catastrophizing items 13, 14 and 15. Item 20 was expected to have at least moderate correlation with the FABQ-W but had low correlation, suggesting that item 8 and 20 should be evaluated together when assessing work demands or fear avoidance of work.
The reliability of the Arabic ÖMPQ was tested between session 1 (baseline) and session 2 (2 days later). Since LBP could change rapidly, the 2-day time interval was considered long enough to reduce recall bias, and short enough to prevent substantial change in status. The reliability was tested with ICC2,1 showed perfect reliability, which was similar to the levels reported in in the Norwegian and Brazilian translated versions (12, 15). We also investigated specific agreements for each risk status between session 1 and 2. It appeared that for the low and medium risk status, there was very good agreement. However, for the high risk status, there was a fair agreement likely due to smaller number of participants in this category.
We investigated the predictive validity of the Arabic ÖMPQ in two ways. One, we used simple linear regression to investigate if the ÖMPQ score at baseline is predictive of the disability score on ODI at 3 months. The simple regression showed that the ÖMPQ at baseline can predict disability at 3 months and can explain 29% of the variability in disability at 3 months. Two, we used RR to determine if being in one risk category increases the chances of developing persistent disability. Participants in the medium risk profile have 1.9 higher chance of developing persistent disability compared to the low risk group. Also, participants in the high risk group have 2.3 higher chances of developing disability compared to the low risk group. The confidence interval of medium risk and high risk groups were overlapped, also the confidence interval of high risk group crossed 1. This could be due to patient receiving treatment “usual care”, or due to smaller number of participants in the high risk group.
We recognized that the original ÖMPQ had been modified to address several limitations such as inconsistent wording, reduced practicality, and lack of independent validation (23). So, just like in Gabel et al. (23), we carefully selected wording of the questions that are related to symptom duration, activity, function variables, and psychosocial constructs. Also, we attempted to divide the Arabic ÖMPQ into themed sections for ease of response and grading (Appendix 1). However, unlike Gabel et al. (23), we did not renumber the questions nor did we modify the construct “pain” to “pain/problem” or reduce the number of body regions. We did so because we were hoping that the Arabic ÖMPQ would be used for conditions other than LBP.
There were several reasons to choose the ÖMPQ for cultural adaptation and validation in Arabic population. At the time of the study, there were not validated psychosocial screening tools for Arabic people with musculoskeletal pain. Also, the ÖMPQ may be more useful clinically as the responses to its items are scaled from 0 to 10 as opposed to dichotomized with “yes” and “no”, which can help clinicians probe on constructs that need further assessment (24). Finally, the ÖMPQ is commonly recommended by clinical practice guidelines of LBP (25, 26).
Several limitations of this study can be identified. We only validated the Arabic ÖMPQ patients with LBP, and we do not know if it generalizes to other musculoskeletal cases. We only used the level disability as a predicted variable of poor outcome, and we do not know if other clinical outcomes can be predicted with Arabic ÖMPQ. Future research should investigate whether the Arabic ÖMPQ improves the delivery of healthcare and reduces its cost.