Translation, Cross-Cultural Adaptation and Validation of the Central Sensitization Inventory for Patients with Rheumatoid Arthritis

Abstract

Introduction. Pain syndrome is one of the leading disabilitating factors in patients with rheumatoid arthritis (RA). Recently the heterogeneity of pathogenetic mechanisms of pain formation in the patients with joints inflammatory diseases has been demonstrated. The phenomenon of central sensitization is among the leading mechanisms of pain perception. In 2012 T. G. Mayer et al. created the Central Sensitization Inventory (CSI), which makes it possible rapid identification of patients whose symptoms may be related to the phenomenon of central sensitization. Currently the Ukrainian version of this questionnaire is not available. The aim of the study. Our investigation was directed towards translation, cross-cultural adaptation, validation, and testing of Central Sensitization Inventory Ukrainian version in rheumatoid arthritis patients. Materials and methods. Translation and cross-cultural adaptation of CSI were carried out according to the standard Guidelines for the process of cross-cultural adaptation of self-report measures. 75 patients diagnosed with RA according to ACR/EULAR (2010) criteria and 15 control group patients were involved in the study. RA activity was determined due to Disease Activity Score – 28 (DAS-28), the Simplified Disease Activity Index (SDAI), the Clinical Disease Activity Index (CDAI), and the functional ability of patients – by Health Assessment Questionnaire – Disability Index (HAQ-DI). Visual analog scoring (VAS) from 0 to 10 points were used to evaluate the intensity of pain. Statistical analysis of the results was performed using the methods of variation statistics in the application package SPSS22 (© SPSS Inc.). The results are presented as the mean value with standard deviation (M ± SD). Results. According to DAS-28, patients had a predominance of moderate and high disease activity (4.99 ± 0.87). Also, high RA activity in most patients was confirmed by CDAI (32.96 ± 9.46) and SDAI (35.90 ± 9.56). Impairment of functional ability in the examined patients according to the HAQ-DI index was 1.36 ± 0.70 points. Severe functional impairment (HAQ-DI value more than 2 points) was observed in 19.0 % of patients. The intensity of pain assessed in patients was 6,92 ± 1,55 points. The reliability of the Ukrainian-language version of the CSI questionnaire was evaluated by a “test-retest” with an interval of 7 days in 65 patients with RA. The obtained data demonstrated the high reliability of the CSI questionnaire – intraclass correlation coefficient was 0.914, and the L. Cronbach’s alpha coefficient was 0.914. The CSI questionnaire in RA patients demonstrated the phenomenon of central sensitization in this category of patients. The CSI value in our patients was 36.32 ± 14.67 versus 15.60 ± 12.10 in controls. At the same time, an indicator of more than 40 (central sensitization present) was detected in 40.0 % of patients. Conclusions. Translation, cross-cultural adaptation and validation of the Central Sensitization Inventory questionnaire were accomplished. The Ukrainian version of the questionnaire showed sufficient reliability and internal consistency. This questionnaire can be useful in both – scientific purposes and clinical practice – regarding the Ukrainian-speaking population with rheumatoid arthritis.