Validity and reliability of the Turkish Örebro musculoskeletal pain screening questionnaire-short form

Abstract

BACKGROUND:

The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) is one of the most recognized and widely used instruments for identifying the risk of pain chronicity.

OBJECTIVE:

The aim of the study was to provide the reliability and validity of the Turkish ÖMPSQ-Short Form (ÖMPSQ-SF).

METHODS:

Fifty-seven acute and subacute low back pain patients were included in the study. ÖMPSQ short form and long form, Oswestry Disability Index (ODI), Central Sensitization Inventory (CSI), fear-avoidance beliefs questionnaires were applied simultaneously for validation. The ÖMPSQ-SF was re-applied after 7–10 days to determine test-retest reliability. The data were analyzed by the paired-samples t test, correlation analysis, Cronbach’s alpha, intraclass correlation coefficient (ICC) and confirmatory factor analysis.

RESULTS:

The mean age of the participants was 39.05±15.68 years. Cronbach’s alpha was 0.723, and the ICC was 0.84. There were moderate to strong correlation among the ÖMPSQ-SF and the ODI, CSI, ÖMPSQ-long form, Fear-Avoidance Beliefs Questionnaire work subscale (r = 0.72, r = 0.353, r = 0.648, r = 0.457 respectively).

CONCLUSION:

The results show that the Turkish version of the ÖMPSQ–SF is a valid and reliable questionnaire and could be used in clinical and scientific studies.

Keywords

Pain musculoskeletal disorders psychosocial factors yellow flags chronicity

1 Introduction

Epidemiological studies have suggested that one in five people suffer from persistent pain, most of which arises from musculoskeletal disorders [1]. Musculoskeletal problems lead to disability, sick leave, and treatment costs constitute a serious financial burden [1]. Occupational loading, sedentary lifestyle, obesity, and psychosomatic behavior disorders are the main risk factors for chronic pain [1 –5]. Despite the reported physical and psychosocial risk factors, the etiology and prognosis of chronic pain has not yet reached full agreement.

One explanation is that chronic pain is not only a nociception signal but also a biopsychosocial experience. The role of psychosocial and physiological factors are both significant in musculoskeletal pain chronicity [6]. Therefore, there is an increasing understanding of the importance of considering musculoskeletal pain disorders from a multidimensional, biopsychosocial perspective. Indeed, biopsychosocial factors are effective in the conversion of acute pain to chronic pain and in the development of disability [6 –9]. Identification and management of psychosocial factors in patients with musculoskeletal pain may also be affected by individual beliefs and culture.

Research has indicated that clinicians have made more mistakes in identifying the risk for chronic pain when they act only on intuition instead of using screening questionnaires [9]. Therefore, the risk of chronic musculoskeletal pain should be screened with reliable scales. Evaluations using a scale are standardised and have become more reliable whilst also serving as bases for clinical and scientific studies. One of the most recognised and widely used instruments for the aforementioned purposes is the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) [8 , 10–12]. Both long and short forms of the ÖMPSQ exist. The long form was developed in 2003 by Linton et al. [10]. The short form ÖMPSQ, which consists of 10 items, was developed by Linton et al. [11].

The long form is available in many languages, including Turkish [12 –14]. A reliability and validity study of the ÖMPSQ-Short Form (ÖMPSQ-SF) is also available in Brazilian-Portuguese and Hong Kong Chinese but not in Turkish [15, 16]. The predictive value of the short form is reported to be as good as the original version. Because the short form is completed in a shorter time, the potential for clinical acceptance increases, and it is more suitable for epidemiological studies [11]. The short form of the ÖMPSQ-SF has also been suggested as suitable for use in the primary care setting as a yellow flag screening tool for chronic pain. Time is precious to everyone, whether this be a patient, an employee, a clinician or an employer. We believe that it is necessary and valuable to demonstrate the reliability and validity of the Turkish version of the ÖMPSQ-SF, which is the most extensively employed scale and accomplishes screening in a short amount of time.

Establishing the validity and reliability of the Turkish version of ÖMPSQ-SF will facilitate pain treatment management and cost-effectiveness in musculoskeletal problems among Turkish Peoples. In addition, it will create reliability in scientific studies. Therefore, this study aimed to perform validity and reliability of the Turkish version ÖMPSQ-SF.

2 Methods

The researchers contacted Dr. Linton to gain permission for analyzing the Turkish psychometric properties of the ÖMPSQ-SF. The study did not contain translation phase, because the researchers took the items from the Turkish ÖMPSQ long form (ÖMPSQ-LF).

2.1 Participants and measurements

Participants admitted to the Trakya University Medical Faculty Hospital Physical Medicine and Rehabilitation Outpatient Clinic, who were diagnosed with acute and subacute low back pain, and whose native language was Turkish were included in the study. Non-native Turkish speakers, people with no mental capacity to answer the questions correctly, the presence or suspicion of illnesses (such as tumors, rheumatoid arthritis, or ankylosing spondylitis), people requiring emergency intervention, people under 18 years of age, and pregnant women were excluded from the study. Pain that persists for longer than 12 weeks despite treatment constitutes chronic pain [12, 17]. The criteria for inclusion in this study were as follows: patients complaining of pain for less than 12 weeks, those who were not diagnosed with another disease that could cause pain, individuals over the age of 18 years and those expressing a voluntary willingness to participate in the research.

The questionnaires were applied to participants who were informed about the research from May 2018 to March 2019. Informed consent was obtained from the participants. During the first interview, the ÖMPSQ-SF was applied simultaneously with the Oswestry Disability Index (ODI), Central Sensitization Inventory (CSI), Fear-Avoidance Beliefs Questionnaire (FABQ), and ÖMPSQ-LF. One week or 10 days later, ÖMPSQ-SF was administered for the second time. The Turkish version of ÖMPSQ-SF was administered twice to the participants to determine its test–retest reliability. In the first round, 68 participants filled out the questionnaires, but in the second administration, 57 respondents completed the questionnaires. This because 6 volunteers did not meet the inclusion criteria and 5 volunteers could not be reached.

2.2 Örebro musculoskeletal pain screening questionnaire-long form (ÖMPSQ-LF)

The ÖMPSQ-LF, which consists of 25 items, was developed by Linton and Boersma in 2003 [10]. Öncü, İlişer and Kuran performed a cross-cultural adaptation to Turkish in 2016 [13]. The ÖMPSQ-LF is a self-administered questionnaire. Each item is scored on a 0–10 Likert scale, and the total score ranges from 4–210 points. A higher score indicates a greater level of chronicity risk with each item weighted equally [13].

2.3 Örebro musculoskeletal pain screening questionnaire- short form (ÖMPSQ-SF)

The ÖMPSQ-SF consists of 10 items and was developed by Linton, Nicholas and MacDonald in 2011 [11]. Each item is scored on a 0–10 Likert scale. The total score range is between 1–100, with a score > 50 indicating higher risk for future disability [10]. The ÖMPSQ-SF consists of five factors (pain, self-perceived function, distress, fear-avoidance beliefs, and return to work expectancy).

2.3.1 Oswestry disability index (ODI)

The ODI is a self-completed questionnaire developed by Fairbank and Pynset [18]. The Turkish reliability and validity was determined by Yakut et al. [19]. The ODI contains 10 subsections, as follows: intensity of pain, lifting, personal care, walking, sitting, standing, social life, sleeping, traveling, and changing degree of pain. The ODI is a six-point Likert-scale questionnaire; the total score range is 0–100.

2.4 Fear-avoidance beliefs questionnaire (FABQ)

The Turkish version of the FABQ was developed by Waddel et al. [20], and the validity and reliability of the Turkish version was performed by Bingül and Aslan [21]. The questionnaire consists of 16 questions and 2 subsections. The first part is concerned with physical activities, and the second part contains questions about work. In the seven-point Likert- type scale, the physical activity is scored between 0–24, while the work-related section is scored between 0–36. Each subdivision is scored separately; a high score shows that fear- avoidance beliefs are high [20].

2.5 Central sensitization inventory (CSI)

In 2012, the CSI was developed by Mayer et al. to determine the symptoms and sensitivity related to central sensitization (CS) [22]. It consists of two parts, A and B. Section A helps clinicians recognize patients/individuals with sensitization symptoms. This portion of the inventory consists of 25 items in five-point Likert scale. The total score is between 0–100. The cut-off score of the inventory is 40. Scores higher than 40 indicate CS. Section B (no scoring) asks if the individual has had any diagnosis of one or more CS or related conditions.

Turkish validity and reliability of the CSI was performed by Duzce and Birtane in 2017 [23], and the Turkish version of this scale and section A were used in this study.

2.6 Statistical analysis

IBM SPSS Statistics for Windows, version 22.0 (IBM Corp., Armonk, NY, USA) and AMOS, version 22.0 (IBM Corp., Chicago, IL, USA) were used for statistical analysis. The normal distribution of the data was investigated with the Kolmogorov-Smirnov test.

Descriptive statistics were analyzed by means, standard deviation, minimum, maximum and percentage. In the test- retest sample, mean and standard deviation were calculated for the two time points. The test-retest scores were compared by a paired samples t test. To assess the reliability of the ÖMPSQ-SF, Cronbach’s alpha was assessed for internal consistency.

When Cronbach’s alpha was greater than 0.7, it was assumed to be satisfactorily reliable. For test-retest analysed, For the reliability intraclass correlation cofficient with oneway random-effects model (ICC1,1) was utilized. The standard error of measurement (SEM), minimum detectable change in 95% confidence interval (MDC 95% CI), and 95% limits of agreement (95% LoA) was computed. Based on the 95% confidence interval of the ICC estimate, values < 0.5 indicated low reliability; values from 0.5–0.75 indicated moderate reliability; values from 0.75–0.9 indicated good reliability; and values > 0.90 indicated excellent reliability [12, 24]. For construct validity, the relationships between ÖMPSQ-SF and the ODI, CSI, Turkish version of ÖMPSQ-LF, and FABQ (applied simultaneously) were evaluated by correlation analysis. Pearson’s correlation analysis was used for normally distributed data, and Spearman’s rho correlation analysis was used for non-normally distributed data.

If the correlation coefficient (CC) was≥0.60, the relationship was considered strong. If it was between 0.30–0.60, the relationship was moderate, and if the CC as≤0.29, the relationship was considered weak [13].

The construct validity of this study was determined using the confirmatory factor analysis (CFA) method; root-mean square error of approximation (RMSEA), comparative fit index (CFI), Tucker-Lewis index (TLI), and chi-square ratio to degrees of freedom (CMIN/DF) values were analyzed. The criteria for model fit was CFI of≥0.95, a TLI of≥0.90, a RMSEA of≤0.06 (24), and a CMIN/DF result of < 3 [26]. A flowchart of the study methods is shown in Fig. 1.

Fig. 1

Flowchart of the study method.

2.7 Ethical procedure

This study was planned in accordance with the Declaration of Helsinki as a cross-sectional study. Permission was obtained from the Medical Faculty Ethics Committee of Ethics Committee of Trakya University (protocol number TÜTF-BAEK 2018/84).

2.8 Sample size

At first, 68 participants were going to be included in the study, according to the application of 5–10 times the number of items used in the validity and reliability studies [27]. However, 10 participants declined to participate the study.

3 Results

Sixty-eight participants were invited to the study. Six participants did not meet the inclusion criteria and five participants could not be reached for the second evaluation. Hence, the study was completed with 57 participants. Of the participants, 42 (73.7%) were women. The mean age was 39.05±15.68 years, and the mean Body Mass Index (BMI) was 25.75±4.60. The descriptive statistics results are shown in Table 1. Cronbach’s alpha was 0.823. The Cronbach’s alpha results for the Turkish version of ÖMPSQ-SF and its sub-items are shown in Table 2.

Table 1
Descriptives statistics (N = 57)

N % X±SD (Min-Max)

Age (Year) 39.05±15.67 (18.0–66.0)

BMI (kg/m²⁾ 26.73±4.14 (18.42–35.44)

Complaint duration (week) 4.92±3.98 (1.00–12.00)

Gender

Male 15 (% 26.3)

Female 42 (% 73.7)

Employed 22 (% 38.6

Unemployed 30 (% 52.6)

Retired 5 (% 8.8)

Occupation

White collar worker 10 (% 17.5)

Blue collar worker 14 (% 24.6)

Housewife 14 (% 24.6)

Other (e.g. student, retiree) 19 (% 33.3)

Additional disease (e.g. high blood pressure, diabetes mellitus) 13 (% 22.8)

	N %	X±SD (Min-Max)
Age (Year)		39.05±15.67 (18.0–66.0)
BMI (kg/m²⁾		26.73±4.14 (18.42–35.44)
Complaint duration (week)		4.92±3.98 (1.00–12.00)
Gender
Male	15 (% 26.3)
Female	42 (% 73.7)
Employed	22 (% 38.6
Unemployed	30 (% 52.6)
Retired	5 (% 8.8)
Occupation
White collar worker	10 (% 17.5)
Blue collar worker	14 (% 24.6)
Housewife	14 (% 24.6)
Other (e.g. student, retiree)	19 (% 33.3)
Additional disease (e.g. high blood pressure, diabetes mellitus)	13 (% 22.8)

Table 2

Turkish version of the ÖMPSQ-SF items test re-test internal reliability (Cronbach’s alpha results)

ÖMPSQ-SF items	Cronbach’s alpha
Item 1 (How long have you had your current pain?)	0.897
Item 2 (How would you rate the pain that you had during the past week?)	0.792
Item 3 (I can do light work for an hour)	0.576
Item 4 (I can sleep at night)	0.404
Item 5 (How tense or anxious have you felt in the past week?)	0.584
Item 6 (How much have you been bothered by feeling depressed in the past week?)	0.833
Item 7 (In your view, how large is the risk that your current pain may become persistent?)	0.883
Item 8 (In your estimation, what are the chances you will be working your normal duties in 3 months?)	0.826
Item 9 (An increase in pain is an indication that I should stop what I’m doing until the pain decreases)	0.717
Item 10 (I should not do my normal work with my present pain.)	0.780
Total	0.823

The ÖMPSQ-SF test-retest results and ICC (1;1) results are shown in Table 3 4. There were not statistical differences as the paired samples test results (p > 0.05). Intraclass Correlation Coefficient (ICC 1;1) were 0.843 (% 95) Confidence Interval (CI) 0.732 to 0.907).

Table 3

Results of the ÖMPSQ-SF test –retest reliability, paired samples t test

	X±SD (Min-Max)	t	P
ÖMPSQ-SF (First-test)	44.12±14.19 (15.00–80.0)	–0.982	0.330
ÖMPSQ-SF (Re-test)	45.58±16.07 (0.00–81.00)

P: Results of paired samples test.

Table 4

Comparison of Turkish, Hong Kong-Chinese, Brazilian-Portuguese versions of ÖMSPSQ-SF in ICC, SEM, MDC and LoA

	ICC 1;1 (95% CI)	SEM	MDC 95%	95% LoA
Turkish version of ÖMPSQ-SF	0.843 (0.732–0.907)	5,97	16,54	(–31.52–27.78)
Hong Kong-Chinese version of ÖMPSQ-SF	0,868 (0.726–0.939)	5.9	16.5	(–16.5–16.4)
Brazillian-Portuguese version of ÖMPSQ-SF	0.78 (0.69–0.85) (ICC 2,1)	6,67	15.51	(–25.26–28.00)

ICC: Intraclass correlation cofficient, CI: Confidence interval, SEM: Standard error of measurement, LoA: Limits of agreement, MDC: Minimum detectable change, ÖMPSQ-SF: Örebro Musculoskeletal Pain Screening Questionnaire- Short Form.

CFA was performed to confirm the factor structure of the Turkish ÖMPSQ-SF. The results of the RMSEA, CFI, TLI, and CMIN/DF model fit indices were analyzed; the path diagram of the CFA is presented in Fig. 2. The model fit the data according to the indices of relative fit (RMSEA = 0.060, CMIN/DF = 1.204, CFI = 0.954, and TLI = 0.918). The construct validity of the ÖMPSQ-SF as measured by Pearson’s correlation analysis between the ÖMPSQ-SF total score and the scores of the ODI, CSI, FABQ, and ÖMPSQ-LF are shown in Table 5.

Fig. 2

The path diagram of the confirmatory factor analysis of the Turkish version ÖMPSQ-SF. ÖMPSQ-SF: Örebro Musculoskeletal Pain Questionnaire-Short Form.

Table 5

Results of the correlation between ÖMPSQ-SF and ÖMPSQ-LF, ODI, CSI, FABQ

	Mean±SD (Min-Max)	ÖMPSQ-SF r p
ÖMPQ-LF	90.123±30.11 (38.00–163.00)	0.648^**, 0.000
ODI	18.754±10.54 (3.00–70.00)	0.723^**, 0.000
CSI	30.72±16.93 (2.00–86.00)	0.353^**, 0.007
FABQ physical activity	17.05±7.95 (0.00–30.00)	0.316^*, 0.018
FABQ work	17.62±7.95 (0.00–52.00)	0.457^**, 0.001

ÖMPSQ-SF: Örebro Musculoskeletal Pain Questionairee- Short Form, ÖMPSQ-LF: Örebro Musculoskeletal Pain Questionairee- Long Form, ODI: Oswestry Disability Index, CSI: Central Sensitization Inventory, FABQ: Fear Avoidance Belief Questionnaire Pearson Correlation Test. ^*: Correlation is significant at the 0.05 level (2 tailed). ^**: Correlation is significant at the 0.01 level (2-tailed).

3.1 Exploratory factor analysis

A Kaiser–Meyer–Olkin (KMO) value of 0.714 and Bartlett’s test of sphericity (p < 0.0001) indicated the suitability of the factor analysis to be conducted. Such analysis revealed that five factors explain 62.26% of the total variance in the model. ÖMPSQ-SF item 1 (‘How long have you had your current pain problem?’) exhibited the lowest factor loading, whereas ÖMPSQ-SF item 2 (‘How would you rate the pain that you have had during the past week?’) had the highest factor loading. Table 5 presents the factor loadings of all the items (listed in Table 6).

Table 6
Factor loadings of ÖMPSQ-SF items

Component

1 2 3 4 5

Item 2 (How would you rate the pain that you had during the past week?) 0.793 –0.145 –0.289 0.052 –0.015

Item 10 (I should not do my normal work with my present pain) 0.732 0.337 –0.239 –0.128 –0.287

Item 4 (I can sleep at night) 0.715 0.198 0.115 –0.178 0.419

Item 9 (An increase in pain is an indication that I should stop what I’m doing until the pain decreases) 0.699 0.154 0.148 –0.283 –0.532

Item 8 (In your estimation, what are the chances you will be working your normal duties in 3 months?) 0.689 –0.170 0.118 –0.264 0.382

Item 7 (In your view, how large is the risk that your current pain may become persistent?) 0.671 –0.379 –0.122 0.338 0.138

Item 6 (How much have you been bothered by feeling depressed in the past week?) 0.331 –0.685 0.255 0.266 –0.188

Item 5 (How tense or anxious have you felt in the past week?) 0.130 0.605 0.517 0.083 0.120

Item 3 (I can do light work for an hour) 0.120 0.444 –0.684 0.407 0.069

Item 1 (How long have you had your current pain problem?) 0.310 0.276 0.482 0.596 –0.077

	Component
Item 2 (How would you rate the pain that you had during the past week?)	0.793	–0.145	–0.289	0.052	–0.015
Item 10 (I should not do my normal work with my present pain)	0.732	0.337	–0.239	–0.128	–0.287
Item 4 (I can sleep at night)	0.715	0.198	0.115	–0.178	0.419
Item 9 (An increase in pain is an indication that I should stop what I’m doing until the pain decreases)	0.699	0.154	0.148	–0.283	–0.532
Item 8 (In your estimation, what are the chances you will be working your normal duties in 3 months?)	0.689	–0.170	0.118	–0.264	0.382
Item 7 (In your view, how large is the risk that your current pain may become persistent?)	0.671	–0.379	–0.122	0.338	0.138
Item 6 (How much have you been bothered by feeling depressed in the past week?)	0.331	–0.685	0.255	0.266	–0.188
Item 5 (How tense or anxious have you felt in the past week?)	0.130	0.605	0.517	0.083	0.120
Item 3 (I can do light work for an hour)	0.120	0.444	–0.684	0.407	0.069
Item 1 (How long have you had your current pain problem?)	0.310	0.276	0.482	0.596	–0.077

4 Discussion

This study was conducted to evaluate the validity and reliability of the ÖMPSQ-SF. ÖMPSQ-SF items are scored from 0 to 100 being the absence of impairment and 100 severe impairment. The scores were summed up and the respondents were divided into three groups: 1. Low-risk (0—39 points), 2. Medium-risk (40—49 points) and 3. High-risk (50—100 points) [28, 29]. Early detection of psychosocial factors prevents chronicty of pain and facilitates management. The fact that the determination of pain via the ÖMPSQ-SF was fast and reliable indicates its considerable value as a reference for correct decision making and time management. Detecting acute pain and its potential for chronicity at an early time can reduce the incidence of chronic pain in society as well as disability, care burdens and medical costs owing to the measures that can be taken as a result of early detection.

It has been reported that the management of low back pain in primary care reduces disability and costs. The importance of the current study lies in its testing of the validity and reliability of the ÖMPSQ-SF. The results support the reliability and validity of the Turkish version, and its Cronbach’s alpha of 0.823 points to the adequate internal consistency of this version [8]. The Hong Kong Chinese version of the short form had a Cronbach’s alpha of 0.757 and for internal consistency [16]. Brazilian-Portuguese version of short form’s Cronbach’s alpha was reported as 0.72. These are very similar results. However, the internal consistency of the Turkish version of the long form was reported to be higher (0.89) [13].

ICC is a widely used reliability index in test-retest, inter-rater, and intra-rater reliability analyses. The (ICC 1;1) value of the test-retest analysis used for reliability was quite good at 0.843 (with 95% confidence interval 0.732–0.907). Brazilian-Portuguese version of short form test-retest reliability was examining intraclass correlation coefficient (ICC 2;1), was 0.78 (% 95 CI 0.69 to 0.85) 15]. Hong Kong Chinese version’s was 0.868 (% 95 CI 0.762 to 0.939). The validity levels of all three versions are similar and good [30]. Comparison of all three versions in terms of intraclass correlation coefficient, standard error of measurement (SEM), minimum detectable change (MDC), limit of agreement (LoA) are shown in Table 4. It can be said that these results are very close each other.

Additionally, test-retest results measured with a paired samples t test were not shown to be significant. These results showed the high consistency of the ÖMPSQ-SF Turkish version over time. Construct validity of the ÖMPSQ-SF, which was measured by the correlation coefficient between the ÖMPSQ-SF total score and the scores of the ODI, CSI, FABQ, and ÖMPSQ-LF, was found to be satisfactory. There were strong correlations between the ÖMPSQ-SF and the ODI and ÖMPSQ-LF. There were moderate correlations between the CSI and the work and the physical activity subscale of the FABQ.

Fagundes demonstrated positive correlations amongst the ÖMPSQ-SF, the Rolland Morris Disability Questionnaire and the Tampa Scale of Kinesiophobia, whilst Öncü et al. uncovered correlations amongst the ÖMPSQ-LF, ODI and FABQ. Similar correlations were found by Forsbrand and Langenfeld et al. as regards the STarT Back Screening Tool and the ÖMPSQ-SF [7 , 31].

The data fit the model according to factor analysis results in five sub-dimensions, which was consistent with original version. When the factor structure was analyzed with structural confirmatory modelling, five factors were determined in accordance with the original version (pain, self-perceived function, distress, return to work expectancy, and fear-avoidance beliefs) [11]. The first two questions are related to pain, questions 3 and 4 enquire into perceived function, questions 5 and 6 focus on distress, questions 7 and 8 concern expectations of returning to work and questions 9 and 10 probe into fear avoidance beliefs. As previously stated, we determined item 1 (‘How long have you had your current pain problem?’) to have the lowest factor loading. We attribute this result to the homogeneity of the sample in terms of duration of complaints. Since our sample group consisted of individuals who suffered from low back pain in less than 12 weeks, it is not surprising that item 2 questioning the severity of pain received the highest factor load. It has been reported that current pain, has a high factor load in the Turkish version of ÖMPSQ-LF too [13]. In the German version, pain, disability, depression, and fear-avoidance beliefs were compatible with the four sub- dimensions of the ÖMPSQ-SF [16]. The Turkish version of the long form, as well as the Finnish and Persian versions, reported five factors [8 , 13]. The long form has many language versions, but the short form has a limited language version. We found no floor or ceiling effects similar to the findings derived with respect to the Brazilian–Portuguese long and short forms of the ÖMPSQ or the German long form of the aforementioned scale [15, 31].

5 Conclusion

The validity and reliability of the Turkish ÖMPSQ-SF was found to be sufficient and the results showed that it is a valid and reliable questionnaire. It can be used in practice and is advantageous because it can be rapidly completed and easily recorded. As a result, the Turkish version of the ÖMPSQ-SF is appropriate for clinical and scientific studies.

5.1 Strengths and limitations

First, the ÖMPSQ-SF is a self-administered questionnaire; therefore, the results may have been affected by response bias.

The omission of testing the predictive validity of the Turkish ÖMPSQ-SF is a major limitation of the present study. We recommend that the predictive validity of the Turkish ÖMPSQ-SF be examined in future studies.

Although a test-retest interval of two weeks is recommended to minimize the effect of recognition, a shorter interval was selected owing to possible varying symptoms in patients with acute or subacute low back pain. On the other hand, in an individual with acute or subacute pain, such as 10 days a time interval, can lead to significant changes in pain intensity. This can be considered a limitation too of this study. Another shortcoming of the study was the limited sample.

The comparison of the construct validity of the Turkish ÖMPSQ-SF with that of many similar questionnaires and scales constitutes this study’s strengths. The research also strongly confirmed the questionnaire’s validity and reliability.

Conflict of interest

The authors have no potential conflicts of interest to report.

Funding

No funding was received for this manuscript.

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