Translation, cultural adaptation and psychometric testing of Igbo fear avoidance beliefs questionnaire in mixed rural and urban Nigerian populations with chronic low back pain

Introduction Low back pain (LBP) is highly prevalent in Nigeria and is more devastating in rural Nigeria due to adverse living and working conditions, reinforced by maladaptive illness beliefs. There is a need to develop measures for assessing such beliefs in this population. This study aimed to cross-culturally adapt the Fear Avoidance Beliefs Questionnaire (FABQ) and test its psychometric properties in mixed rural and urban Nigerian populations with chronic LBP. Methods Translation, cultural adaptation, test-retest, and cross-sectional psychometric testing. FABQ was forward and back translated by clinical/non-clinical translators. A review committee evaluated the translations. Twelve people with chronic LBP in a rural Nigerian community pre-tested the questionnaire. Cronbach's alpha assessing internal consistency; intra-class correlation coefficient and Bland-Altman plots assessing test-retest reliability; and minimal detectable change were investigated in a convenient sample of 50 chronic low back pain sufferers in rural and urban Nigeria. Construct validity was examined using Pearson's correlation analyses with the eleven-point box scale and Igbo Roland Morris Disability Questionnaire (Igbo-RMDQ), and exploratory factor analysis in a random sample of 200 adults with chronic low back pain in rural Nigeria. Ceiling and floor effects were investigated in all samples. Results Amendments allowed interviewer-administration. Item 8 was modified to 'I have a compensation or gains I get from having my pain' as there is no benefit system in Nigeria. Igbo phrase for 'physical activity' could also mean 'being active', 'moving the body' or 'moving about' and was used in the items with 'physical activity'. The Igbo-FABQ had good internal consistency (alpha = 0.80-0.86); intra class correlation coefficients (ICC = 0.71-0.72); standard error of measurements (3.21-7.40) and minimal detectable change (8.90-20.51). It correlated moderately with pain intensity and disability, with a two-factor structure and no floor and ceiling effects. Conclusions Igbo-FABQ is valid, reliable, and can be used clinically and for research.