Reliability and construct validity of the modified Finnish version of the 9-item patient health questionnaire and its associations within the biopsychosocial framework among female health-care workers with sub-acute or recurrent low back pain

J. H. Suni; T. Virkkunen; P. Husu; K. Tokola; J. Parkkari; M. Kankaanpää

doi:10.1186/s12891-020-03832-y

Reliability and construct validity of the modified Finnish version of the 9-item patient health questionnaire and its associations within the biopsychosocial framework among female health-care workers with sub-acute or recurrent low back pain

J. H. Suni
, T. Virkkunen
, P. Husu
, K. Tokola
, J. Parkkari
, M. Kankaanpää^*

^*Corresponding author for this work

Health Sciences

Research output: Contribution to journal › Article › Scientific › peer-review

10 Citations (Scopus)

32 Downloads (Pure)

Abstract

Background: Health-care workers have an increased risk for chronic low back pain (LBP) leading to reduced workability. Depression, a highly prevalent, costly and disabling condition, is commonly seen in patients with sub-acute LBP. This study investigated the psychometric properties and construct-validity of a modified 9-item Patient Health Questionnaire (PHQ-9-mFIN) in female health-care workers with sub-acute LBP. Methods: Reliability (internal consistency, test-retest repeatability) was assessed using standard methods. Construct validity of the PHQ-9-mFIN was assessed as level of depressive symptoms (PHQ-9-mFIN: 0–4 none, 5–9 mild, ≥10 at least moderate) against the RAND 36 Health Survey, a valid measure of health-related quality of life (HRQoL). Additionally, the strength of the association between the levels of PHQ-9-mFIN and selected biopsychosocial factors was determined. Results: The internal consistency of the PHQ-9-mFIN was high (Cronbach’s α = 0.82) and the test-retest repeatability scores (n = 64) were moderate: Pearson’s correlation was 0.73 and Intraclass Correlation Coefficient (ICC) 0.73 (95% CI: 0.58 to 0.82). Construct validity (Spearman correlation) against the Physical and Mental component items and their summary scales of the RAND 36 were much higher for the Mental (range, − 0.40 to − 0.67 and − 0.64) than for the Physical (range, − 0.08 to − 0.43 and − 0.22). There was a clear stepwise association (p < 0.001) between the levels of depressive symptoms and General health (physical component, range, 59.1 to 78.8). The associations with all items of the Mental components were strong and graded (p < 0.001). All participants had low scores for Bodily pain, regardless of the level of depressive symptoms. There was a strong association (p ≤ 0.003) between the levels of PHQ-9-mFIN and multisite pain, lumbar exertion and recovery after workdays, neuromuscular fitness in modified push-ups, workability, and fear of pain related to work. Conclusions: The PHQ-9-mFIN showed adequate reliability and excellent construct validity among female health-care workers with recurrent LBP and physically strenuous work. Trial registration: NCT01465698.

Original language	English
Article number	37
Journal	BMC Musculoskeletal Disorders
Volume	22
Issue number	1
DOIs	https://doi.org/10.1186/s12891-020-03832-y
Publication status	Published - 2021
Publication type	A1 Journal article-refereed

Funding

The authors wish to thank the female health-care workers who participated in the NURSE-RCT. We would also like to thank the Social Insurance Institution of Finland and the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital for their financial support. The authors wish to thank the female health-care workers who participated in the NURSE-RCT. We would also like to thank the Social Insurance Institution of Finland and the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital for their financial support. The NURSE RCT was funded by the Social Insurance Institution of Finland (37/26/2011 and 31/26/2015; for planning the study, data collection, and conducting the study interventions) and by the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital (9R015, 9S017, 9 T015, and 9 U017; for data analysis, interpretation, and reporting the results).

Publication forum classification

Publication forum level 1

ASJC Scopus subject areas

Rheumatology
Orthopedics and Sports Medicine

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10.1186/s12891-020-03832-y

reliability_and_construct_2021
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Suni, J. H., Virkkunen, T., Husu, P., Tokola, K., Parkkari, J., & Kankaanpää, M. (2021). Reliability and construct validity of the modified Finnish version of the 9-item patient health questionnaire and its associations within the biopsychosocial framework among female health-care workers with sub-acute or recurrent low back pain. BMC Musculoskeletal Disorders, 22(1), Article 37. https://doi.org/10.1186/s12891-020-03832-y

@article{4a0fba1f273949b0be8fddf4d4c9e9ea,

title = "Reliability and construct validity of the modified Finnish version of the 9-item patient health questionnaire and its associations within the biopsychosocial framework among female health-care workers with sub-acute or recurrent low back pain",

abstract = "Background: Health-care workers have an increased risk for chronic low back pain (LBP) leading to reduced workability. Depression, a highly prevalent, costly and disabling condition, is commonly seen in patients with sub-acute LBP. This study investigated the psychometric properties and construct-validity of a modified 9-item Patient Health Questionnaire (PHQ-9-mFIN) in female health-care workers with sub-acute LBP. Methods: Reliability (internal consistency, test-retest repeatability) was assessed using standard methods. Construct validity of the PHQ-9-mFIN was assessed as level of depressive symptoms (PHQ-9-mFIN: 0{\textendash}4 none, 5{\textendash}9 mild, ≥10 at least moderate) against the RAND 36 Health Survey, a valid measure of health-related quality of life (HRQoL). Additionally, the strength of the association between the levels of PHQ-9-mFIN and selected biopsychosocial factors was determined. Results: The internal consistency of the PHQ-9-mFIN was high (Cronbach{\textquoteright}s α = 0.82) and the test-retest repeatability scores (n = 64) were moderate: Pearson{\textquoteright}s correlation was 0.73 and Intraclass Correlation Coefficient (ICC) 0.73 (95\% CI: 0.58 to 0.82). Construct validity (Spearman correlation) against the Physical and Mental component items and their summary scales of the RAND 36 were much higher for the Mental (range, − 0.40 to − 0.67 and − 0.64) than for the Physical (range, − 0.08 to − 0.43 and − 0.22). There was a clear stepwise association (p < 0.001) between the levels of depressive symptoms and General health (physical component, range, 59.1 to 78.8). The associations with all items of the Mental components were strong and graded (p < 0.001). All participants had low scores for Bodily pain, regardless of the level of depressive symptoms. There was a strong association (p ≤ 0.003) between the levels of PHQ-9-mFIN and multisite pain, lumbar exertion and recovery after workdays, neuromuscular fitness in modified push-ups, workability, and fear of pain related to work. Conclusions: The PHQ-9-mFIN showed adequate reliability and excellent construct validity among female health-care workers with recurrent LBP and physically strenuous work. Trial registration: NCT01465698.",

author = "Suni, \{J. H.\} and T. Virkkunen and P. Husu and K. Tokola and J. Parkkari and M. Kankaanp{\"a}{\"a}",

note = "Funding Information: The authors wish to thank the female health-care workers who participated in the NURSE-RCT. We would also like to thank the Social Insurance Institution of Finland and the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital for their financial support. Funding Information: The authors wish to thank the female health-care workers who participated in the NURSE-RCT. We would also like to thank the Social Insurance Institution of Finland and the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital for their financial support. Funding Information: The NURSE RCT was funded by the Social Insurance Institution of Finland (37/26/2011 and 31/26/2015; for planning the study, data collection, and conducting the study interventions) and by the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital (9R015, 9S017, 9 T015, and 9 U017; for data analysis, interpretation, and reporting the results). Publisher Copyright: {\textcopyright} 2020, The Author(s).",

year = "2021",

doi = "10.1186/s12891-020-03832-y",

language = "English",

volume = "22",

journal = "BMC Musculoskeletal Disorders",

issn = "1471-2474",

publisher = "BioMed Central",

number = "1",

}

Suni, JH, Virkkunen, T, Husu, P, Tokola, K, Parkkari, J & Kankaanpää, M 2021, 'Reliability and construct validity of the modified Finnish version of the 9-item patient health questionnaire and its associations within the biopsychosocial framework among female health-care workers with sub-acute or recurrent low back pain', BMC Musculoskeletal Disorders, vol. 22, no. 1, 37. https://doi.org/10.1186/s12891-020-03832-y

Reliability and construct validity of the modified Finnish version of the 9-item patient health questionnaire and its associations within the biopsychosocial framework among female health-care workers with sub-acute or recurrent low back pain. / Suni, J. H.; Virkkunen, T.; Husu, P. et al.
In: BMC Musculoskeletal Disorders, Vol. 22, No. 1, 37, 2021.

Research output: Contribution to journal › Article › Scientific › peer-review

TY - JOUR

T1 - Reliability and construct validity of the modified Finnish version of the 9-item patient health questionnaire and its associations within the biopsychosocial framework among female health-care workers with sub-acute or recurrent low back pain

AU - Suni, J. H.

AU - Virkkunen, T.

AU - Husu, P.

AU - Tokola, K.

AU - Parkkari, J.

AU - Kankaanpää, M.

N1 - Funding Information: The authors wish to thank the female health-care workers who participated in the NURSE-RCT. We would also like to thank the Social Insurance Institution of Finland and the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital for their financial support. Funding Information: The authors wish to thank the female health-care workers who participated in the NURSE-RCT. We would also like to thank the Social Insurance Institution of Finland and the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital for their financial support. Funding Information: The NURSE RCT was funded by the Social Insurance Institution of Finland (37/26/2011 and 31/26/2015; for planning the study, data collection, and conducting the study interventions) and by the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital (9R015, 9S017, 9 T015, and 9 U017; for data analysis, interpretation, and reporting the results). Publisher Copyright: © 2020, The Author(s).

PY - 2021

Y1 - 2021

N2 - Background: Health-care workers have an increased risk for chronic low back pain (LBP) leading to reduced workability. Depression, a highly prevalent, costly and disabling condition, is commonly seen in patients with sub-acute LBP. This study investigated the psychometric properties and construct-validity of a modified 9-item Patient Health Questionnaire (PHQ-9-mFIN) in female health-care workers with sub-acute LBP. Methods: Reliability (internal consistency, test-retest repeatability) was assessed using standard methods. Construct validity of the PHQ-9-mFIN was assessed as level of depressive symptoms (PHQ-9-mFIN: 0–4 none, 5–9 mild, ≥10 at least moderate) against the RAND 36 Health Survey, a valid measure of health-related quality of life (HRQoL). Additionally, the strength of the association between the levels of PHQ-9-mFIN and selected biopsychosocial factors was determined. Results: The internal consistency of the PHQ-9-mFIN was high (Cronbach’s α = 0.82) and the test-retest repeatability scores (n = 64) were moderate: Pearson’s correlation was 0.73 and Intraclass Correlation Coefficient (ICC) 0.73 (95% CI: 0.58 to 0.82). Construct validity (Spearman correlation) against the Physical and Mental component items and their summary scales of the RAND 36 were much higher for the Mental (range, − 0.40 to − 0.67 and − 0.64) than for the Physical (range, − 0.08 to − 0.43 and − 0.22). There was a clear stepwise association (p < 0.001) between the levels of depressive symptoms and General health (physical component, range, 59.1 to 78.8). The associations with all items of the Mental components were strong and graded (p < 0.001). All participants had low scores for Bodily pain, regardless of the level of depressive symptoms. There was a strong association (p ≤ 0.003) between the levels of PHQ-9-mFIN and multisite pain, lumbar exertion and recovery after workdays, neuromuscular fitness in modified push-ups, workability, and fear of pain related to work. Conclusions: The PHQ-9-mFIN showed adequate reliability and excellent construct validity among female health-care workers with recurrent LBP and physically strenuous work. Trial registration: NCT01465698.

AB - Background: Health-care workers have an increased risk for chronic low back pain (LBP) leading to reduced workability. Depression, a highly prevalent, costly and disabling condition, is commonly seen in patients with sub-acute LBP. This study investigated the psychometric properties and construct-validity of a modified 9-item Patient Health Questionnaire (PHQ-9-mFIN) in female health-care workers with sub-acute LBP. Methods: Reliability (internal consistency, test-retest repeatability) was assessed using standard methods. Construct validity of the PHQ-9-mFIN was assessed as level of depressive symptoms (PHQ-9-mFIN: 0–4 none, 5–9 mild, ≥10 at least moderate) against the RAND 36 Health Survey, a valid measure of health-related quality of life (HRQoL). Additionally, the strength of the association between the levels of PHQ-9-mFIN and selected biopsychosocial factors was determined. Results: The internal consistency of the PHQ-9-mFIN was high (Cronbach’s α = 0.82) and the test-retest repeatability scores (n = 64) were moderate: Pearson’s correlation was 0.73 and Intraclass Correlation Coefficient (ICC) 0.73 (95% CI: 0.58 to 0.82). Construct validity (Spearman correlation) against the Physical and Mental component items and their summary scales of the RAND 36 were much higher for the Mental (range, − 0.40 to − 0.67 and − 0.64) than for the Physical (range, − 0.08 to − 0.43 and − 0.22). There was a clear stepwise association (p < 0.001) between the levels of depressive symptoms and General health (physical component, range, 59.1 to 78.8). The associations with all items of the Mental components were strong and graded (p < 0.001). All participants had low scores for Bodily pain, regardless of the level of depressive symptoms. There was a strong association (p ≤ 0.003) between the levels of PHQ-9-mFIN and multisite pain, lumbar exertion and recovery after workdays, neuromuscular fitness in modified push-ups, workability, and fear of pain related to work. Conclusions: The PHQ-9-mFIN showed adequate reliability and excellent construct validity among female health-care workers with recurrent LBP and physically strenuous work. Trial registration: NCT01465698.

U2 - 10.1186/s12891-020-03832-y

DO - 10.1186/s12891-020-03832-y

M3 - Article

C2 - 33413235

AN - SCOPUS:85098881318

SN - 1471-2474

VL - 22

JO - BMC Musculoskeletal Disorders

JF - BMC Musculoskeletal Disorders

IS - 1

M1 - 37

ER -

Suni JH, Virkkunen T, Husu P, Tokola K, Parkkari J, Kankaanpää M. Reliability and construct validity of the modified Finnish version of the 9-item patient health questionnaire and its associations within the biopsychosocial framework among female health-care workers with sub-acute or recurrent low back pain. BMC Musculoskeletal Disorders. 2021;22(1):37. doi: 10.1186/s12891-020-03832-y