VALIDATION OF THE SPANISH VERSION OF THE ROLAND-MORRIS SCALE
Title.
Roland Morris Questionnaire: Validation of
its cross-cultural adaptation to the Spanish population.
Background.
Back problems limit the quality of life of
those people who suffer them. This limitation must be measured,
objectively and reliably, in order to evaluate the effectiveness
of pain treatments. Furthermore, it can contribute to decision-making
about the aggressivity and kind of the treatments which should
be applied in a given case.
The Roland-Morris Scale is a reliable mechanism for evaluating
the disability that non-specific low back pain (or mechanical
pathology of the spine affecting the lower back) entails.
It consists of a questionnaire that was designed for use in
primary care. It is simple, quick and can be filled out directly
by the patient. Its scoring is quick and simple, providing
a value between 0 (=no disability) and 24 (=maximum disability).
A patient's scores on this scale have been shown to be better
related to his or her disability than other diagnostic tests
(such as radiographs, magnetic resonances, scanners, or scales
measuring pain intensity). The scale is in English and there
is no version in Spanish whose validity and reliability have
been evaluated.
A Spanish version allows a reliable evaluation of the efficacy
or efficiency of treatments for low back pain in the Spanish
population. Additionally, it provides useful information when
choosing among treatment options with varying degrees of aggressiveness.
Objectives.
- To adapt the Roland-Morris scale
to the Spanish population.
- To determine the metric characteristics
of the Spanish version.
- To evaluate the relation between
the degree of disability evaluated by the Roland Morris
scale and that evaluated by a specific, more complex and
already validated measure in Spanish--the Oswestry Questionnaire--,
as well as that of the two together with pain intensity
and quality of life measured by the corresponding scales,
visual analog scale for pain and EuroQol for quality of
life.
Methodology.
Established in four phases:
-
Translation into Spanish and re-translation back into
English of the questionnaire.
The original questionnaire was translated into Spanish,
and this version was then translated back into English.
The new English version was compared with the original
to discover errors of interpretation and nuance. Thus,
a definitive version of the questionnaire was put together
whose use was validated.
-
Pilot study: analysis of the comprehensibility of the
Spanish version.
The pilot study was made with 55 subjects. They were
people who went to the INSALUD Primary Care centers
in Mallorca and were literate but of a low socio-educational
level. They were given the questionnaire and were then
asked how they understood each one of the questions.
The questionnaire was repeated three times:
- Twice on the day the subjects
were included in the study, with the questions in
a different order each time, in order to appraise
the repeatability of the result.
- Some 15 days later, to assess
the questionnaire's sensitivity to the changes in
the patient's situation.
- Validation study: measurement
of the metric characteristics.
- Correlation study: determination
of the correlation among the results of the Roland-Morris
scale, disability by another scale (Oswestry) and pain
(measured by the visual analog scale), and limitation
in the quality of life measured by a general scale (EuroQol).
The validation and correlation study was
made with 195 patients, selected with the same criteria as
those participants in the pre-pilot, except that a low socio-educational
level was no longer required. They were given the questionnaire
under the same conditions as in the pre-pilot study, except
that the first day they were given it only once.
On each occasion in which the Roland-Morris scale was given,
a visual analog scale, an Oswestry and a EuroQol questionnaire
were also given
Participants, along with the Foundation's
Science Department.
Research Units of: INSALUD Primary Care of
Baleares and the Ramon y Cajal Hospital, Research Unit in
Health Services of the Carlos III Institute, and the Inca,
Coll d'en Rebassa, Santa Catalina, Arquitecto Bennassar, Valldargent,
Son Serra/La Vileta and S' Excorxador Health Centers.
Funded in its entirety by the Kovacs Foundation.
Status.
The study has finished and been published
by the journal Spine (Kovacs FM, Abraira V, Zamora J et al.
Spine 2002; 27:538-542.). In short, its results show that
the Spanish version of the Roland-Morris Scale is understandable,
valid and reliable in determining the degree of disability
due to back pain.
At the same time, it casts doubts on the applicability of
the Spanish version of the Oswestry Scale in setting this
parameter since, unlike the Roland-Morris Scale, its results
do not correlate with the patients' pain or quality of life.
In fact, the results of the Oswestry Scale do not even correlate
with those of the Roland-Morris Scale, despite the fact that
it presumably evaluates the same aspect. Additionally, probably
because of its greater complexity, of all the questionnaires
used in the study, the Oswestry Scale was that which the greatest
number of patients left unanswered, which limits its applicability
even more.
After having completed this study, the Foundation decided
to promote the transfer of its results to clinical practice.
With this aim:
- It has opted not to receive copyright
payment for its use.
- It has included the reference
to the validation study in the scale and a review explaining
that its clinical use is free of charge, though when the
scale is used for teaching or research, reference to its
validation study must be made and it should be indicated
that the copyright belongs to the Kovacs Foundation.
- In order to facilitate its use
in the health care setting, the scale has been sent-along
with a copy of the article published in Spine and a sheet
describing briefly how it should be used and what its
function is in daily clinical practice-to all of the Primary
Care Centers of the National Health System, by means of
the corresponding Primary Care managers.
|
Home
