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Cross-cultural adaptation and validation of the STarT back screening tool in isiZulu
Peta-Ann Schmidt1, Vaneshveri Naidoo1
1Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Insights
The isiZulu STarT back screening tool is validated for non-specific low back pain (NSLBP) patients. This reliable tool improves clinical decision-making and treatment outcomes for isiZulu speakers.
Area of Science:
- Medical research
- Public health
- Linguistic adaptation of health tools
Background:
- Non-specific low back pain (NSLBP) is a global health concern.
- Effective management of NSLBP requires early identification of patients at risk for chronicity.
- The STarT back screening tool aids in stratifying NSLBP patients and guiding primary care treatment.
Purpose of the Study:
- To translate the STarT back screening tool from English to isiZulu.
- To assess the content validity and reliability of the isiZulu version of the STarT back screening tool.
Main Methods:
- Translation involved forward and backward translation with expert review.
- Content validity was evaluated by experts.
- Reliability was assessed through test-retest on 30 patients, internal consistency, and usability.
Main Results:
- The isiZulu translation demonstrated excellent content validity (relevance 1.00, clarity/simplicity/ambiguity 0.94, scale-content validity 0.955).
- Test-retest reliability was acceptable (Spearman's correlation 0.73).
- Internal consistency was acceptable (Cronbach's alpha for total score: 0.68-0.77; psychosocial scale: 0.62-0.77). Usability was high, with 33% finding it very easy to understand and 40% very easy to complete.
Conclusions:
- The isiZulu STarT back screening tool is a valid and reliable instrument.
- This tool can enhance clinical decision-making and improve treatment outcomes for isiZulu-speaking NSLBP patients in primary care settings.
Background:
Non-specific low back pain (NSLBP) is one of the most prevalent conditions in the world. Identifying patients at risk for developing chronic NSLBP is key to effective treatment. The STarT back screening tool is a validated, prognostic screening tool identifying subgroups of NSLBP patients, and the risk factors associated with each subgroup, guiding treatment in the primary care of NSLBP.
Objectives:
To translate the English version of the STarT back screening tool into isiZulu and determine the content validity and reliability of the translated tool.
Method:
Translation was completed in four phases - forward translation and synthesis, backward translation and expert review. Validation included expert review for content validity and testing of the translated tool on 30 patients, determining test-retest reliability, internal consistency and usability.
Results:
Minor linguistic differences were addressed during the translation phase. Item content validity was excellent for relevance (1.00), satisfactory (0.94) for clarity, simplicity and ambiguity, with scale-content validity acceptable (0.955). Spearman's correlation coefficient for test-retest reliability was acceptable (0.73). Cronbach's alpha for internal consistency for the total score for test 1 and test 2 was 0.68 and 0.77, and for the psychosocial scale 0.62 and 0.77 respectively. Overall, 33% found the tool very easy to understand and 40% found it very easy to complete.
Conclusion:
The isiZulu STarT back screening tool showed excellent content validity, acceptable reliability and acceptable internal consistency.
Clinical Implications:
Use of the isiZulu tool in local clinics and private practices can improve clinical decision-making and treatment outcomes for isiZulu-speaking patients with NSLBP.
