Cross‐Cultural Adaptation and Psychometric Properties of Low Back Pain Core Outcome Measures: A Systematic Review

OBJECTIVE: The purpose of this systematic review was to identify and evaluate the quality of cross-cultural adaptations of the six core outcome measures (NRS, SF-12, PROMIS, ODI, RMDQ and VAS) for low back pain (LBP) and assess their psychometric properties. METHODS: Medline, EMBASE, Emcare and CINAHL databases were searched from inception to August 2024. Eligible studies included those assessing core LBP outcome measures in adults with LBP. The COSMIN checklist was used to assess the quality of cross-cultural adaptations and evaluate the psychometric properties. Additionally, the COSMIN risk of bias tool and GRADE approach were employed to assess study quality and provide levels of evidence. RESULTS: A total of 82 studies were included. Among them, 35 studies examined the cross-cultural adaptations of the ODI, 25 for the RMDQ, 4 for PROMIS, 1 for SF-12 and 2 for NRS/VAS. The quality of cross-cultural adaptations was generally poor or fair due to inadequate reporting of pre-testing processes and small sample sizes. Most psychometric properties were rated as having an inadequate risk of bias, with evidence quality ranging from very low to low. CONCLUSION: This review highlights that the cross-cultural adaptations of the five core LBP outcome measures have generally been conducted with low quality. To improve the adaptation process, studies should employ larger sample sizes and standardised pre-testing procedures. Additional research is needed to explore a broader range of psychometric properties of cross-cultural adaptations, ensuring better validity, reliability and comparability across adapted versions. SIGNIFICANCE STATEMENT: Improving the quality of cross-cultural adaptations of LBP outcome measures is crucial to ensuring that assessments are culturally relevant and accurate across diverse populations, leading to better-informed clinical decisions and equitable care for patients with LBP globally. TRIAL REGISTRATION: CRD42023413077.