Abstract

Background: Chronic musculoskeletal pain disorders (CMPDs) are a leading cause of global disability, imposing substantial functional, psychological, and socioeconomic burden. Validated and culturally adapted outcome measures are essential for the equitable and accurate assessment of pain-related disabilities across linguistically diverse populations. The Pain Disability Questionnaire (PDQ), a 15-item self-report instrument encompassing Functional and Psychosocial domains, has demonstrated strong psychometric properties across multiple languages; however, a validated Gujarati version is lacking. Objective: This study aimed to translate and culturally adapt the PDQ into Gujarati (PDQ-G) and evaluate its reliability and construct validity in individuals with CMPDs. Methods: This study was conducted in two sequential phases. Phase I involved cross-cultural adaptation following Beaton et al.’s internationally recognized guidelines, which comprise forward translation, back translation, expert committee review, and cognitive debriefing. Phase II involved the psychometric evaluation of 150 Gujarati-speaking adults (25-60 years) diagnosed with CMPDs and recruited from physiotherapy and orthopedic outpatient clinics in Surat, Gujarat, India. Internal consistency was assessed using Cronbach’s alpha, and testretest reliability was assessed using the intraclass correlation coefficient (ICC) in 30 participants. Construct validity was examined through convergent and divergent validity analyses using Pearson’s correlations with established measures, including the Numeric Pain Rating Scale (NPRS), Roland-Morris Disability Questionnaire-Gujarati (RMDQ-G), Fear- Avoidance Beliefs Questionnaire-Gujarati (FABQ-G), and Patient Health Questionnaire-9-Gujarati (PHQ-9-G). Exploratory factor analysis (EFA) was performed to investigate the underlying factor structures. Results: The PDQ-G demonstrated acceptable internal consistency (Cronbach’s α = 0.700) and excellent test-retest reliability (ICC = 0.999; 95% CI: 0.997–0.999), with a minimal Bland–Altman mean difference of 0.07 and narrow limits of agreement (−0.65 to 0.78). Construct validity was supported by strong convergent correlations with the NPRS (r = 0.691) and RMDQ (r = 0.574) scores. The PDQ-G total score showed a moderate correlation with the FABQ (r = 0.372) and PHQ (r = 0.491), indicating that fear-avoidance beliefs contribute meaningfully, albeit less dominantly, to overall pain-related disability than pain intensity or psychological distress. Exploratory factor analysis (EFA) revealed a five-factor solution Kaiser-Meyer-Olkin (KMO = 0.562; Bartlett’s p < 0.001) that collectively explained 66.154% of the total variance, with the first component accounting for 22.833% of the variance. Following varimax rotation, the variance was more evenly distributed across all five components (range: 10.393%–14.623%), and most items loaded strongly (≥0.50) on a single component, supporting the multidimensional construct of the PDQ-G. The mean total PDQ-G score was 64.27 ± 15.12, with 73.3% of participants classified as having a mild disability. Conclusion: The PDQ-G is a reliable, valid, and culturally appropriate instrument for assessing pain-related disability in Gujarati-speaking adults with CMPDs. It is suitable for use in both clinical and research settings.

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