Cross-Cultural Adaptation,Preliminary Validity And Reliability Of The Chinese Version Of The KING'S Parkinson's Disease Pain Scale

ObjectiveThe objective was to perform cross-cultural adaption of the KING'S Parkinson's Disease Pain Scale(KPPS)and to explore its reliability and validity in Chinese Parkinson's disease(PD)patients.Methods1.Identified KING'S PD PAIN SCALE through literature research.Cross-cultural adaptation was performed after obtaining authorization from the original author,according to published international guidelines.Two rounds of Delphi expert consultation were performed to evaluate content validity and form a preliminary Chinese version of KPPS.3.A total of 180 PD patients with pain were surveyed from the Second Affiliated Hospital of Soochow University through convenience sampling.All the patients completed a questionnaire booklet containing the Chinese version of the KPPS(KPPS-CV),the Hoehn and Yahr Stage(H&Y),the Numeric Rating Scale for pain(NRS).The following psychometric properties were evaluated:basic item analysis;floor and ceiling effects;construct validity(exploratory factor analysis,EFA);content validity(content validity index,CVI);criterion validity(Spearman's rho between the Chinese version of KPPS and Numeric Rating Scale;internal consistency reliability(Cronbach's alpha);test-retest reliability(Spearman rho).Results1.Translation and transcultural adaptation were conducted in accordance with the international recommendation.The Chinese version of KPPS included seven domains(musculoskeletal pain,chronic pain,fluctuation-related pain,nocturnal pain,oro-facial pain,swelling-related pain,radicular pain),and 14 items.A total of 34 experts,from Parkinson disease and dyskinesia group,neurological branch of Chinese Medical Association,were involved.Expert positive coefficient of two rounds were 100.00%and 82.35%,the authority coefficients(Cr)was 0.87.After two rounds of Delphi expert consultation,Kendall's coefficient of concordance(W)=0.405.The mean value of item importance assignment was 3.24(Item 10 Does patients experience pain due to grinding their teeth during the night)-4.91(Item 4 Does patients experience dyskinetic pain),and the coefficient of variation(CV)ranged from 0.06(Item 4)to 0.36(Item 10;Item 11 Does patients experience burning mouth syndrome).The translation was slightly changed according to the result of Delphi expert consultation,but the number of items was not increased or decreased.The translation was deemed understandable and appropriate as to the transcultural adaptation and all the items were retained.2.The CR value of item 4 was 0.53(P>0.05),and the CR value of item 10 was 0.91(P>0.05),while the CR value of other items ranged from 2.26(item 9 pain during chewing)to 8.79(item 5 "off' period dystonia in a specific region)(P<0.05).Item-total correlation coefficient r of Item 4 was 0.005(P>0.05).Item-total correlation coefficient r of Item 10 was 0.093(P>0.05),and item-total correlation coefficient r of other items ranged from 0.21(Item 13 Does the patients experience generalised lower abdominal pain)to 0.55(Item 5)(P<0.001).The average content validity s-CVI of the scale was 0.9,and the item content validity index i-CVI ranged from 0.7(item 10)to 1.0(item 4,5,7).Combining the results of item analysis and content validity,item 10 was deleted.The Chinese version of KPPS contained seven domains and 13 items.3.The 13 items retained after item 10 was deleted were analyzed by exploratory factor analysis(EFA).The KMO test statistic value was 0.616 and the spherical test statistic value was 338.221(P<0.001).Principal component analysis revealed five factors partly matching those in previous study.factor 1 "oro-facial pain"(item 9,10),factor 2"internal pain"(item 3,12,13,14),factor 3 "pain related to PD originally"(item 2,5),factor 4 " pain related to limbs"(item 1,7,8),factor 5 "pain related to fluctuation"(item 4,6).The cumulative variance contribution rate was 58.97%.The correlation coefficient between Chinese version KPPS scores and NRS scores ranged from 0.9 to 0.98.4.For the internal consistency test,the Cronbach'a coefficient of the KPPS-CV was 0.64,and the Cronbach'a coefficient after deleting each item ranged from 0.59 to 0.65.The retest reliability was 0.73-0.92.ConclusionThis research has been consulted by Delphi experts,and the process was scientific and reliable.The results suggest that the Chinese version of KPPS is an acceptable,valid measure to evaluate pain in PD patients and can be used to evaluate pain in Chinese patients with Parkinson's disease.Nevertheless,further validation is warranted accounting differences in culture and clinical practices.