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April 11, 2026Clinical Parkinsonism & Related Disorders0 citationsOpen Access

Cross-cultural adaptation, reliability, and preliminary construct validity of the Japanese version of the Parkinson’s disease pain classification system

SIShuhei IshidaPrefectural University of Hiroshima TNTomohiko NishigamiPrefectural University of Hiroshima AMAkira MibuKonan Women's University

Key Points

The aim was to develop and evaluate the reliability and preliminary construct validity of the Japanese version of the Parkinson’s Disease Pain Classification System (PD-PCS).
Developed using ISPOR-based cross-cultural adaptation process.
Cognitive debriefing finalized the culturally appropriate version.
Assessments conducted for intra- and inter-rater reliability.
Reliability evaluated using intraclass correlation coefficients and kappa statistics.
Construct validity examined through correlation with the Brief Pain Inventory.
Good intra-rater reliability (ICC = 0.768) and excellent inter-rater reliability (ICC = 0.917).
Scores correlated significantly with Brief Pain Inventory averages (ρ = 0.744) and interference (ρ = 0.747).
Cognitive debriefing resolved wording issues, contributing to the version's clarity.
Substantial to perfect agreement between pain mechanisms and pain classification (κ = 0.755–1.000).

Abstract

• Japanese PD-PCS developed using ISPOR-based cross-cultural adaptation. • Cognitive debriefing finalized a clear and culturally appropriate version. • Pain score showed good intra- and excellent inter-rater reliability. • Scores correlated with pain burden and health-related quality of life. • Measurement error suggests caution for individual longitudinal changes. Pain is a burdensome non-motor symptom of Parkinson’s disease (PD). However, its mechanisms are complex, complicating pain phenotyping. The PD Pain Classification System (PD-PCS) classifies pain mechanisms and their relationship with PD pathology. We developed a Japanese PD-PCS and evaluated its reliability and preliminary construct validity. The PD-PCS was translated and adapted under developer supervision using an ISPOR-guided process. People with PD and chronic pain were recruited from two hospitals (n = 31). Intra- and inter-rater reliability were assessed with intraclass correlation coefficients (ICCs) for the PD-PCS pain score and κ for categorical classifications (95% CIs). The standard error of measurement (SEM) and the smallest detectable change (SDC) were calculated. Construct validity was examined using Spearman’s correlations between the PD-PCS pain score and the Brief Pain Inventory (BPI; average pain, interference). Cognitive debriefing identified wording issues that were resolved through revisions, resulting in the final Japanese version. Participants (n = 31) had a mean age of 70. 5 ± 8. 3 years, and 16 (51. 6%) were men. The intra-rater reliability was good (ICC3, 1 = 0. 768, 95% CI, 0. 575–0. 880; SEM 10. 4; SDCᵢndividual 29. 0), and the inter-rater reliability was excellent (ICC2, 1 = 0. 917, 95% CI, 0. 836–0. 959; SEM 5. 8; SDCᵢndividual 16. 0). The agreement between pain mechanisms and PD-related pain classification was substantial to perfect (κ = 0. 755–1. 000). The PD-PCS pain score correlated with BPI average pain (ρ = 0. 744) and interference (ρ = 0. 747). The Japanese PD-PCS demonstrated good to excellent reliability and preliminary construct validity, supporting its use in mechanism-informed pain classification in Japanese people with PD.

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