Background & Aims

Improving pain education for undergraduate healthcare students across disciplines is one of the possible solutions to the global burden of pain. Consequently, there is a demand for rigorous and dependable assessment of pain education programs designed for future healthcare professionals. The Neurophysiology of Pain Questionnaire (NPQ) is frequently used to assess knowledge about pain neurophysiology in undergraduate healthcare students. However, it was originally developed to assess how an individual with pain conceptualizes the biological mechanisms behind, and its measurement properties have mainly been assessed in patient populations. This study aimed to 1) translate and cross-culturally adapt the NPQ for use in populations of Danish-speaking healthcare students and 2) evaluate the validity and reliability of the NPQ in Danish students of physiotherapy, medicine, and odontology.

Methods

The questionnaire was translated from English to Danish by a professional English language translator specializing in medical translation and by an experienced pain researcher from the project group. It was then back-translated from Danish to English by a professional native English-speaking translator without prior knowledge of the original version. The back-translation was compared to the original version by the translator and by two project group members. After cognitive debriefing interviews with a sample of students(n=7), all project group members reviewed and approved the translation report. Structural validity and internal consistency were evaluated by explorative factor analysis and calculation among 224 healthcare students (medicine n=129, odontology n=48, and physiotherapy n=47). Test-retest reliability and measurement error were evaluated in a sub-sample of the physiotherapy students (n = 29).

Results

A few minor disagreements arose during the translation process and were solved by consensus. Slight rephrasing of a few items and using synonyms for some technical terms were necessary for adaptation to the Danish language, based on the cognitive debriefing interviews. The exploratory factor analysis identified 11 factors (eigenvalue <1 for all factors), and Cronbach’s Alpha was 0.37 (95% CI: 0.27 to 0.47). The Interclass Correlation Coefficient for test-retest, determined through a mixed-effects model, was 0.39 (95% CI: 0.03 to 0.66). The systematic and random measurement error was estimated to be 1.9 points (95% CI: 1.5 to 2.6) and 5.4 points (95% CI: 4.3 to 7.3). Item-by-item agreement (Cohen’s Kappa) ranged from -0.13 to 0.76, while sum-score agreement was estimated to 0.23 [95% CI: -0.03 to 0.45]. No floor or ceiling effects were found.

Conclusions

The Danish version of the NPQ demonstrated poor measurement properties for assessing pain neurophysiology knowledge in undergraduate healthcare students. Therefore, using the questionnaire for testing this population cannot be recommended. The implications of this study raises concerns about the continued use of NPQ in Danish undergraduate students. The identified limitations underscore the need for caution, suggesting a reconsideration of alternative tools or potential adaptations. Given the observed deficiencies, a meticulous revision may be warranted to enhance its structural validity, internal consistency, and reliability, aligning it more closely with Danish healthcare students.

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Presenting Author

Nikolaj Agger

Poster Authors

Nikolaj Agger

MSc

Viborg Regional Hospital

Lead Author

Topics

  • Education