Challenges of measuring self-reported exposure to occupational biomechanical risk factors amongst people with low literacy engaged in manual labour: Findings from a cross-cultural adaptation and psychometric investigation in an African population with chronic low back pain

Purpose
Occupational biomechanical factors are implicated in the aetiology and progression of low back pain (LBP). This study cross-culturally adapted and psychometrically investigated the occupational risk factor questionnaire (ORFQ) in a low literate Nigerian Igbo population with chronic LBP.
Methods
Forward and back translation of the original ORFQ by clinical and non-clinical translators was followed by an expert committee review. The adapted ORFQ was pre-tested amongst rural Nigerian adults with chronic LBP using cognitive think-aloud interviewing. Internal consistency (Cronbach’s alpha) and test–retest reliability (unweighted and linear weighted k statistic for item-by-item agreement, and intra-class correlation coefficient—ICC) were investigated amongst 50 rural and urban Nigerian dwellers with chronic LBP. Spearman’s correlation and regression analyses were conducted with the Igbo-ORFQ, and measures of disability [World Health Organisation Disability Assessment Schedule (WHODAS 2.0), Roland Morris Disability Questionnaire (RMDQ), Back performance scale (BPS)], pain intensity [Eleven-point box scale (BS-11)] and social support [Multidimensional Scale of Perceived Social Support (MSPSS)], to test construct validity with 200 rural Nigerian dwellers with chronic LBP.
Results
Cross-cultural adaptation highlighted difficulty conceptualising and concretising exposure to biomechanical risk factors. Item-by-item agreement, internal consistency (α = 0.84) and intraclass correlation coefficient (ICC = 0.83) were good. Some unexpected direction of associations between the biomechanical components of the Igbo-ORFQ, and disability, pain intensity, and social support prohibits establishment of construct validity.
Conclusions
Prospective studies comparing the Igbo-ORFQ to other measures of exposure to occupational biomechanical risk factors are required to establish the construct validity of the Igbo-ORFQ.