Translation, cross-cultural adaptation, and preliminary psychometric evaluation of the Urdu BackPAQ, pain resilience scale, and medical imaging beliefs questionnaire in adults with low back pain.

OBJECTIVES: Low back pain (LBP) is the leading cause of disability worldwide. Unhelpful beliefs, low pain resilience, and overreliance on imaging contribute to chronicity and poor outcomes. Despite growing recognition of psychosocial influences, culturally adapted assessment tools for Urdu-speaking populations are lacking. This study aimed to translate and cross-culturally adapt Urdu versions of the back pain attitudes questionnaire (BackPAQ), pain resilience scale (PRS), and medical scans beliefs questionnaire (MSBQ), and to conduct an initial evaluation of their structural validity and internal consistency. METHODS: Following Beaton's six-step protocol and COSMIN guidelines, the BackPAQ, PRS, and MSBQ were translated and culturally adapted into Urdu. A cross-sectional sample of 461 adults with LBP (mean age=38.5 ± 12.3 years; 66.6 % female) completed the translated instruments. Item distributions, internal consistency, and exploratory factor analyses (EFA) were examined. Reliability was evaluated using Cronbach's α and standard error of measurement (SEM). Associations with established Urdu versions of the oswestry disability index and pain catastrophizing scale, were visually examined using scatter plots. RESULTS: EFA supported a four-factor structure for the Urdu BackPAQ (14 items, 46.0 % variance explained, α=0.69). The PRS retained its original two-factor structure (51.5 % variance explained, α=0.88), and the MSBQ demonstrated a unidimensional structure (46.2 % variance explained, α=0.71). Scatter plots indicated small, directionally consistent associations between the Urdu instruments with disability and catastrophizing. CONCLUSIONS: The Urdu versions of the BackPAQ, PRS, and MSBQ demonstrated acceptable structural validity and internal consistency, with the PRS showing excellent content validity. Test-retest reliability, responsiveness, and predictive validity should be evaluated in future clinical and longitudinal studies before broader clinical application.