title: Development of the Italian Version of the Pain Vigilance and Awareness Questionnaire in Subjects with Chronic Low Back Pain: Cross-cultural Adaptation, Confirmatory Factor Analysis, Reliability and Validity.
abstract: BACKGROUND
  Growing attention is being given to cognitive-behavioural measures to improve interventions for spinal disorders. The Pain Vigilance and Awareness Questionnaire (PVAQ) has never been validated in Italian subjects with chronic low back pain (LBP).
  
  
  OBJECTIVE
  The purpose of this study is translating, culturally adapting and validating the Italian version of PVAQ (PVAQ-I).
  
  
  METHODS
  A cross-sectional evaluation of the psychometric properties of the PVAQ-I on patients with chronic LBP was conducted. The questionnaire was culturally adapted in accordance with international standards. The psychometric testing included confirmatory factor analysis, reliability by internal consistency (Cronbach's alpha) and test-retest reliability (intra-class correlation coefficient, ICC); construct validity by comparing the PVAQ-I with the Pain Catastrophising Scale (PCS), the Tampa Scale of Kinesiophobia (TSK), the Hospital Anxiety and Depression Score (HADS), the Chronic Pain Acceptance Questionnaire (CPAQ), a Numerical Rating Scale of pain intensity (NRS) and the Oswestry Disability Questionnaire (ODI); and sensitivity to change by calculating the smallest detectable change.
  
  
  RESULTS
  The PVAQ-I was administered to 131 subjects with chronic LBP (77 females, mean age of 48 ± 16 years, median symptoms duration of 12 months). Factor analysis confirmed a two-factor (passive awareness and active vigilance), 13-item solution, which led to an acceptable data-model fit. Internal consistency (α = 0.91) and test-retest reliability (ICC = 0.92) were good. As a priori hypothesized, construct validity showed moderate correlations between the PVAQ-I and PCS (r = 0.60), TSK (r = 0.44) and HADS-Anxiety (r = 0.53) and low correlations with HADS-Depression (r = 0.28), NRS (r = 0.28), ODI (r = 0.23) and CPAQ (r = -0.12). The smallest detectable change was 9.
  
  
  CONCLUSIONS
  The PVAQ was successfully translated into Italian and proved to have satisfactory psychometric properties. Its use is recommended for clinical and research purposes.
authors.affiliation: Salvatore Maugeri Foundation, Institute of Care and Research, IRCCS, Scientific Institute of Lissone (Monza Brianza), Physical Medicine and Rehabilitation Unit, Via Monsignor Bernasconi 16, 20851, Lissone, Monza Brianza, Italy. marco.monticone@fsm.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Monticone
authors.affiliation: Salvatore Maugeri Foundation, Institute of Care and Research, IRCCS, Scientific Institute of Lissone (Monza Brianza), Physical Medicine and Rehabilitation Unit, Via Monsignor Bernasconi 16, 20851, Lissone, Monza Brianza, Italy.|Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano, 20133, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Ambrosini
authors.affiliation: Salvatore Maugeri Foundation, Institute of Care and Research, IRCCS, Scientific Institute of Lissone (Monza Brianza), Physical Medicine and Rehabilitation Unit, Via Monsignor Bernasconi 16, 20851, Lissone, Monza Brianza, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Rocca
authors.affiliation: School of Physiotherapy, University of Milan, Milan, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Nava
authors.affiliation: School of Physical Medicine and Rehabilitation Unit, Bicocca University of Milan, Milan, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Terragni
authors.affiliation: School of Physical Medicine and Rehabilitation Unit, Bicocca University of Milan, Milan, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Cerri
authors.affiliation: Psychology Department, Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, England.
authors.forename: Lance M
authors.initials: LM
authors.lastname: McCracken
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology*; D001364:Awareness; D058443:Catastrophization; D059350:Chronic Pain / Q000523:psychology*; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007558:Italy; D007802:Language; D017116:Low Back Pain / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: Confirmatory factor analysis; Low back pain; Outcome measures; Pain Vigilance and Awareness Questionnaire; Psychometric properties