Cross-cultural adaptation and validation of the STarT back screening tool in isiZulu.
Peta-Ann Schmidt, Vaneshveri Naidoo
PMID 32537525WHAT IT FOUND
IsiZulu-speaking patients found the translated STarT Back tool easy to understand and complete.
While patients accepted it, the scores were not consistent enough to reliably group patients into low, medium, or high risk, so it should not yet be used to direct treatment.
Key findings
01Patients reported the translated tool was easy to understand and complete, with 33% finding it very easy to understand and 40% finding it very easy to complete.
02The internal consistency of the tool was 0.68, which is below the acceptable threshold of 0.70, indicating the items do not consistently measure the same construct in this population.
03Test-retest reliability was acceptable with a correlation coefficient of 0.73, suggesting patients' scores remained stable over two weeks.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study included only 30 participants, which is a small sample size for validating a clinical tool. Internal consistency was poor (0.68), meaning the questions did not hang together well as a measure of the same concept. The tool was not tested against a gold standard reference measure (criterion validity) because no such isiZulu tool exists. Participants took longer to complete the tool than in other language versions, possibly due to lower education levels or unfamiliarity with health questionnaires. The study was conducted in only one province (Mpumalanga), so results may not apply to all isiZulu speakers in South Africa.
Declared interests
The first author reimbursed transport costs for participants. The original developers at Keele University approved the methodology and outcome.
The easy way to misread this
Do not assume that because patients found the tool easy to use, it is clinically accurate. The low internal consistency score (0.68) indicates that the tool's items do not reliably measure the same construct in this population, so using it to categorize patients into risk groups for targeted treatment could lead to incorrect clinical decisions.