# Cross-cultural adaptation, validity, and reliability of the Danish version of the neurophysiology of pain questionnaire

## TL;DR

This study evaluates the Danish version of a questionnaire for assessing healthcare students' knowledge of pain neurophysiology and finds it unreliable and poorly structured.

## Contribution

The study provides a critical evaluation of the Danish adaptation of the Neurophysiology of Pain Questionnaire's validity and reliability in healthcare students.

## Key findings

- The Danish NPQ showed poor structural validity with low factor loadings and eigenvalues.
- Internal consistency (Cronbach’s alpha = 0.37) and test-retest reliability (ICC = 0.39) were low.
- Measurement error was high with an SEM of 1.94 and MDC of 5.38.

## Abstract

Despite advances in medicine and technology, pain remains a significant global burden. Improving pain education for undergraduate healthcare students is considered an important step toward enhancing pain management. The Neurophysiology of Pain Questionnaire (NPQ) is commonly used to assess pain knowledge in healthcare students, but its validity and reliability in this population remain uncertain. This study aimed to translate and cross-culturally adapt the NPQ for Danish-speaking healthcare students and evaluate its measurement properties in Danish physiotherapy, medicine, and odontology students.

The study was conducted in two phases: (1) translation and cross-cultural adaptation of the NPQ following international guidelines, and (2) a cross-sectional study to evaluate its validity and reliability in a sample of 224 Danish undergraduate healthcare students. Structural validity was assessed using exploratory factor analysis. Internal consistency was evaluated using Cronbach’s alpha, while test-retest reliability was determined using the intraclass correlation coefficient (ICC). Measurement error was analyzed using the standard error of measurement (SEM) and minimal detectable change (MDC).

Factor analysis revealed 11 factors, each with eigenvalues below 1, suggesting poor structural validity. Factor loadings were below the recommended threshold of 0.50, indicating weak item clustering. Internal consistency was low (Cronbach’s alpha = 0.37, 95% CI: 0.27 to 0.47), and test-retest reliability was poor (ICC = 0.39, 95% CI: 0.03 to 0.66). Measurement error analysis showed an SEM of 1.94 (95% CI: 1.54 to 2.63) and an MDC of 5.38 (95% CI: 4.27 to 7.28). No floor or ceiling effects were observed.

The Danish version of the NPQ demonstrated poor structural validity, internal consistency, and reliability in undergraduate healthcare students. These findings raise concerns about its suitability for assessing pain neurophysiology knowledge in this population. Alternative tools or modifications to the NPQ may be necessary to improve its measurement properties.