Content validity and reproducibility of a low back pain questionnaire in Zimbabwean adolescents: results from a pilot study Tafadzwa Nicole Chikasha Supervisor :Matthew Chiwaridzo Department of Rehabilitation University of Zimbabwe

Introduction What is Low Back Pain?? 12th rib Inferior gluteal fold

No specific cause!!! Types of Low back pain Causes e.g. Non specific Inflammatory process Cancer Infection Osteoporosis Non specific No specific cause!!!

Recurrent Non Specific Low back pain No specific cause Pain that comes and goes At least 2 episodes per year Region between 12th rib & inferior gluteal fold

Characteristics of Recurrent NSLBP Pain of High intensity Episodes usually lasts a week Tendency to manifest as chronic NSLBP in adulthood

Prevalence of Recurrent NSLBP Lifetime prevalence 28-74% 7-10% (disabled) Zimbabwe 29%

Risk factors Age Tight muscles (Hamstrings & Quads) Body mass index Psychosocial factors

Risk factors cont.. Weight of the satchel Sports e.g. basketball Sitting for long hours

Consequences of NSLBP

Consequences of NSLBP Health Psychosocial Economic Education Quality of life Health Psychosocial Economic Education

Increased analgesic use Disability (7-10%) Health consquences Increased analgesic use Disability (7-10%) Poor health treatment outcomes Economic consequences Increased medical costs

Frustrated caregivers Psychosocial consequences Loss of self esteem Depression Frustrated caregivers

Education Consequences School absenteeism Poor school grades

What was the Problem??? In Zimbabwe there was no study ever conducted on validating a survey questionnaire designed for the investigation of recurrent non-specific low back pain among the young population

Objective To determine the content validity and test-retest reliability of a low back pain survey questionnaire used to screen for recurrent non- specific low back pain in high school adolescents in Harare, Zimbabwe.

Why is this essential to us?? Validated and reliable questionnaire Early identification Primary & Secondary preventative strategies Early treatment Improved rehabilitation outcomes Better prognosis & outlook Decreased economic and social burden

Methodology Reliability Content validity 3 schools randomly selected A panel of four experts to evaluate relevance of each item on the questionnaire Item Content Validity Index’s & Scale Content Validity Index Reliability 3 schools randomly selected 150 students (11-19)years Test -retest design used (1 week interval) Percentage agreement &kappa statistic Statistica version 13 (data analysis)

Results Reliability Content Validity Final sample =125 adolescents. Mean age 15.9 (SD=1.9). Content Validity (26/30) had (I-CVIs) of 1.00 except Items on smoking status, recurrence and duration had I-CVI’s of 0.75. The overall (S-CVI/Ave) was 0.97. Reliability High levels of reproducibility were for items that evaluated perceived characteristics , consequences of low back pain, demographic characteristics and also for factors associated with low back pain (kappa coefficient=0.61-1.00). Low level of reproducibility was found for items on functional limitations (kappa coefficient=0.17-0.39).  

Discussion The questionnaire offered excellent content valid for 26 of the items although further elaboration on questions on smoking status, recurrence and duration is necessary. The questionnaire used provided reproducible information except for few items on functional limitations as consistent with other studies

Conclusion Questionnaire offered excellent content validity and highly reproducible information Revision on smoking status, recurrence and duration

Recommendations Low back pain Questionnaire Used in conjunction with a function limitations questionnaire Used in clinical and non clinical settings e.g. schools

“LOOKING FORWARD TO THE FUTURE” (Future research) Focus should be on recurrent cases of NSLBP to identify Coping strategies employed to deal with the condition Efficacy of primary and secondary prevention strategies (short term & long term effectiveness)

References 1. Chiwaridzo M, Naidoo N. Prevalence and Associated Characteristics of Recurrent Non-specific Low Back Pain in Zimbabwean Adolescents: A cross-sectional study. BMC Musculoskeletal Disorders. 2014; 15(381): 1-10.  2. Chiwah RV, Chiwaridzo M, Dambi JM, Matare T. Recurrent Non-Specific Low Back Pain in Adolescents: A Cross-sectional Survey on Prevalence, Nature of Recurrent episodes and the Role of Physical Activity and Psychological factors. Annals of Paediatric Rheumatology. 2015; 4(4):63-69. doi: 10.5455/apr.120120151543

Acknowledgements I also want to express my profound appreciation to the following Mr Chiwaridzo my supervisor The parents and school children who participated in filling out the questionnaire Mrs. F Kaseke, Mr. J Dambi, Mr. T Mudawarima, Miss C Tadyanemhandu for participating in this study as the content validity experts. The Ministry of Primary and Secondary Education and the Provincial Education Officer The Headmasters of the schools and teachers

Thank you for listening !!!

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