# Reliability and validity of the Turkish version of the pain attention and awareness questionnaire for nonspecific musculoskeletal pain

## TL;DR

This study evaluates the reliability and validity of a Turkish version of a questionnaire used to assess attention and awareness in people with musculoskeletal pain.

## Contribution

The study provides the first culturally adapted and validated Turkish version of the Pain Vigilance and Awareness Questionnaire.

## Key findings

- The Turkish version of the questionnaire showed good internal consistency and test-retest reliability.
- The two-factor structure was supported, but the confirmatory factor analysis showed only modest improvements after item removal.
- The questionnaire correlated strongly with other pain-related scales, supporting its validity.

## Abstract

Reliable and valid assessments of pain vigilance and awareness are crucial for understanding and treating pain within cognitive-behavioral frameworks, such as the fear-Avoidance Model. While the Pain Vigilance and Awareness Questionnaire (PVAQ) is a widely used tool for this purpose, no culturally adapted and validated version exists for the Turkish-speaking population, creating an instrumental and clinical gap.

This study aimed to translate, culturally adapt, and comprehensively evaluate the psychometric properties of the Turkish version of the PVAQ in a sample of patients with nonspecific musculoskeletal pain.

An instrumental, cross-sectional study was conducted. The PVAQ was translated and adapted into Turkish according to established guidelines. A sample of 131 patients with low back, neck, or shoulder pain completed the PVAQ-T, the Pain Catastrophizing Scale (PCS), the Tampa Scale for Kinesiophobia (TSK), the Hospital Anxiety and Depression Scale (HADS), and a visual analog scale (VAS) for pain intensity. Reliability was assessed via internal consistency (Cronbach’s alpha) and test-retest reliability (intraclass correlation coefficient - ICC). Construct validity was examined via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Criterion validity was evaluated through Pearson correlations with the PCS, TSK, and HADS.

The PVAQ-T demonstrated acceptable internal consistency (Cronbach’s α = 0.83) and good test-retest reliability (ICC = 0.918). EFA supported a two-factor structure (vigilance and awareness), explaining 62.3% of the variance. CFA indicated that the original 16-item model had a suboptimal fit (CFI = 0.807; GFI = 0.732; SRMR = 0.060; RMSEA = 0.138, and χ²/df = 3.46). Following the removal of items 4 and 12 based on exploratory and item-level findings, some fit indices showed modest improvement (CFI = 0.836; GFI = 0.768; SRMR = 0.006), whereas others remained unchanged or worsened (RMSEA = 0.144; χ²/df = 3.69). The PVAQ-T total score showed moderately to strongly, statistically significant (p < 0.001) correlations with the PCS (r = 0.681), TSK (r = 0.694), HADS-Anxiety (r = 0.491), and HADS-Depression (r = 0.416) scores, supporting its criterion validity.

Within a Turkish sample of individuals with nonspecific musculoskeletal pain, the 14-item Turkish version of the PVAQ demonstrates adequate reliability and validity for assessing pain-related attention and awareness. While the two-factor structure was supported at the exploratory level, confirmatory findings suggest that results should be interpreted with caution. The PVAQ-TR may be a useful instrument for research and clinical assessment of pain-related attentional processes, highlighting the importance of cultural adaptation and empirical evaluation of psychometric instruments.

The online version contains supplementary material available at 10.1186/s12891-026-09535-0.