Cross-cultural adaptation and validation of the Turkish version of the knowledge and attitudes of pain (KNAP) questionnaire in physiotherapists and physiotherapy students

BackgroundThe biopsychosocial approach has become increasingly central to modern physiotherapy, yet validated instruments for assessing this shift remain limited in Turkey.ObjectiveThis study aimed to translate and culturally adapt the Knowledge and Attitudes of Pain (KNAP) questionnaire into Turkish and to evaluate its psychometric properties among physiotherapists and physiotherapy students.MethodsFollowing established cross-cultural adaptation guidelines, the KNAP was administered to 405 participants, including physiotherapy students and practicing physiotherapists. Internal consistency was assessed using Cronbach's alpha, while test-retest reliability was evaluated with the intraclass correlation coefficient (ICC) in a randomly selected subsample of 120 participants over a 7-day interval. Construct validity was examined through exploratory factor analysis (EFA) and correlations with the PABS-PT-TR and HC-PAIRS-TR.ResultsKNAP-TR showed strong internal consistency (α = 0.84) and good test-retest stability (ICC = 0.88; 95% CI: 0.71-0.93; p < 0.001). Principal Axis Factoring with Promax rotation supported a two-factor structure accounting for 54.71% of the total variance, with factor loadings ranging from 0.41 to 0.78. Correlations with the HC-PAIRS-TR (r = -0.540, p < 0.001), the biopsychosocial subscale of the PABS-PT-TR (r = 0.510, p < 0.001), and its biomedical subscale (r = -0.440, p < 0.001) confirmed construct validity, with no floor or ceiling effects observed.ConclusionKNAP-TR demonstrates satisfactory preliminary psychometric properties and represents a suitable tool for assessing pain-related knowledge and attitudes among physiotherapists and physiotherapy students in Turkey. Confirmatory factor analysis is recommended in future work to further validate its factor structure.