title: Cross-cultural translation, adaptation, and psychometric testing of the Roland-Morris disability questionnaire into modern standard Arabic.
abstract: METHODS
  Cross-cultural translation, adaptation, and psychometric testing.
  
  
  OBJECTIVE
  To cross-culturally translate and adapt the Roland-Morris Disability Questionnaire (RMDQ) into Modern Standard Arabic and examine its validity with Arabic-speaking patients with low back pain (LBP).
  
  
  BACKGROUND
  The English RMDQ is valid, reliable, and commonly used to assess LBP disability in clinical practice and research. There is no valid and reliable version of the RMDQ in Modern Standard Arabic.
  
  
  METHODS
  The RMDQ was forward translated and back translated. An expert committee of musculoskeletal physiotherapists reviewed the translation. Eight patients with LBP evaluated item-by-item comprehensibility. Ten patients piloted the RMDQ for overall comprehensibility and acceptability. Seventeen bilingual patients tested the agreement of the Arabic and English RMDQs. Two-hundred one patients completed the RMDQ and the visual analogue scale. Sixty-four patients were followed-up for test-retest reliability.
  
  
  RESULTS
  Translation of most items was uncontroversial. The expert committee found the Arabic RMDQ clinically and culturally appropriate. They reviewed item 11, addressing bending and kneeling, because this has a clinical significance and cultural/religious implication regarding prayer positions. All patients reported that it was easy to understand and complete. The Arabic RMDQ had high overall agreement with the English RMDQ for the global score (intraclass correlation coefficient [ICC] = 0.925; 0.811-0.972). Kappa statistics showed good item-by-item agreement (none ≤0.30). Mean (SD) RMDQ and visual analog scale scores of 201 patients were 10.53 (4.80) and 5.11 (2.28), respectively. The RMDQ had a low correlation against pain intensity (r = 0.259; P < 0.01). A Cronbach α of 0.729 showed high internal consistency. Test-retest reliability of the Arabic RMDQ was good (ICC = 0.900; 95% confidence interval, 0.753-0.951). Kappa statistics were high for 18 items and fair for 6.
  
  
  CONCLUSIONS
  The Arabic version of the RMDQ has good comprehensibility and acceptability, high internal consistency and reliability, low correlation against pain intensity, and good agreement with the English RMDQ. We recommend its use with Arabic-speaking patients with LBP.
  
  
  METHODS
  3.
authors.affiliation: *Division of Health and Social Care Research, School of Medicine, King's College London, United Kingdom †Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Bahrain ‡Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
authors.forename: Dana
authors.initials: D
authors.lastname: Maki
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Rajab
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Watson
authors.forename: Duncan J
authors.initials: DJ
authors.lastname: Critchley
mesh_terms: D000328:Adult; D000352:Africa, Northern; D003431:Cross-Cultural Comparison; D065246:Culturally Competent Care / Q000379:methods*; D004739:England; D005260:Female; D006801:Humans; D007802:Language; D017116:Low Back Pain / Q000175:diagnosis* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D008877:Middle East; D011594:Psychometrics / Q000379:methods*; D011795:Surveys and Questionnaires; D014175:Translating