Cross-cultural adaptation, reliability, and validity of the Chinese version of the STarT Back Screening Tool in patients with low back pain.
METHODS
Translation and psychometric testing.


OBJECTIVE
The study aims to investigate the reliability and validity of the Chinese version of the STarT Back Screening Tool (STarT) in Chinese-speaking patients with low back pain (LBP) after translation and cultural adaptation.


BACKGROUND
To date, no previous studies exist on the translation process and validation of the Chinese version of the STarT.


METHODS
The procedure of translation, which included 6 stages, was performed according to the current recommended guidelines. Psychometric testing included face validity, test-retest reliability, and discriminant validity. A total of 307 patients completed a questionnaire booklet containing the Chinese version of the STarT, Roland-Morris Disability Questionnaire, Coping Strategies Questionnaire, Tampa Scale for Kinesiophobia-17, and Hospital Anxiety and Depression Scale. Seventy-four randomly selected patients were asked to finish the STarT a second time within 24 to 48 hours. The demographic characteristics and outcomes of psychometric testing were compared with the original English cohort.


RESULTS
No items of the final version had reported ambiguity after the face validation and no floor or ceiling effects were noted. The intraclass correlation coefficient was 0.933 (95% confidence interval, 0.896-0.957), demonstrating very good reliability. Discriminant validity was established, with area under curve results in the range from 0.751 to 0.893 (95% confidence interval, 0.697-0.930) in the Chinese cohort compared with 0.840 to 0.925 (95% confidence interval, 0.772-0.948) in the original English cohort.


CONCLUSIONS
The results confirm the successful translation and adaptation of the STarT into Chinese, with appropriate reliability and validity. Therefore, this version can be recommended for clinical and research use for Chinese patients with LBP.
*Pain Treatment Centre of Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China †Central Hospital of Panyu District, Guangzhou, Guangdong Province, China ‡Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China; and §Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom.
Shuo
S
Luan
Yu
Y
Min
Guoqi
G
Li
Caina
C
Lin
Xiao
X
Li
Shaoling
S
Wu
Chao
C
Ma
Jonathan C
JC
Hill
D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000523:psychology; D044466:Asian People; D002681:China; D003431:Cross-Cultural Comparison; D003863:Depression / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007802:Language; D017116:Low Back Pain / Q000175:diagnosis* / Q000208:ethnology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*; D014177:Translations