Translation,cross cultural adaptation,and validation of Arabic version of Interview administered version of Work Rehabilitation Questionnaire (WORQ)

Abstract

BACKGROUND:

Accurate assessment tools for work rehabilitation are essential in healthcare settings. Adapting the Work Rehabilitation Questionnaire (WORQ) to Arabic-speaking populations ensures effective evaluation and intervention for individuals with work-related disabilities.

OBJECTIVE:

To execute a cross-cultural adaptation of interview-administered version Work Rehabilitation Questionnaire –Arabic (WORQ-A) and assess the psychometric properties of WORQ-A in patients with musculoskeletal problems.

METHODS:

WORQ is mainly intended to assess the work functioning of persons who are involved in vocational rehabilitation. Psychometric properties were scrutinized in the outpatient rehabilitation center. Test–retest reliability was examined with intraclass correlation coefficient (ICC), and internal consistency was evaluated with Cronbach’s alpha. The usability of WORQ-A was established in 46 patients with musculoskeletal problems.

RESULTS:

WORQ-A exhibited exceptional internal consistency (0.93) and a great test–retest reliability (0.87). Regarding usability, the ability to understand the questions and answer choices was established as good. Five percent of the participants encountered minor difficulties with certain words, while the majority found it quite straightforward to choose the correct answers.

CONCLUSIONS:

The WORQ-A is an effective, consistent, and very easy to administer questionnaire to assess the work-related functions assumed in our study context and the individualities of the sample.

Keywords

Translation cross-cultural adaptation validation vocational rehabilitation WORQ

1 Introduction

Vocational rehabilitation (VR) is a heterogeneous, evidence-based treatment executed in various settings [1]. Vocational rehabilitation after any injury, is generally delivered once a person has finished either inpatient or outpatient rehabilitation and is ready to go back to work. Vocational rehabilitation mainly improve the work participation outcomes after the commencement of physical disability and facilitates the workers to retain their occupations after an accident, or injury [2]. In the healthcare sector, numerous assessment questionnaires are commonly utilized post VR to aid in analysis, and evaluate the quality of life, and predict the prognosis of individuals [3]. VR motivates the individual’s involvement in day-to-day activities and also helps to ameliorate the injuries associated with chronic health problems [4]. There is an abundant need for scoring the patient’s problems after VR to review the different functions of the body. Another important aspect to discuss here is Return to work (RTW) after any injuries or illness. Return to work (RTW) after illness or injury is a significant indicator of an individual’s well-being. Those unable to return to the workplace are at greater risk, including physical complaints, worst psychosocial changes, inadequate professional openings, and diminished personal resources [5].

Musculoskeletal problems are a significant health concern in Saudi Arabia, reflecting a global trend of increasing prevalence especially back pain and neck pain [6 –10]. These musculoskeletal problems can stem from a complex interplay of factors, including age-related wear and tear, physical inactivity, improper work postures, ageing, overuse, repetitive strain, trauma / injury, excess body weight, etc. which can stress the joints in majority of the cases. Occupational hazards and certain health conditions, such as autoimmune disorders, infections, or nerve compression, may also exacerbate musculoskeletal problems. An effective VR is crucial for management to mitigate the impact of musculoskeletal disorders on an individual’s well-being. Furthermore, the Saudi government and healthcare authorities have been actively addressing this public health challenge by promoting awareness, providing access to specialized care, and implementing preventive measures to mitigate the burden of musculoskeletal disorders on the population.

In this context, Work Rehabilitation Questionnaire (WORQ) is one such measure designed which would be able to assess and document the utmost appropriate areas associated with functions and actions of the body, and involvement in the framework of work-related functions and VR [11]. WORQ was primarily developed to assess changes in occupational function over time, based on a patient’s abilities. Additionally, this questionnaire is highly practical for use in clinical settings [12]. The complete description of WORQ comprises forty-two items on various functions related to work and holds four subscales highlighting feeling, perception, skill, and flexibility and ten extra single factors. For forty items on a measure of 0 to 10, an overall average score was proposed which indicated adequate test–retest reliability and excellent internal consistency, [13] and the next two questions will provide information regarding the time it takes the subject to prepare in the morning and complete all necessary tasks over the course of a week.

It has been initially validated and recommended in English and later validated in other languages, such as French, Japanese, and Dutch. Additionally, all these translations presented very good internal consistency and test–retest reliability (ICC 0.90 and 0.85 appropriately) in a moderately lesser sample population with various health-related problems [14, 15]. So, in the present study for Arabic-speaking patients, the WORQ has been translated and validated into the Arabic language.

In Saudi Arabia, vocational rehabilitation facilities, with premediated strategies have developed and become gradually significant [16, 17]. Vocational rehabilitation centers in Saudi Arabia provide good amenities to upsurge the employment facilities for individuals with incapacities and assist their contribution to the job marketplace [18, 19]. Hence, the significance of valid and reliable assessment questionnaires cannot be understated, as could make a valuable impact on individuals. In Arabic literature, there is a lack of questionnaires specifically designed to assess the functioning of workers with impairments or injuries in the context of vocational rehabilitation. Thus, to address this gap, the study examined the psychometric properties of the Arabic version of the WORQ questionnaire.

2 Methods

2.1 Design and study population

Data was collected from 87 participants in this cross-sectional study and was directed in the physical therapy out-patient department of King Khalid University, Abha, Saudi Arabia. Data was collected from May to October 2022. The study was permitted by the Research Ethics Committee of King Khalid University (ECM # 2022-1502), directed rendering to the values defined in the Declaration of Helsinki.

Study population

To be included in this study, the subjects need to be between 18 and 60 years old, participants with musculoskeletal problems (low back pain and neck pain) receiving out-patient therapy, getting at least one VR intervention regardless of their kind of musculoskeletal problem, and who were working or looking for new employment. Subjects who were not capable to speak and read Arabic confidently were omitted from this research study. All the participants gave informed consent to take part in the study.

2.2 WORQ questionnaire instrumentation: It mainly contains two parts

Part 1:

Part 1 of this questionnaire contains items on 17 socio-demographics and background information related to occupation comprising work status, current rehabilitation programs, level of education and items about the support from the family, employer, and the government or private agencies.

Part 2:

The second part of this questionnaire comprises a total of 42 items, with two questions specifically addressing the duration needed for self-care and treatment. Remaining 40 items have been categorized into seven domains through descriptive factor analysis. cognition (nine items), physical (eight items), mood (three items), activities of day-to-day living (five items), sensory (five items), emotional (three items), and social (seven items). The next two questions will provide information about how much time the subject spends getting ready in the morning and completing all necessary tasks throughout the entire week. These functions related to the participant, each with feedback on a measure of 0–10; 0 = no problem, 10 = complete problem, ranging from 0–400 (Cronbach’s α- 0.88 and test–retest reliability 0.78 [13]. Along with these, the participants might also inform their general outcomes and feelings regarding the WORQ-A version.

The study was fundamentally divided into two steps: I) Translation and cross-cultural version II) Reliability and validity assessment.

Step 1: Conversion and Cross-Cultural Modification of the Arabic version of WORQ

Stage 1: Preliminary translation to Arabic

Standards suggested by Beaton et al. were utilized in this translation and cross-cultural adaptation process [20]. In this process, two intuitive Arabic translators were recognized who were also experts in English. Then the English version of WORQ was forwarded to them. The first translator was a language expert member without any medical background and the second translator was a vocational rehabilitation specialist. The language expert version was designated T1 and the vocational rehabilitation specialist version as T2. Both of these translators understood the questionnaire and developed individual Arabic versions of the questionnaire.

Stage 2: Combining preliminary translations

These T1 and T2 Arabic versions of WORQ were discussed by the research team members with the translators and synthesized the outcomes of their translations. After a detailed discussion and corrections, a single Arabic version (T3) of WORQ was created.

Stage 3: Back translation from Arabic to English

In this stage, the T3 Arabic version of WORQ which had been created was back translated into English. To resolve this, we sent this version to two translators whose first language was English. These translators were neither involved nor attentive to the original WORQ questionnaire. Both of them developed individual back-translated English versions were are B1 and B2.

Stage 4: Professional expert group

In this stage, the panel members discussed all these findings with all translators and, if needed, the members approved the changes. During this back translation from Arabic to English, some words like “refreshed”, “thinking clearly”, “handling”, and “irritable”, were modified. These words were amended in the conversation procedure. Finally, the two English scales, one- the original one and the second- the back-translated one, were matched and revised to form a pre-final WORQ-A version.

Stage 5: Trial of the Pre-final WORQ-A version

At this point, a pilot study was conducted on 41 participants who met the inclusion criteria of this study.

All the participants completed the original English WORQ questionnaire first and later the WORQ-A version.

They were requested to provide their opinions on the clarity and understandability of all the items in both questionnaires, as well as the ease of carrying out these WORQ questionnaires.

All were pleased with our translation and revision process.

Four participants stated particular difficulties with responding entries from portion one- associated with their employment grade, workplace settings and vocational restoration therapy protocols, however, all patients stated upright comprehensibility of the operative stuff in portion two of the WORQ questionnaire.

Only one contestant raised the issue of numerical evaluation in the implementation of the entries.

Stage 6: Proposal of the Final WORQ-A version

Finally, all the research members of the present study established the subsequent description of the WORQ questionnaire centered on the evidence since the pretest and concluded the Arabic description of WORQ (Fig. 1).

Fig. 1

Process of cross-cultural adaptation of WORQ English version to Arabic version.

2.3 Psychometric evaluation of WORQ-A version

Content Validity

In the perspective of the current WORQ-A version, it is essential to examine the content validity, so that all the items can indicate the satisfaction level of the subjects. The final WORQ-A version was sent to four vocational rehabilitation specialists to check the content validity of the questionnaire by comparing to the original version of WORQ. We examined the content validity commenting on the comprehensiveness of the WORQ-A version, as this questionnaire assesses not only the work-related functioning of the participants but also, the emotional, physical, mental, and body functions of the subjects who receive vocational rehabilitation [21].

All the research team members evaluated each question under the following aspects of the questionnaire; socio-demographic information, and to what extent the problems of the body interfere with different functions of the body and activities of daily living. Along with this, the research team members assessed the following measures: suitability, clarity and transparency of the terminology for all items in the questionnaire. The content validity was tested by assessing each of the items with the subsequent criteria: 1-strongly disagree”, 2-“disagree”, 3-“neutral”, 4-“agree”, and 5-“strongly agree”. All these responses were utilized to evaluate the content validity of the questionnaire.

Test re-test reliability and Internal consistency

To examine whether the WORQ-A version was constant over a period, we intended to comprise at least 46 participants who met the inclusion criteria. All the participants were instructed to answer the WORQ-A questionnaire two times with a minimum interim of 14 days with the same evaluator.

No intervention or other treatment was administered during this period to all the participants. For each participant, a typical score was determined for every subject by adding the grades from the forty similarly scored items from the second portion of the questionnaire, split by the overall responses. Test–retest reliability was intended centered on the typical result using interclass correlation. An ICC value of 0.4–0.7 was interpreted as reasonable, while a value ≥0.75 was interpreted as exceptional [22].

2.4 Statistical analysis

The SPSS software (SPSS version 22.0 for Windows; Inc, USA) was utilized to conduct statistical analyses. Explanatory scrutiny was utilized to describe the demographic characteristics of the sample and WORQ-A questionnaire results. Internal consistency was analyzed using Cronbach’s alpha (α), higher than 0.70 is considered satisfactory. Test–retest reliability was evaluated using the Spearman-Brown coefficient.

3 Results

3.1 Usability

Approximately 95% of the subjects in the current study indicated, with strong agreement, that all the questions were flawless and extremely straightforward to discern. Regarding the questions related to the scoring system, most of the participants mentioned it was very easy to select the appropriate answer. On the other hand, 5% of the participants reported some difficulties with some words. Sufficient time was given to all participants to complete the questionnaire. The usual time taken to administer the WORQ-A was 25.4 minutes.

3.2 Cross-cultural adaptation of WORQ-A version

The research team members in the panel suggested some minor changes to the final version of WORQ-A version. The proposal was to change some words to make them understand more accurately such as “rejuvenated”, to “refreshed” and “bad-tempered” to “bad attitude”.

3.3 Psychometric Evaluation of WORQ-A version

In the present study, to test the pre-final WORQ-A version, 41 participants were included and to test the final approved version 46 participants were included in the study. The participant’s demographic features are presented in Table 1.

Table 1
Characteristics of the participants

Characteristics Test sample (n = 46)

Age: (Mean±SD), years (35.2±6.8) Number, percentage

Gender Male 33 (71.7%)

Female 13 (28.3%)

Marital status Single 7 (15.2%)

Married 36 (78.2%)

Separated 3 (6.5%)

Education Less than primary school 3 (6.5%)

Primary school 8 (17.3%)

Secondary school 21 (45.6%)

University 14 (30.4%)

Work status Working 28 (60.8%)

Not working 12 (26%)

Student 5 (10.8%)

Retired 1 (2.1%)

Type of disability Orthopaedic 25 (54.3%)

Neurological 14 (30.4%)

Mental 6 (13%)

Other health problems 1 (2.1%)

Vocational rehabilitation (VR) type Physical therapy 28 (60.8%)

Cognitive training 4 (8.6%)

Psychiatry management 6 (13%)

Workplace adjustments 8 (17.3%)

Characteristics		Test sample (n = 46)
Age: (Mean±SD), years	(35.2±6.8)	Number, percentage
Gender	Male	33 (71.7%)
	Female	13 (28.3%)
Marital status	Single	7 (15.2%)
	Married	36 (78.2%)
	Separated	3 (6.5%)
Education	Less than primary school	3 (6.5%)
	Primary school	8 (17.3%)
	Secondary school	21 (45.6%)
	University	14 (30.4%)
Work status	Working	28 (60.8%)
	Not working	12 (26%)
	Student	5 (10.8%)
	Retired	1 (2.1%)
Type of disability	Orthopaedic	25 (54.3%)
	Neurological	14 (30.4%)
	Mental	6 (13%)
	Other health problems	1 (2.1%)
Vocational rehabilitation (VR) type	Physical therapy	28 (60.8%)
	Cognitive training	4 (8.6%)
	Psychiatry management	6 (13%)
	Workplace adjustments	8 (17.3%)

3.4 Reliability

Explorative analysis for internal consistency of the present study is presented in Table 2. This provides additional evidence for all the seven items of this scale varying from 0.80 to 0.92. The total value of Cronbach’s alpha (α) for all the 40 items which were on the measure of 0 to 10 of WORQ-A version was 0.93.

Table 2
Reliability: internal consistency and test-retest reliability

Sub items Internal consistency (Cronbach’s alpha (α)) Test re-test reliability p-value

Cognition 0.91 0.83 (0.74–0.89) < 0.001^*

Physical 0.87 0.87 (0.82–0.91) < 0.001^*

Mood 0.81 0.86 (0.70–0.94) < 0.001^*

ADL 0.79 0.81 (0.75–0.86) < 0.001^*

Sensory 0.77 0.92 (0.88–0.95) < 0.001^*

Emotion 0.88 0.78 (0.66–0.87) < 0.001^*

Social 0.84 0.82 (0.75–0.88) < 0.001^*

WORQ-A (sum score) 0.93 0.88 (0.76–0.95) < 0.001^*

Sub items	Internal consistency (Cronbach’s alpha (α))	Test re-test reliability	p-value
Cognition	0.91	0.83 (0.74–0.89)	< 0.001^*
Physical	0.87	0.87 (0.82–0.91)	< 0.001^*
Mood	0.81	0.86 (0.70–0.94)	< 0.001^*
ADL	0.79	0.81 (0.75–0.86)	< 0.001^*
Sensory	0.77	0.92 (0.88–0.95)	< 0.001^*
Emotion	0.88	0.78 (0.66–0.87)	< 0.001^*
Social	0.84	0.82 (0.75–0.88)	< 0.001^*
WORQ-A (sum score)	0.93	0.88 (0.76–0.95)	< 0.001^*

3.5 Test-Retest Reliability

The intraclass correlation coefficient for the WORQ-A version was 0.87 and the intraclass correlation coefficients for the seven aspects varied from 0.78 to 0.96, indicative of worthy test–retest reliability (Table 2).

4 Discussion

The current analysis has defined the cross-cultural modification, content validity, test re-test reliability and internal consistency of the WORQ version. Regarding the current study, the participants with various musculoskeletal problems especially low back pain and neck pain from the Southern province in the Kingdom of Saudi Arabia were included. The outcomes showed that the WORQ-A version displayed adequate validity, reliability and an outstanding internal consistency. Hence, we strongly consider that the WORQ questionnaire was effectively amended to the Arabic version and appropriate for usage in the Arabic context.

All phases of Beaton guidelines [20] for cross-cultural adaptation were productively accomplished and led to the WORQ-A version.

Concerning the cross-cultural adaptation, in part 1, some participants didn’t show their willingness to mention the type of vocational intervention received by them, especially in the case of psychological support. Moreover, the families are more caring about their disabled members in the family and discourage them from pursuing employment. WORQ-A version signifies the foremost psychometric indication of the self-reported form of WORQ.

Regarding part 2, it took time to explain to some participants regarding questions 7 –“your temper” 9 –“thinking clearly”, and 23 –“handling stress, crises, or conflict? These difficulties were effectively modified to the Arabic language and made it appropriate for practice in the Arabic context.

Concerning the psychometric analysis, the presentation of internal consistency is an important phase of any questionnaire. The WORQ-A questionnaire attained good outcomes in the total score (α= 0.93), for cognition (α= 0.91), physical (α= 0.87), mood (α= 0.81), ADL (α= 0.79), sensory (α= 0.77), emotions (α= 0.88), and social (α= 0.84).

This suggests that the stability of the questionnaire was significant (p < 0.01) and was similar to that of other versions of this questionnaire [14, 23]. Although this is slightly higher than that observed by Vermeulen et al. [15], due to the age, diagnosis, and mode of treatment received in the current study.

One more important aspect of this study was the current study comprised several categories of disability unlike the study done by Vasilchenko et al. [14] which stated its psychometric properties only in traumatic spinal cord injury patients, thereby representing that the WORQ-A questionnaire might be utilized for various disabilities.

Regarding the subscale, the “emotions” factor has a weak intraclass correlation coefficient (0.78), while other factors were above 0.83 and specify a good test-retest reliability. Regardless of the circumstances, we believe that the emotion stays for only a shorter period than other factors.

In the present study, the exploratory factor analysis showed 7 factors-cognition, physical, mood, ADL, sensory, emotions, and social aspects in Part II of the WORQ questionnaire. All its psychometric properties are promising in the WORQ-A questionnaire which is similar to the findings of Orkun Tahir Aran et al. [24] who conducted in Dutch version. These results showed good internal consistency and test-retest reliability. The use of the sub-scales might be beneficial in addressing particular patients while undergoing vocational rehabilitation programs and indicate that this WORQ-A questionnaire has more than one operational domain. In contrast, a study done by Finger et al. [25] described only four-factor analysis –emotion, cognition, dexterity, and mobility instead of seven-factor analysis, which might be a reason for ordinary construct validity.

The present study has some limitations. First, it was conducted only on a smaller sample size. Second, our research was restricted to musculoskeletal disorder patients only in the lower back and neck at the University’s out-patient department, which can limit these results to other populations. Further studies involving a variety of patients in different vocational rehabilitation centers are necessary. Third, further research of the psychometric properties such as construct validity, convergent and divergent validity involving a greater sample size will be necessary in further studies.

5 Conclusions

In the present analysis, we executed a cross-cultural conversion of WORQ into Arabic and assessed its psychometric properties. Our judgements recommend that WORQ-A is a consistent, reliable, usable, and valid assessment questionnaire to evaluate work-related functioning in low back and neck pain musculoskeletal disorder patients. We admit that it is essential to highlight the significance of occupational rehabilitation assistances, not only to provide employment to persons with ill health, but also enrich their involvement through work contribution in the form of assessment through the context of the WORQ-A version.

It will also help the rehabilitation specialists to help the people whose occupational functioning is limited for the time being or forever due to disorders related to health and to recommence their participation in work.

Data availability

The data analyzed in the current study are not publicly available due to data protection concerns but are available from the corresponding author on reasonable request.

Ethical approval

The study was permitted by the Research Ethics Committee of King Khalid University (ECM # 2022-1502), directed rendering to the values defined in the Declaration of Helsinki.

Informed consent

All the participants gave informed consent to take part in the study.

Conflict of interest

The authors declare no conflict of interest.

Footnotes

Acknowledgments

The authors extend their gratitude to the Deanship of Scientific Research and Graduate studies at King Khalid University for funding thiswork through a Large Research Project under grant number RGP. 2/23/45.

Funding

The authors extend their gratitude to the Deanship of Scientific Research at King Khalid University for funding this work through a large group research project under grant number RGP. 2/23/45.

References

Finger

, Escorpizo

, Tennant

. Measuring work-related functioning using the Work Rehabilitation Questionnaire (WORQ), International Journal of Environmental Research and Public Health. 2019;16(15), 2795.

Escorpizo

, Finger

, Reneman

Schultz IZ, Gatchel RJ, editor. New York: Springer; 2016 .

Fortes

CPDD

, AraújoAPdQC. . Check list for healthcare questionnaires cross-cultural translation and adaptation. Cadernos Saúde Coletiva. 2019;27: 202–9.

Von Celsing

A-S

, Kristiansson

, Svärdsudd

, Wallman

. Effects of a vocational rehabilitation programme on return to work among sick-listed primary health care patients: a population-based matched, case-control study, BMC Family Practice. 2020;21(1): 1–9.

Cancelliere

, Donovan

, Stochkendahl

, Biscardi

, Ammendolia

, Myburgh

, et al. Factors affecting return to work after injury or illness: best evidence synthesis of systematic reviews, Chiropractic & Manual Therapies. 2016;24(1), 1–23.

Almutairi

, II Almalki

, Alharthi

, Alhossaini

, Alkurayzi

, Alharthi

, et al. LifeStyle and Exercise Relation to Neck and Back Pain in Saudi Arabia, Cureus.. 2022;14(12).

Maayah

, Abdel-Aziem

, Arafah

, Gaowgzeh

, Neamatallah

, Alfawaz

, et al.The prevalence of low back pain and risk factors in academic teaching staff at King Abdulaziz University Jeddah: A cross-sectional study. Work. 2023(Preprint):1-9.

Alhakami

, Madkhli

, Ghareeb

, Faqih

, Abu-Shamla

, Batt

, et al. editors. The Prevalence and Associated Factors of Neck Pain among Ministry of Health Office Workers in Saudi Arabia: A Cross Sectional Study. Healthcare; 2022: MDPI.

Alzahrani

, Alshehri

, Alzhrani

, Alshehri

, Al Attar

WSA

. The association between sedentary behavior and low back pain in adults: a systematic review and meta-analysis of longitudinal studies, PeerJ. 2022;10:e13127.

10.

Kakaraparthi

, Vishwanathan

, Gadhavi

, Reddy

, Samuel

, Alshahrani

, et al. The prevalence, characteristics, and impact of work-related musculoskeletal disorders among physical therapists in the Kingdom of Saudi Arabia–a cross-sectional study, Medycyna Pracy. 2021;72(4), 363–73.

11.

Finger

, Bie

, Nowak

, Escorpizo

Development and Testing of an ICF-based Questionnaire to evaluate functioning in vocational rehabilitation: The Work Rehabilitation Questionnaire (WORQ). Handbook of vocational rehabilitation and disability evaluation: Springer; 2015. p. 495-520.

12.

Roels

, Reneman

, Post

. Measurement properties of the full and brief version of the Work Rehabilitation Questionnaire in persons with physical disabilities, Journal of Occupational Rehabilitation. 2021;31(4), 886–94.

13.

Finger

, Escorpizo

, Bostan

, De Bie

. Work Rehabilitation Questionnaire (WORQ): development and preliminary psychometric evidence of an ICF-based questionnaire for vocational rehabilitation, Journal of Occupational Rehabilitation. 2014;24(3): 498–510.

14.

Finger

, Wicki-Roten

, Leger

, Escorpizo

. Cross-cultural adaptation of the work rehabilitation questionnaire (WORQ) to French: A valid and reliable instrument to assess work functioning, Journal of Occupational Rehabilitation. 2019;29(2): 350–60.

15.

Vermeulen

, Woestyn

, Oostra

, Geers

, Ryngaert

, Van de Velde

, et al. Cross-cultural adaptation and psychometric evaluation of the Dutch Version of the Work Rehabilitation Questionnaire (WORQ-VL), Journal of Occupational Rehabilitation. 2019;29(3): 514–25.

16.

Alwashmi

. Vocational Rehabilitation Awareness among Spinal Cord Injury Male Patients in Saudi Arabia: A Brief Communication, Cureus.2019; 11(1).

17.

Almutairi

Teachers and practitioners’ perceptions of transition services for females with intellectual disability in Saudi Arabia: University of Northern Colorado; 2018.

18.

Bindawas

, Vennu

. The national and regional prevalence rates of disability, type, of disability and severity in Saudi Arabia—Analysis of 2016 demographic survey data, International Journal of Environmental Research and Public Health. 2018;15(3):419.

19.

Alnahdi

. Special Education Programs for Students with Intellectual Disability in Saudi Arabia: Issues and Recommendations, Journal of the International Association of Special Education. 2014;15(1) .

20.

Beaton

, Bombardier

, Guillemin

, Ferraz

. Guidelines for the process of cross-cultural adaptation of self-report measures, Spine. 2000;25(24), 3186–91.

21.

Thygesen

, Korshøj

, Verpe

, Vestergaard

, Escorpizo

, Mortensen

. Translation and cross-cultural adaptation of the Work Rehabilitation Questionnaire (WORQ) into Danish, Frontiers in Rehabilitation Sciences. 2023;4:1134039.

22.

WeirJP. . Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM, The Journal of Strength & Conditioning Research. 2005;19(1): 231–40.

23.

Aran

, Abaoglu

, EkiciÇağlar

, Akel

, Akı

, Karahan

, et al. Cross-cultural adaptation, reliability, and validity of a Turkish version of the Work Rehabilitation Questionnaire (WORQ-Turkish), Journal of Occupational Rehabilitation. 2021;31(2), 285–92.

24.

Aran

, Abaoglu

, EkiciÇağlar

, Akel

, Akı

, Karahan

, et al. Cross-cultural adaptation, reliability, and validity of a Turkish version of the Work Rehabilitation Questionnaire (WORQ-Turkish), Journal of Occupational Rehabilitation. 2021;31:285–92.

25.

Finger

, Wicki-Roten

, Leger

, Escorpizo

. Cross-cultural adaptation of the Work Rehabilitation Questionnaire (WORQ) to French: A valid and reliable instrument to assess work functioning, Journal of Occupational Rehabilitation. 2019;29:350–60.