# Cross-cultural adaptation and psychometric validation of the STarT back tool for Jordanian Arabic-speaking adults with low back pain

## TL;DR

This study adapts and validates a tool for assessing low back pain risk in Jordanian Arabic speakers, showing it is reliable and useful for targeted treatment.

## Contribution

The study provides the first cross-cultural adaptation and validation of the STarTBack tool for Jordanian Arabic-speaking adults with low back pain.

## Key findings

- The adapted STarTBack-AR showed good internal consistency (Cronbach’s α = 0.73).
- Moderate-to-high correlations supported its construct validity.
- Discriminative validity was acceptable-to-excellent for disability and related psychological factors.

## Abstract

The Keele STarT Back Tool (STarTBack) was developed to categorize people with low back pain based on disability risk. The tool was cross-culturally adapted and validated in different languages and countries, including Arabic in Saudi Arabia. However, the tool has not been cross-culturally adapted and validated among Arabic-Jordanian speakers.

To cross-culturally adapt and validate the Keele STarT Back Tool (STarTBack) for Arabic-speaking adults with low back pain (LBP) in Jordan.

This prospective cross-sectional study was conducted in hospitals and physical therapy departments. The STarTBack was translated following international guidelines. Cross-cultural adaptation was assessed through interviews with experts and individuals with LBP. Internal consistency, construct validity (via correlation with related measures), and discriminative validity (using Receiver Operating Characteristic curves) were examined.

Twenty participants participated in the content validity assessment (mean age: 41.3 years; 50% female), while 107 participants took part in the pre-final version testing (mean age: 39.2 years; 54.2% female). One item required minor modification for clarity. Our preliminary results showed that the adapted STarTBack-AR demonstrated good internal consistency (Cronbach’s α = 0.73). Moderate-to-high correlations supported construct validity. Discriminative validity was acceptable-to-excellent for disability, catastrophizing, anxiety and depression.

The culturally adapted STarTBack-AR is a reliable and valid tool for stratifying Arabic-speaking Jordanian patients with LBP according to their risk of disability. Its implementation has potential to improve care through targeted treatment approaches, thereby reducing the risk of disability.