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Background The leading cause of years lived with disability globally is low back pain (LBP). Chronic low back pain (CLBP) is responsible for the cost and disability associated with LBP, which is more devastating in low-income countries, particularly in rural Nigeria with one of the greatest global LBP burdens. No Igbo back pain specific measure captures remunerative/non-remunerative work outcomes. Disability measurement using these tools may not fully explain work-related disability and community participation, a limitation not evident in the World Health Organisation Disability Assessment Schedule (WHODAS 2.0). This study aimed to cross-culturally adapt the WHODAS 2.0 and validate it in rural and urban Nigerian populations with CLBP. Methods Translation, cultural adaptation, test–retest reliability and cross-sectional validity testing. WHODAS 2.0 was translated forwards and backwards by clinical/non-clinical translators. Translations were evaluated by expert review committee. The questionnaire was pre-tested among twelve rural Nigerian dwellers having CLBP. Cronbach’s alpha evaluating internal consistency; intraclass correlation coefficient and Bland–Altman plots investigating test–retest reliability; and minimal detectable change were examined in a convenient sample of 50 CLBP victims in rural and urban Nigeria. Spearman’s correlation analyses with the back-performance scale, Igbo Roland Morris Disability Questionnaire and eleven-point box scale; and exploratory factor analysis in a random sample of 200 adults with CLBP in rural Nigeria determined construct validity. Ceiling and floor effects were investigated in all participants. Results Translation was straight forward. Patient instructions were translated. ‘Waist pain/lower back pain’ was added to ‘illness(es)’ to make the measure relevant for this study whilst allowing for future studies of other conditions. The Igbo phrase for ‘family and friends’ was used to better represent ‘people close to you’ in item D4.3. The Igbo-WHODAS had good internal consistency (α = 0.75–0.97); intra class correlation coefficients (ICC = 0.81–0.93); standard error of measurements (5.05–11.10) and minimal detectable change (13.99–30.77). Igbo-WHODAS correlated moderately with performance-based disability, self-reported back pain-specific disability and pain intensity, with a seven-factor structure and no floor and ceiling effects. Conclusions Igbo-WHODAS can be used clinically or for research as it is a psychometrically sound measure of self-reported disability. |
