Original articleCross-cultural adaptation, reliability, and validity of the German version of the Pain Catastrophizing Scale
Introduction
Chronic nonspecific musculoskeletal pain is a burden for patients and is associated with high socioeconomic costs [1], [2], [3]. The underlying construct of chronic pain is complex, and biopsychosocial factors influence both its development and its maintenance: psychological components, such as unhelpful pain cognitions [4], depression, and fearful or catastrophizing thoughts, can influence perceived pain, quality of life [5], physical performance [4], [6], and subjective disability [6]. Catastrophizing is defined as a maladaptive response to pain and is characterized by an experience of heightened pain intensity and difficulty in disengaging from pain [6]; it is an important predictor of pain severity, and of how people cope with pain [7], [8], [9], and appears to predict future disability better than do other variables [6]. Some studies have indicated that pain catastrophizing predicts depression or even mediates the reduction in depression, the perception of pain and the behavior in response to cognitive-behavioral or graded-exercise therapy [10], [11], [12]. Diminishing catastrophizing thoughts can positively influence coping with pain, and behavioral and cognitive traits [13], [14], [15]. In psychological research, it has been shown that pain catastrophizing behavior can influence those involved with the catastrophizer, leading to overcautious treatment decisions [16], [17].
For all these reasons, diminishing catastrophizing thoughts should constitute an important ingredient of therapy for chronic low back pain (LBP) [11]. The Pain Catastrophizing Scale (PCS) was developed in the English language by Sullivan et al. [18] to screen patients with catastrophizing thoughts and to improve treatment planning, implementation, and outcome assessment. The English version of the PCS has been well investigated and its psychometric properties are good [18], [19], [20], [21]. A systematic search of the literature revealed that, to date, no validated German version exists.
The aim of this study was to cross-culturally adapt the English version of the PCS into German and to evaluate its psychometric properties (internal consistency, construct validity, factor structure, reproducibility) in a large group of patients with LBP.
Section snippets
The Pain Catastrophizing Scale (PCS)
The PCS is a self-administered questionnaire that consists of 13 items to assess the extent of the patient's catastrophizing thoughts and behaviors. It comprises three subscales: helplessness, magnification, and rumination. The questionnaire is completed in relation to the patient's thoughts and feelings when they are in pain. It contains questions concerning, for example, the degree to which the person worries all the time about whether the pain will end, thinks how awful and overwhelming it
Cross-cultural adaptation of the PCS
The final version of the German PCS is shown in Appendix A. A few noteworthy difficulties arose during the development of the German version of the PCS, as follows:
Translation and cross-cultural adaptation of the PCS
The aim of the present study was to cross-culturally adapt the PCS, for use with German-speaking patients, and to examine the psychometric properties of the German version produced. Overall, the German version of the PCS showed good psychometric properties. In the following, the translation process and the results concerning validity and reliability will be discussed.
Adaptation of a German version of the PCS
The process of translating and back-translating the English PCS was carried out strictly in accordance with established
Concerns about floor effects
Using the traditional approach, we detected a floor effect of 12% and no ceiling effect for the PCS total score. However, with the more sensible scale width approach, using the minimal detectable change at the two ends of the scale, we detected a noticeable floor effect of 33.7% for the total scale and even greater floor effects for the subscales. This may indicate a scaling problem of the PCS, and it suggests that the PCS would not be able to identify/detect changes in catastrophizing thoughts
Conclusion
The psychometric properties of our German version of the PCS were comparable to those reported by Osman et al. and Van Damme et al. [19], [20], [21] and exceeded those of the original English version [18]. The PCS showed good internal consistency, and the three-factor structure, reported in previous studies, could be replicated. It also showed acceptable to good reproducibility, with a minimal detectable change score of approximately 13 points. Tests of concurrent validity showed that it
Acknowledgments
This project was funded by the National Research Programme NRP53 “Musculoskeletal Health—Chronic Pain” of the Swiss National Science Foundation (Project 405340-104787/2). We thank Gabi Umbricht, Astrid Junge, Marco Saltzmann, Sue Huber, and Vivien Robinson for their exact and unremitting work in performing the forward- and back-translations and Daniel Uebelhart for providing the infrastructure within our Research Unit to carry out this study. Further thanks go to Sven Hoffman and Alex Tschopp
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