ABSTRACT

Our study aimed to perform the face and content validity of Self-Estimated Functional Inability because of Pain (SEFIP) for workers, here called the SEFIP-work questionnaire. This is a questionnaire validity study. Our group previously translated and adapted the original version of the SEFIP, which was developed to investigate musculoskeletal pain and dysfunction to be applied to dancers (SEFIP-dance). However, due to the broad scope of the SEFIP-dance, we made changes and adaptations in the Brazilian Portuguese version of the SEFIP-dance to allow its use in workers. Therefore, face and content validity were performed for the development of the SEFIP-work based on opinions of committee of occupational disease and rehabilitation experts. After face and content validity, this SEFIP-work version was applied to 30 working individuals with musculoskeletal pain. The participants were native Brazilian Portuguese speakers aged 18 years and older. Thus, three changes were made to the questionnaire. All participants understood the SEFIP-work items and alternatives. The average total SEFIP-work score was 6.59 (SD=3.66), with the item “parte inferior das costas” (lower back) being the most marked (n=28; 93.33%), with an average score of 1.18 (SD=0.73). In conclusion, the Brazilian Portuguese version of SEFIP-work presents an acceptable level of understanding by workers in the investigation of musculoskeletal pain or discomfort.

Keywords:
Pain; Reproducibility of Results; Surveys and Questionnaires

RESUMO

Este estudo teve como objetivo verificar a validade de face e conteúdo do questionário Self-Estimated Functional Inability because of Pain (SEFIP) para trabalhadores, aqui chamado de questionário SEFIP-work. Este é um estudo de validade do questionário. Nosso grupo já traduziu e adaptou a versão original do SEFIP, que foi desenvolvido para investigar a dor musculoesquelética e disfunção a ser aplicada a dançarinos (SEFIP-dance). No entanto, devido ao amplo escopo da SEFIP-dance, fizemos mudanças e adaptações na versão traduzida e adaptada ao português brasileiro para permitir o seu uso com trabalhadores. Assim, a validade de face e conteúdo foram realizadas para o desenvolvimento do SEFIP-work baseadas em pareceres de especialistas em doenças ocupacionais e reabilitação. Após a validade de face e de conteúdo, esta versão da SEFIP-work foi aplicada a 30 indivíduos que trabalham com dor músculoesquelética. Os participantes eram falantes nativos de português brasileiro com idade igual ou superior a 18 anos. Assim, foram introduzidas três alterações no questionário. Todos os participantes entenderam os itens e alternativas da SEFIP-work. O escore total médio da SEFIP-work foi de 6,59 (DP=3,66), com o item “parte inferior das costas” sendo o mais marcado (n=28; 93,33%), pontuação média de 1,18 (SD=0,73). Em conclusão, a versão brasileira adaptada da SEFIP-work apresenta um nível aceitável de compreensão por parte dos trabalhadores na investigação da dor ou desconforto músculoesqueléticos.

Descritores:
Dor; Reprodutibilidade dos Testes; Inquéritos e Questionários

RESUMEN

Este estudio objetivó verificar la validez aparente y de contenido del cuestionario Self-Estimated Functional Inability because of Pain (SEFIP) destinado a trabajadores, aquí llamado cuestionario SEFIP-work. Este es un estudio sobre la validez del cuestionario. Nuestro grupo ya ha traducido y adaptado la versión original de SEFIP, que fue desarrollada para investigar el dolor musculoesquelético y su disfunción destinada a la aplicación a bailarines (SEFIP-dance). Debido al amplio alcance de SEFIP-dance, se realizó cambios y adaptaciones en la versión traducida y adaptada al portugués brasileño para permitir su aplicación a los trabajadores. Así se realizó la validez aparente y de contenido para desarrollar el SEFIP-work con base en dictámenes de expertos en enfermedades profesionales y en rehabilitación. Después de la validez aparente y de contenido, la versión de SEFIP-work se aplicó a 30 personas que trabajan con dolor musculoesquelético. Los participantes son hablantes nativos de portugués brasileño con edad igual o superior a 18 años. Se agregaron tres cambios al cuestionario. Todos los participantes entendieron los ítems y las alternativas de SEFIP-work. El promedio de la puntuación total de SEFIP-work fue de 6,59 (DE=3,66), con el ítem “parte inferior de la espalda” como el más marcado (n=28; 93,33%) y puntuación promedio de 1,18 (DE=0,73). Se concluye que la versión brasileña adaptada de SEFIP-work presenta un nivel aceptable de comprensión por parte de los trabajadores en la investigación del dolor o malestar musculoesquelético.

Palabras clave:
Dolor; Reproducibilidad de los Resultados; Encuestas y Cuestionarios

INTRODUCTION

Researchers and occupational health professionals have used different occupational health assessment instruments to implement preventive, ergonomic, and/or rehabilitation measures¹1. Valentim DP, Sato TO, Comper MLC, Silva AM, Boas CV, Padula RS. Reliability, Construct Validity and Interpretability of the Brazilian version of the Rapid Upper Limb Assessment (RULA) and Strain Index (SI). Braz J Phys Ther. 2018;22(3):198-204. doi:10.1016/j.bjpt.2017.08.003
https://doi.org/10.1016/j.bjpt.2017.08.0... ^{)- (4}4. Lamarão AM, Costa LCM, Comper MLC, Padula RS. Translation, cross-cultural adaptation to Brazilian-Portuguese and reliability analysis of the instrument Rapid Entire Body Assessment-REBA. Braz J Phys Ther. 2014;18(3):211-7. doi: 10.1590/bjpt-rbf.2014.0035
https://doi.org/10.1590/bjpt-rbf.2014.00... . Most of these instruments are questionnaires and, due to their basic characteristics, are based on the measurement of variables related to the worker’s own report, as in the case of pain investigation⁵5. Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Validity of four pain intensity rating scales. Pain. 2011;152(10):2399-404. doi: 10.1016/j.pain.2011.07.005
https://doi.org/10.1016/j.pain.2011.07.0... ^{), (6}6. Fagundes FRC, Costa LOP, Fuhro FF, Manzoni ACT, Oliveira NTB, Cabral CMN. Örebro Questionnaire: short and long forms of the Brazilian-Portuguese version. Qual Life Res. 2015;24(11):2777-88. doi: 10.1007/s11136-015-0998-3
https://doi.org/10.1007/s11136-015-0998-... .

In general, we can divide occupational health evaluation into ergonomic assessment and worker’s health assessment. Within the context of ergonomics and its relationship to biomechanical risks during the execution of work tasks, the instruments commonly used for this evaluation are: Rapid Upper Limb Assessment¹1. Valentim DP, Sato TO, Comper MLC, Silva AM, Boas CV, Padula RS. Reliability, Construct Validity and Interpretability of the Brazilian version of the Rapid Upper Limb Assessment (RULA) and Strain Index (SI). Braz J Phys Ther. 2018;22(3):198-204. doi:10.1016/j.bjpt.2017.08.003
https://doi.org/10.1016/j.bjpt.2017.08.0... , Rapid Entire Body Assessment⁴4. Lamarão AM, Costa LCM, Comper MLC, Padula RS. Translation, cross-cultural adaptation to Brazilian-Portuguese and reliability analysis of the instrument Rapid Entire Body Assessment-REBA. Braz J Phys Ther. 2014;18(3):211-7. doi: 10.1590/bjpt-rbf.2014.0035
https://doi.org/10.1590/bjpt-rbf.2014.00... , Quick Exposure Check³3. Comper MLC, Costa LOP, Padula RS. Quick Exposure Check (QEC): a cross-cultural adaptation into Brazilian-Portuguese. Work. 2012;41 Suppl 1:2056-9. doi: 10.3233/WOR-2012-0430-2056
https://doi.org/10.3233/WOR-2012-0430-20... , and Rapid Office Strain Assessment²2. Rodrigues MS, Sonne M, Andrews DM, Tomazini LF, Sato TO, Chaves TC. Rapid office strain assessment (ROSA): Cross cultural validity, reliability and structural validity of the Brazilian-Portuguese version. Appl Ergon. 2019;75:143-54. doi: 10.1016/J.APERGO.2018.09.009
https://doi.org/10.1016/J.APERGO.2018.09... .

Regarding occupational health, several variables can be measured by questionnaires. The Need for Recovery Scale is a questionnaire that measures worker’s fatigue⁷7. Moriguchi CS, Alem MER, van Veldhoven M, Coury HJCG. Cultural adaptation and psychometric properties of Brazilian Need for Recovery Scale. Rev Saude Publica. 2010;44(1):131-139. doi: 10.1590/S0034-89102010000100014
https://doi.org/10.1590/S0034-8910201000... ; the Strain Index measures risk of upper limb dysfunction¹1. Valentim DP, Sato TO, Comper MLC, Silva AM, Boas CV, Padula RS. Reliability, Construct Validity and Interpretability of the Brazilian version of the Rapid Upper Limb Assessment (RULA) and Strain Index (SI). Braz J Phys Ther. 2018;22(3):198-204. doi:10.1016/j.bjpt.2017.08.003
https://doi.org/10.1016/j.bjpt.2017.08.0... ; the Maastricht Upper Extremity Questionnaire investigates arm, cervical, and shoulder involvement^(8.) In addition to these specific instruments, there are questionnaires to measure various dimensions of pain, including the Numerical Rating Scale⁵5. Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Validity of four pain intensity rating scales. Pain. 2011;152(10):2399-404. doi: 10.1016/j.pain.2011.07.005
https://doi.org/10.1016/j.pain.2011.07.0... and Örebro Musculoskeletal Pain Questionnaire⁶6. Fagundes FRC, Costa LOP, Fuhro FF, Manzoni ACT, Oliveira NTB, Cabral CMN. Örebro Questionnaire: short and long forms of the Brazilian-Portuguese version. Qual Life Res. 2015;24(11):2777-88. doi: 10.1007/s11136-015-0998-3
https://doi.org/10.1007/s11136-015-0998-... .

Despite the wide variety of questionnaires for workers’ health, the Nordic Musculoskeletal Questionnaire (NMQ) is still the most used instrument. This instrument was developed approximately three decades ago and allows for regionalized measurement of musculoskeletal pain, i.e., considering separate body parts. Musculoskeletal pain in the NMQ is investigated at two different times: the previous 12 months and last 7 days⁹9. Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sørens F, Andersson G, Jørgensen K. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233-37. doi: 10.1016/0003-6870(87)90010-x
https://doi.org/10.1016/0003-6870(87)900... ^{), (10}10. Dickinson CE, Campion K, Foster AF, Newman SJ, O'Rourke AM, Thomas PG. Questionnaire development: an examination of the Nordic Musculoskeletal questionnaire. Appl Ergon. 1992;23(3):197-201. doi: 10.1016/0003-6870(92)90225-k
https://doi.org/10.1016/0003-6870(92)902... . However, the NMQ lacks a severity or disability score.

In addition to and based on the NMQ, researchers developed a questionnaire to assess musculoskeletal pain in dancers entitled the Self-Estimated Functional Inability because of Pain (SEFIP-dance). The SEFIP-dance also contains a disability score that ranges from 0 to 4 points, a feature that allows for a total score¹¹11. Ramel E, Moritz U, Jarnlo G. Validation of a pain questionnaire (SEFIP) for dancers with a specially created test battery. Med Probl Perform Art. 1999;14(4):196-203.. Given this context and considering the broad and generic construction of this questionnaire, our study aimed to perform the face and content validity of SEFIP for workers, here called the SEFIP-work questionnaire. Our hypothesis is that the adapted SEFIP-work questionnaire is adequately understood by the target population of our study.

METHODOLOGY

Study design

This questionnaire validity study was conducted based on the Guidelines for the Process of Cross-cultural Adaptation of Self-Report Measures¹²12. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. Spine. 2000;25(24):3186-91. doi: 10.1097/00007632-200012150-00014
https://doi.org/10.1097/00007632-2000121... and Consensus-based Standards for the Selection of Health Measurement Instruments¹³13. Prinsen CAC, Mokkink LB, Bouter LM, Alonso J, Patrick DL, de Vet HCW, Terwee CB. COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res. 2018;27:1147-57. doi: 10.1007/s11136-018-1798-3
https://doi.org/10.1007/s11136-018-1798-... .

Our study was conducted at the Department of Physical Education of the Universidade Federal do Maranhão (São Luís, MA, Brazil). All participants included in the study signed an informed consent form. The study participants were recruited from communities around the university by verbal invitations, posters, and social media.

Adaptation of the SEFIP-work questionnaire

Our group previously translated and adapted the original version of the SEFIP, which was developed to investigate musculoskeletal pain and dysfunction in dancers (SEFIP-dance) ⁽¹⁴14. Reis-Júnior JR, Protázio JB, Muribeca-de-Castro AM, Pinheiro JS, Takahasi HY, Pires FO. Brazilian version of the Self-Estimated Functional Inability because of Pain questionnaire for musculoskeletal injuries relating to dance and sport: translation and cross-cultural adaptation. Sao Paulo Med J. 2020;138(1):11-8. doi: 10.1590/1516-3180.2019.0375.r1.08102019
https://doi.org/10.1590/1516-3180.2019.0... . However, due to the SEFIP-dance broad scope, we made changes and adaptations in the Brazilian Portuguese version to allow its use in workers (SEFIP-work). Therefore, face and content were validated in two stages for the development of the SEFIP-work¹⁵15. De Groef A, Van Kampen M, Moortgat P, Anthonissen M, Van den Kerckhove, Christiaens M-R, et al. An evaluation tool for Myofascial Adhesions in Patients after Breast Cancer (MAP-BC evaluation tool): concurrent, face and content validity. PLoS One. 2018;13(3):e0193915. doi: 10.1371/journal.pone.0193915
https://doi.org/10.1371/journal.pone.019... . A committee of occupational disease and rehabilitation experts was consulted to adjust or change the SEFIP-dance. This consultation provided features for the SEFIP-work to enable its application to workers.

In the first stage, four physical therapists that work in occupational disease rehabilitation were instructed to perform technical judgment, alterations, inclusion, or exclusion of items. Moreover, these four physical therapists were asked to give their opinion on the ability of the SEFIP-work to measure musculoskeletal-pain-related disability.

In the second stage, four healthcare professionals were consulted to verify possible difficulties in reading the questionnaire, clarity of response alternatives, presence of typographical errors, font size, level of understanding of items, length, application time, and overall evaluation.

We have adopted the following inclusion criteria for physical therapists: working with occupational health for at least 24 months; be native and fluent in Brazilian Portuguese; be available for meetings and consultations to clarify the opinion issued. For healthcare professionals (two physical therapists and two physical education professionals), we adopted the following inclusion criteria: prior experience using questionnaires in patient assessment; be Brazilian and speak Brazilian Portuguese as mother tongue; be available for meetings and consultations to clarify the opinion issued.

After face and content validation, with 100% of agreement of the experts, the pre-final SEFIP-work version was established and applied to 30 workers with musculoskeletal pain. The participants were aged 18 years and older with Brazilian Portuguese as their mother tongue. Participants answered the questionnaire and established their understanding of the pre-final version of the SEFIP-work by ticking “yes” or “no” for each item. An item understood by less than 20% of the participants would be changed and retested in a new sample of 30 participants until the achievement of the desired understanding level¹²12. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. Spine. 2000;25(24):3186-91. doi: 10.1097/00007632-200012150-00014
https://doi.org/10.1097/00007632-2000121... ^{), (13}13. Prinsen CAC, Mokkink LB, Bouter LM, Alonso J, Patrick DL, de Vet HCW, Terwee CB. COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res. 2018;27:1147-57. doi: 10.1007/s11136-018-1798-3
https://doi.org/10.1007/s11136-018-1798-... . This procedure established the final version of the SEFIP-work in the Brazilian Portuguese.

SEFIP-work score

The questionnaire consists of 14 items, each item related to a body part. There are five answers for each item, with scores that range from 0 to 4. Thus, the total score varies between 0 and 56 points; the higher the score, the higher disability¹¹11. Ramel E, Moritz U, Jarnlo G. Validation of a pain questionnaire (SEFIP) for dancers with a specially created test battery. Med Probl Perform Art. 1999;14(4):196-203.. In addition to this total score, we suggest estimating a separate score for each body region to produce a score from 0 (no disability) to 4 (maximum disability). This regionalized score avoids errors in interpreting the magnitude of disability that can be generated by pure analysis of the total score.

Statistical analysis

Descriptive analysis was performed; qualitative variables are presented as absolute numbers (percentage) and quantitative variables as means (standard deviation[SD]). Data processing was performed using SPSS software version 17.0 (Chicago, IL, USA).

RESULTS

After face and content validation, three changes were made to the questionnaire: the answer associated with score 4 was changed from “Não consigo dançar por causa da dor” (I cannot dance because of the pain) to “Não consigo trabalhar por causa da dor” (I cannot work because of the pain); item 13 was changed from “Tornozelos/pés” (ankles/feet) to “Tornozelos” (ankles), item 14 was changed from “Dedos dos pés” (toes) to “Pés” (feet).

Therefore, this version subjected to the face and content validity was considered the pre-final SEFIP-work version. Thirty workers that spoke Brazilian Portuguese as mother tongue answered the questionnaire. The average age of participants was 34.76 years (SD=6.84); 20 (66.66%) participants were men. Table 1 shows other personal and worker characteristics.

All participants understood the SEFIP-work items and alternatives, and thus no changes in the pre-final phase were necessary. The average total SEFIP-work score was 6.59 (SD=3.66), with the item “parte inferior das costas” (lower back) being the most marked (n=28; 93.33%), with an average score of 1.18 (SD=0.73). Table 2 shows further details on the results of functional disability and pain measured by SEFIP-work. Figures 1 and 2 show the final version of the SEFIP-work questionnaire in Brazilian Portuguese and English, respectively.

DISCUSSION

We performed the face and content validity of the SEFIP-work questionnaire for Brazilian workers. This process is the first step in the validation process of this questionnaire, and it will allow its future use to investigate musculoskeletal injuries in this population.

The process of initial validity is usually published as the basis for future studies that focus on the analysis of psychometric properties. In this sense, the methods and objectives of our study are similar to the investigations conducted by Kamonseki, Fonseca and Calixtre¹⁶16. Kamonseki DH, Fonseca CL, Calixtre LB. The Brazilian version of the Bournemouth questionnaire for low back pain: translation and cultural adaptation. Sao Paulo Med J. 2019;137(3):262-9. doi: 10.1590/1516-3180.2018.0482120419
https://doi.org/10.1590/1516-3180.2018.0... , Donat et al. ⁽¹⁷17. Donat JC, Lobo NS, Jacobsen GS, Guimarães ER, Kristensen CH, Mendlowicz MV, et al. Translation and cross-cultural adaptation of the International Trauma Questionnaire for use in Brazilian Portuguese. Sao Paulo Med J. 2019;137(3):270-7. doi: 10.1590/1516-3180.2019.0066070519
https://doi.org/10.1590/1516-3180.2019.0... , and De Bortoli et al. ⁽¹⁸18. De Bortoli PS, Jacob E, Castral TC, Santos CB, Fernandes AM, Nascimento LC. Cross-cultural adaptation of the adolescent pediatric pain tool for Brazilian children and adolescents with cancer. Texto Contexto Enferm. 2019;28:e20160108. doi: 10.1590/1980-265x-tce-2016-0108
https://doi.org/10.1590/1980-265x-tce-20... . Our study and these investigations¹⁶16. Kamonseki DH, Fonseca CL, Calixtre LB. The Brazilian version of the Bournemouth questionnaire for low back pain: translation and cultural adaptation. Sao Paulo Med J. 2019;137(3):262-9. doi: 10.1590/1516-3180.2018.0482120419
https://doi.org/10.1590/1516-3180.2018.0... ^{)- (18}18. De Bortoli PS, Jacob E, Castral TC, Santos CB, Fernandes AM, Nascimento LC. Cross-cultural adaptation of the adolescent pediatric pain tool for Brazilian children and adolescents with cancer. Texto Contexto Enferm. 2019;28:e20160108. doi: 10.1590/1980-265x-tce-2016-0108
https://doi.org/10.1590/1980-265x-tce-20... were mainly based on the classics publications of Beaton et al. ⁽¹²12. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. Spine. 2000;25(24):3186-91. doi: 10.1097/00007632-200012150-00014
https://doi.org/10.1097/00007632-2000121... and Prinsen et al. ⁽¹³13. Prinsen CAC, Mokkink LB, Bouter LM, Alonso J, Patrick DL, de Vet HCW, Terwee CB. COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res. 2018;27:1147-57. doi: 10.1007/s11136-018-1798-3
https://doi.org/10.1007/s11136-018-1798-... .

According to a previous study¹⁹19. da Silva Rodrigues EK, de Cássia Registro Fonseca M, MacDermid JC. Brazilian version of the Patient Rated Wrist Evaluation (PRWE-BR): cross-cultural adaptation, internal consistency, test-retest reliability and construct validity. J Hand Ther. 2015;28(1):69-76. doi: 10.1016/j.jht.2014.09.008
https://doi.org/10.1016/j.jht.2014.09.00... , the understanding of a questionnaire by 80% of the sample included in the pre-final testing phase is acceptable. In our study, 100% of the sample comprehended all SEFIP-work items, statements, and instructions. This result was expected for the questionnaire due to the simple presentation, straight forward structure, and absence of long and interpretive sentences.

“Lower back”, followed by “upper back”, were the regions with the highest prevalence of musculoskeletal pain. Our sample consisted of workers from various professional fields. Using NMQ, other studies also investigated pain distribution in workers and found similar results: Akodu and Ashalejo²⁰20. Akodu AK, Ashalejo ZO. Work-related musculoskeletal disorders and work ability among hospital nurses. J Taibah Univ Med Sci. 2019;14(3):252-61. doi: 10.1016/j.jtumed.2019.02.009
https://doi.org/10.1016/j.jtumed.2019.02... identified a greater presence of lower back pain in hospital nurses, López-González, González and González-Menéndez²¹21. López-González MJ, González S, González-Menéndez E. Prevalence of musculoskeletal problems in laboratory technicians. Int J Occup Saf Ergon. 2019;25:1-12. doi: 10.1080/10803548.2019.1646531
https://doi.org/10.1080/10803548.2019.16... found the highest presence of pain in the neck region of laboratory technicians, and Özdinç et al. ⁽²²22. Özdinç S, Kayabinar E, Özen T, Turan FN, Yilmaz S. Musculoskeletal problems in academicians and related factors in Turkey. J Back Musculoskelet Rehabil. 2019;32(6):1-7. doi: 10.3233/BMR-181171
https://doi.org/10.3233/BMR-181171... observed higher prevalence of pain in the neck and lumbar region of scholars.

Our study has some limitations. Although face and content validity is the first step in the validation process, it alone does not support research or occupational use. Thus, future studies should measure the psychometric properties of the SEFIP-work in Brazilian Portuguese. Moreover, we recommend the translation the SEFIP-work questionnaire and its adaptation to other languages. We present in our article an English version of the SEFIP-work (Figure 2); however, it has been freely translated. Thus, textual revisions and cross-cultural adaptations must be performed by researchers that speak English as mother tongue. Finally, we include workers from different professional categories, which makes the sample heterogeneous. This fact must be considered when interpreting the results presented here.

CONCLUSION

The Brazilian Portuguese version adapted of SEFIP-work presents an acceptable level of understanding by workers in the investigation of musculoskeletal pain or discomfort.

Publication Dates

History