With the increase in the number of international research projects, the need to adapt health status measures for use in other than the source language is of primary importance. The SBST questionnaire has been developed recently but is increasingly used in the country of origin [12, 13, 18–21]. A recent high profile article reported the relevance and benefits of a stratified care approach to low back pain management based on the SBST with matched pathways . The objective of this study was to translate this questionnaire from English into French by following the international guidelines recommendations [16, 17]. All items had a 100% response rate and no subjects experienced difficulty completing the questionnaire.
The strengths of this study include the use of three centres in various locations to recruit a broad spread of patients with LBP with a wide age distribution and good representation of both sexes. The main limitation of this study was that it was only performed in the French speaking part of Belgium. While we believe that this version of the questionnaire could be used without further adaptation in most of the French speaking countries in the world (e.g. Belgium, France, Switzerland, etc.) it remains possible that a cultural adaptation of the questionnaire could still be needed in other French speaking countries outside of Europe.
Translation difficulties encountered as part of this study included the fact that some English words and sentences from the original SBST were hard to translate into French (e.g. the sentence “worrying thoughts have been going through my mind a lot of the time”). However, a translation was identified that was considered to be equivalent. There was also considerable discussion regarding the translation of the word “leg”. The scientific translation is “membre inférieur” but current common parlance is to use the term “jambe” which refers, from a “scientific point of view” only to the lower part of the leg. It was decided to keep with the more scientific term “membre inférieur”, and interestingly, no patient expressed any difficulties with this choice of wording.
It should be acknowledged that while this formal translation process has provided useful insights into how a person interprets each questionnaire item, it did not address the construct validity, reliability, or item response patterns necessary for a successful cross-cultural adaptation [16, 17]. Consequently, additional testing of the psychometric properties of the French version of the SBST questionnaire is necessary and is currently being planned. There are many ways in which translated questionnaires could be tested for their psychometric comparability with the source version. The objective is to ensure that the new version has demonstrated the measurement properties needed for the intended application. For example, strong evidence of construct validity is needed (i.e. is it measuring what it is supposed to be measuring?). In addition to construct validity, test-retest reliability (do the scores stay the same when the patients have not changed?) and responsiveness (ability to detect a change when it has occurred) is also of primary importance when assessing change over time. Finally, a further important step in the validation of this French version of the SBST will be to confirm the efficiency of this questionnaire alongside a matched treatment approach to test the effectiveness of stratified LBP management within a French speaking patient population.