Translation and Cross-Cultural Adaptation of the Delphi Definitions of Low Back Pain Prevalence into Swedish (Swedish DOLBaPP)

Abstract

Background: Previous studies on the prevalence of low back pain have found large variations between different population-based studies. The use of different definitions could partly explain these differences. In a Delphi study 28 experts in back pain research agreed on standardized items: the "Delphi Definitions of Low Back Pain Prevalence” (DOLBaPP). The Delphi DOLBaPP needs to be adapted to different languages and cultures. The aim was to translate and cross-culturally adapt the English definitions and corresponding Delphi Definitions of Low Back Pain Prevalence (DOLBaPP) questionnaire forms into Swedish.
Methods: Translation and cross-cultural adaptation of the Delphi DOLBaPP into Swedish was conducted following recommended guidelines. After the translation process, an expert committee including medical and language experts independently provided comments on the questionnaire. The pre-final online optimal questionnaire was pretested in 181 employees from the home care, education, and food and retail sectors.
Results: The DOLBaPP questionnaire forms were translated successfully into Swedish and cross-culturally adapted with few linguistic changes. Face validity of the translated version of the questionnaire was considered good by the expert committee. In question 2 about low back pain, the expression "was this pain bad enough" was re-worded into "was the pain so strong". In the pre-test 92% of the participants found the questions in the questionnaire clear, 86% that the questionnaire covered the subject adequately, and 88% needed less than five minutes to complete the questionnaire. Fifteen percent had comments including linguistic issues and issues of expanding the content. The comments were not interpreted by the review committee as improving the language nor targeting the aim. After the pre-test, consensus was reached in the review committee on the final DOLBaPP-S.
Conclusions: The translation and cross-cultural adaptation of the Delphi Definitions of Low Back Pain Prevalence into Swedish was successful, and the DOLBaPP-S can be used in epidemiological studies on the prevalence of LBP in Swedish speaking populations.

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Translation and Cross-Cultural Adaptation of the
Delphi Denitions of Low Back Pain Prevalence into
Swedish (Swedish DOLBaPP)
Paul Enthoven (  paul.enthoven@liu.se )
Linköping University
Yvonne Lindbäck
Linköping University
Allan Abbott
Linköping University
Emma Gustafsson
Linköping University
Elias Lindholm
Linköping University
Clermont E Dionne
Centre hospitalier de l'Université Laval
Birgitta Öberg
Linköping University
Research Article
Keywords: Translation, Cross-cultural adaptation, Low back pain, Prevalence, Denition
Posted Date: November 18th, 2021
DOI: https://doi.org/10.21203/rs.3.rs-1063420/v1
License:   This work is licensed under a Creative Commons Attribution 4.0 International License. 
Read Full License

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Abstract
Background: Previous studies on the prevalence of low back pain have found large variations between
different population-based studies. The use of different denitions could partly explain these differences.
In a Delphi study 28 experts in back pain research agreed on standardized items: the "Delphi Denitions
of Low Back Pain Prevalence” (DOLBaPP). The Delphi DOLBaPP needs to be adapted to different
languages and cultures. The aim was to translate and cross-culturally adapt the English denitions and
corresponding Delphi Denitions of Low Back Pain Prevalence (DOLBaPP) questionnaire forms into
Swedish.
Methods: Translation and cross-cultural adaptation of the Delphi DOLBaPP into Swedish was conducted
following recommended guidelines. After the translation process, an expert committee including medical
and language experts independently provided comments on the questionnaire. The pre-nal online
optimal questionnaire was pretested in 181 employees from the home care, education, and food and
retail sectors.
Results: The DOLBaPP questionnaire forms were translated successfully into Swedish and cross-
culturally adapted with few linguistic changes. Face validity of the translated version of the questionnaire
was considered good by the expert committee. In question 2 about low back pain, the expression "was
this pain bad enough" was re-worded into "was the pain so strong". In the pre-test 92% of the participants
found the questions in the questionnaire clear, 86% that the questionnaire covered the subject adequately,
and 88% needed less than ve minutes to complete the questionnaire. Fifteen percent had comments
including linguistic issues and issues of expanding the content. The comments were not interpreted by
the review committee as improving the language nor targeting the aim. After the pre-test, consensus was
reached in the review committee on the nal DOLBaPP-S.
Conclusions: The translation and cross-cultural adaptation of the Delphi Denitions of Low Back Pain
Prevalence into Swedish was successful, and the DOLBaPP-S can be used in epidemiological studies on
the prevalence of LBP in Swedish speaking populations.
Background
Low back pain (LBP) is the leading worldwide cause of years lived with disability [1]. LBP is a complex
condition that may affect different aspects of a person’s life, which is important to recognize to be able to
provide optimal treatment [2]. Previous studies on the prevalence of LBP have found large variations
between different population-based studies [3–6], and the use of different denitions is suggested to be
one of the reasons that could explain the differences. To provide more standardized denitions, 28
experts in back pain research from 12 countries agreed in a Delphi study on standardized items – the
“Delphi Denitions of Low Back Pain Prevalence” (DOLBaPP) [7]. The standardized denitions
correspond to questionnaires that can be used in prevalence studies to provide comparable data [7]. Both
a minimal and an optimal denition were developed. The minimal denition consists of one question on

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pain characteristics (symptoms, site, and time frame), and a second question on functional limitation due
to LBP and is proposed for use in studies with time or space constraints. The optimal denition contains
ve more questions covering sciatica, frequency and duration of symptoms, and pain intensity, and is
more appropriate for studies specically focusing on LBP [8]. Both denitions in English can be openly
accessed [9].
The Delphi DOLBaPP must be adapted to different languages and cultures and has so far been
successfully translated and cross-culturally adapted for German [10], Spanish [11], and French [12]
speaking populations. However, equivalent denitions for Swedish speaking populations are missing.
Therefore, this study’s aim was to translate and perform a cross-cultural adaptation of the denitions and
the related Delphi DOLBaPP questionnaires into Swedish for the adult population.
Methods
The cross-cultural adaptation procedure followed recommended methodology [8, 13, 14] and applied a
mixed-method design in six steps (see Figure 1).
Step 1. Forward translation
The English DOLBaPP Denitions and questionnaires were translated into Swedish simultaneously and
independently by translator 1 (Tr1) and 2 (Tr2). Tr1 was a native Swedish speaking professional
translator English/Swedish without clinical background. Tr2 (author PE) was knowledgeable in English
and Swedish, and had knowledge of the research area.
Step 2. Synthesis
The translations by Tr1 and Tr2 were reconciled by an independent native reconciler (Rec1, author BÖ)
with knowledge of the research area. Then the translations by Tr1, Tr2 and Rec1 were discussed by the
four-member review committee containing authors PE, YL, AA, and BÖ, all knowledgeable in the research
area and physiotherapists, with YL and AA also working clinically. The review committee reached
agreement on the forward translation.
Step 3. Expert committee review
An expert committee containing experts from different parts of Sweden and interdisciplinary
multiprofessional elds within health care were asked to comment on the translation, wording, phrasing,
and understandability of the Delphi DOLBaPP optimal questionnaire (face validity [15, 16]). Furthermore,
information was gathered about their expertise, age, and gender.
Step 4. Consensus
All independent reports from the expert committee were examined by the review committee, who reached
consensus on a pre-nal version of the instrument.
Step 5. Pre-testing

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The pre-nal version of the instrument was pre-tested in employees from different economic sectors. The
inclusion criteria were being employed, age 18–65 years, and uency in Swedish. Information about the
study was sent to employers. In companies willing to participate, the employees received an electronic
mail with information about the study. Acceptance to participate was requested in the rst question of the
online questionnaire that was reached via a link or QR code. The participants were asked to complete the
questionnaire within four weeks, with a reminder after two weeks. Questionnaire data was collected
between January 14 and February 16, 2021. Two physiotherapy graduate students (authors EG and EL)
from Linköping University managed all contacts with the employers and collected the data from the
employees.
The online questionnaire contained background questions, the pre-nal DOLBaPP optimal questionnaire,
and evaluation questions about how the participants perceived the DOLBaPP. Background questions
concerned participants gender, age group, and usual physical strenuousness of their work (see Table 2 for
details). Inspired by the German DOLBaPP study [10] the evaluation questions were about how long time
it took to ll in the questionnaire, what participants thought about the diagram accompanying question 1,
if they thought one or some of the questions were unclear, and if so, could they describe the problem(s),
and if possible, suggest a solution. Furthermore, they were asked if they missed any question, and invited
to provide any other comments they had on the questionnaire (see Table 4 for details). The open
questions in the evaluation questionnaire were about the wording, phrasing, or content of the
questionnaire.
The pre-test was planned and conducted in accordance with the Helsinki Declaration of 1996, and the
European General Data Protection Act [17]. According to Swedish law (2003: 460) on the ethics of human
research, it is described that all research performed and dealing with sensitive personal data should be
ethically tested. Section 2 of this law states that regional ethical committee assessment is required for
"Scientic experimental or theoretical work to acquire new knowledge or scientic quality improvement
work, but no such work done in the framework of rst or second cycle education [18]. Therefore, because
this study was conducted as a part of a bachelor's thesis and did not include sensitive personal data,
ethical approval was provided after assessment performed according to the Helsinki declaration by the
ethics board of second cycle education at Linkoping University. All participants gave written consent after
receiving online written information. To further guarantee anonymity it was not recorded at which
company participants that lled in the online questionnaire were employed (no patients were involved).
Quantitative data were analysed with the Statistical Package for the Social Sciences (SPSS) version 27.
Comparisons between groups were done with the Mann-Whitney U test, independent sample t-test, chi-2
test or Kruskal Wallis test. Comparisons within groups were done with the Wilcoxon test or the dependent
sample t-test. Only those reporting that they had LBP in the last 4 weeks (question 1) were included in the
follow-up questions 2, 5, 6 and 7. Only those reporting that they had pain that goes down the leg
(question 3) were included in the follow-up question 4. For interpretation of pain intensity (question 7) the
categories suggested by Ly et al. (2021) [12] are used: “Mild” = ≤ 3/10, “Moderate” = 4 – 6/10, “Severe” =
≥ 7/10.

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Step 6. Final Consensus
The comments from all translations, the expert committee and employees that answered the pre-nal
version of the optimal questionnaire were discussed by the review committee and a nal consensus was
reached on the Swedish DOLBaPP questionnaires.
Results
The translation and cross-cultural adaptation process was conducted between September 2020 and
March 2021. After the forward translation, the review committee agreed on consensus Swedish
denitions of the Delphi DOLBaPP and the related questionnaire forms for telephone surveys, and online,
paper or face-to-face use (see Table 3 for optimal denition) and telephone surveys.
The review committee discussed the translations by Tr1, Tr2 and Rec, and addressed minor issues (step
2). In Swedish, both the expressions “
ländryggssmärta
” (low back pain) and “
ländryggsbesvär
” (low back
problems) are commonly used by the public to describe LBP. The review committee decided to
consistently use the expression “
ländryggssmärta
”. The expression "
pain that goes down the leg
” in
question 3 was changed to “
radiate
” because “
radiate
” (“
strålar ner
”) better expresses the meaning of the
question in Swedish. The review committee reached agreement on the translations.
Eleven experts were approached (step 3) and independently provided comments on the Swedish
DOLBaPP optimal questionnaire. The experts’ age was between 35 and 72, seven were women and four
were men (see Table 1). Two experts were Swedish language teachers. Nine experts had different medical
professions of which two had clinical work, two had academic work, and ve had both clinical and
academic work. A general comment from the experts was that the instrument was clear, comprehensive,
and relevant. Besides comments related to the wording of the questions and answer alternatives (see
below) some experts had comments on the content of the questionnaire. A comment was that the
diagram accompanying question 1 indicated a larger area on the back than the area subjects would point
out in case they had LBP. Another comment was that the pain could originate from kidney (stones) pain.
Regarding question 2, some experts commented that it should be split into one question asking if the
pain limited your usual activities, and another question asking if the pain changed your daily routine for
more than one day. A comment on question 3 was that "pain that goes down the leg" should be claried:
“goes down into one of the legs” with a follow-up question “which leg?”.
In a consensus meeting (step 4), based on the experts comments, in question 2 the expression ”var
smärtan
så kraftig
” (was this pain “
bad enough
”) was changed into “var smärtan så
stark
” (was the pain
so “
strong
”), and the expression “
ändrade vardagliga rutiner under mer än en dag
” (“
changed daily
routines for more than one day
”) was changed into “
ändrade dina vardagliga rutiner under mer än en
dag
" (“
changed your daily routines for more than one day
”). After that the review committee reached
agreement on the pre-nal version of the optimal questionnaire.

Page 6/19
Pre-test
For pre-test of the pre-nal questionnaire, 116 companies were invited of which 86 did not respond and
15 declined to participate. The 15 companies within the home care, education, and food and retail sectors
that agreed to participate had 522 employees of which 184 (35.2%) participated. Three respondents were
excluded because they were older than 65 years of age. Thus, the nal sample consisted of 181
participants of which 75.1% (136/181) were women and 24.9% (45/181) were men, see Table 2 for more
background information.
The participants responses to the questionnaire are shown in Table 3. More than half of the participants
(n = 103/181, 57%) reported that they had LBP in the last four weeks. Thirty-ve (19.3%) participants
reported pain that goes down the leg, of which 18 (51.4%) had pain that went below the knee. Six
participants (3%) reported they had pain in the leg but not LBP in the last four weeks. Thirty-nine (37.9%)
participants had mild pain, 42 (40.7%) moderate pain, and 22 (21.4%) reported severe pain. The full scale
of the answer alternatives in questions 5, 6 and 7 was utilized.
In total 26 participants erroneously provided answers on questions 2, 5, 6 or 7, because they reported in
question 1 that they had not had LBP in the last four weeks. Of these, 22 participants answered that their
LBP had not limited their usual activities or changed their daily routine in question 2, while none reported
the opposite. Two participants erroneously answered question 5. Ten participants erroneously answered
question 7 about pain intensity. However, nine of these reported the pain intensity to be zero and one
reported a pain intensity of one. Fifty-two (28.7%) participants erroneously provided an answer on
question 4, because they already reported that they had not had LBP that goes down the leg in question
3. However, none of these reported that the pain had gone below the knee in question 4. Altogether,
although several participants erroneously answered questions 2, 4, 5, or 7, this had no signicant impact
on the results.
Participants’ evaluation of the questionnaire
The mean (SD) time to answer the questionnaire was 2.5 (1.3) min and 99% answered the questionnaire
within 5 minutes (see Table 4). Participants in age group 56-65 years reported longer time to answer
compared to participants in age group 18-25 years (mean (SD) 3.0 (1.4) minutes versus 2.0 (1.1) minutes,
respectively, p = 0.046).
The participants gave 70 written comments, of which 15 were excluded because the content was not
aimed at the survey questions or could not be interpreted. Forty-four (24.9%) participants had one or two
comments.
Most (91.7%) participants found the questions in the questionnaire clear. Five participants expressed that
it was unclear if and/or which question(s) they should answer if they responded in question 1 that they
had not had LBP in the last 4 weeks. Two participants suggested that the answer option “one day” should
be added as an extra alternative to the three answer alternatives for reporting the frequency of the pain in

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question 5. Six participants experienced question 6 about time passed since previous LBP period as
dicult to understand.
Most participants reported that the diagram accompanying question 1 about LBP was easy to
understand, while 6 (3.3%) and 2 (1.1%) participants found it partly dicult or dicult to understand,
respectively. One participant wanted to have the same diagram at the end of the questionnaire, ve
responded that they did not notice or looked at the diagram because they did not have LBP, and two
participants commented that the diagram was clear and easy to interpret.
A majority (n = 155, 85.6%) did not miss any question in the form, while 26 (14.4%) participants missed
one or more questions. Seventeen participants missed questions about the cause of the pain, and four
about the duration of the problems. Six participants wanted to have questions about previous LBP
problems and how they effected the individual, two wanted to have questions about physical activity, and
two about problems with their feet. Eight participants proposed to add questions about LBP management
or treatment. There were no statistically signicant differences between men and women in their
judgement of the clarity of the questions or the diagram, questions missing, or time needed to answer the
questionnaire, but women tended to give more written comments compared to men.
In the nal consensus meeting, the review committee decided to make no changes in the pre-nal
questionnaires used in the pre-test, and consensus was reached on the nal Swedish DOLBaPP
questionnaires (see Figure 2).
Discussion
The translation and cross-cultural adaptation of the denitions and related Delphi DOLBaPP
questionnaires into Swedish using standardized methods [8, 13, 14] resulted in Swedish versions of the
Delphi DOLBaPP denitions and can be recommended for use in Swedish speaking populations.
Some problems of conceptual equivalency were found with the original English version, which could be
solved with minor modications. During the translation process the expression
"go below the knee"
in
question 3 was changed to
“radiate”
as also was done in the German translation [10]. The general
comment from the experts was that the questionnaire was clear, comprehensive and relevant. Based on
the experts’ comments in question 2 the expression "
pain bad enough
" ("
smärtan så kraftig
”) was
changed into "
pain so strong
” ("
smärtan så stark
”), and the expression "
changed daily routine
" (“
ändrade
vardagliga rutiner
") was rephased into "
changed your daily routine
" (“
ändrade dina vardagliga rutiner
").
One expert remark on the original English DOLBaPP optimal questionnaire was that some people may
receive the diagnosis “low back pain” but only have pain in the leg. However, in the current study only 3%
(n = 6/181) reported pain in the leg in the last four weeks without reporting LBP, indicating that this is
rare. A suggestion for change in question 3 was to clarify "pain that goes down the leg" into “goes down
into one of the legs” with a follow-up question “which leg?”.
Most of the 181 participants in the pre-test found the questionnaire easy to understand and clear. For
question 5 on pain duration the participants proposed, as in the German DOLBaPP study [10], to add the

Page 8/19
additional answer option “on one day”. Some participants had diculty understanding question 6 about
time since previous LBP episode and participants in the German study suggested to remove the negation
in the question and to shorten the sentence [10]. As for the German version [10], most participants needed
less than 5 minutes to complete the questionnaire.
Furthermore, participants suggested to add questions about the cause of the pain, the duration of the
problems, previous LBP episodes, physical activity, and LBP management and treatment. These aspects
are well-known and recognized [19]. Questionnaires including more aspects of LBP might be suitable for
studies in LBP populations, but not for less extensive prevalence studies. A possibility is to combine the
DOLBaPP with existing instruments for e.g. disability, mental health, general health, work ability, and
disability-adjusted life years [20–25].
The use of an online survey made it easy to distribute the questionnaire to the employees and was pilot
tested to ensure feasibility [26]. The sample chosen for the pre-test consisted of 181 employees from
various economic sectors including both blue-collar and white-collar workers. However, younger and older
populations were not included, and further evaluation of the instrument in these groups might be useful.
The prevalence of LBP was somewhat higher than the about 50% prevalence found in the German
DOLBaPP study by Leonhardt et al. [10]. One explanation could be that the German study only included
white-collar workers. It is unknown whether employees with LBP were more likely to answer the
questionnaire than those without LBP, which might indicate a selection bias. However, this could not be
inuenced by the research team. The prevalence rates are strongly inuenced by the denition, for
example in the current study the prevalence range changed from 56.9–13.8% if LBP was combined with
activity limitations, and corresponding gures in the German DOLBaPP study were changed from 50–
12% [10]. The questionnaire allows to use a combination of reporting LBP with activity limitation, and to
report LBP in relation to its burden is often proposed as more relevant to use [19, 27, 28].
Besides lling in the questions the participants provided suggestions for improvement. Similar to the
German DOLBaPP paper form questionnaire, several participants that did not report LBP in question 1
erroneously provided answers on questions 2, 5 and 7. Although these erroneous answers had no impact
on the prevalence rates and all responses were plausible, they might be avoided. If using the paper
questionnaire, an instruction could be added explaining that if participants answer "no" to question 1 on
LBP, they can skip to answer the questions 2, 5, 6 and 7, as also suggested by Leonhardt et al. [10]. In
case an online form is used, inbuilt data validation rules can ensure that people get the right questions
based on the previous answers [29]. The use of the Swedish version of the Delphi DOLBaPP
questionnaires allows for further investigation of the measurement properties, such as test-retest
reliability. Also, further evaluations of the questionnaires for telephone surveys may be warranted.
Conclusions
The translation and cross-cultural adaptation of the Delphi Denitions of Low Back Pain Prevalence
(DOLBaPP) and the corresponding questionnaires into Swedish was successful and required only minor

Page 9/19
linguistic adaptation. The DOLBaPP-S can be used in epidemiological studies on the prevalence of LBP in
Swedish speaking populations.
Abbreviations
LBP
Low Back Pain
DOLBaPP
Denitions of Low Back Pain Prevalence
Tr
Translator
Rec
Reconciler
QR code
Quick Response code
SPSS
Statistical Package for the Social Sciences
SD
Standard Deviation.
Declarations
Ethics approval and consent to participate
According to Swedish law (2003: 460) on the ethics of human research, it is described that all research
performed and dealing with sensitive personal data should be ethically tested. Section 2 of this law
states that regional ethical committee assessment is required for "Scientic experimental or theoretical
work to acquire new knowledge or scientic quality improvement work, but no such work done in the
framework of rst or second cycle education[18]. Therefore, because this study was conducted as a part
of a bachelor's thesis and did not include sensitive personal data, ethical approval was provided after
assessment performed according to the Helsinki declaration by the ethics board of second cycle
education at Linkoping University. Informed consent was obtained from each participant. No patients
were involved.
Consent for publication
Not applicable.
Availability of data and materials
Data are available upon request to the corresponding author.

Page 10/19
Competing interests
The authors declare that they have no competing interests.
Funding
This research received no specic grant from any funding agency in the public, commercial, or not-for-
prot sectors.
Authors' contributions
The authors declare the following contributions to the preparation of the
manuscript: : BÖ and CED initialized the study. CED, BÖ, PE, YL and AA were responsible for study
conception and design; PE, YL, EG and EL did the data collection, data analysis and prepared gures 1-2
and tables 1-4. PE prepared the draft of the manuscript. All authors were involved in interpretation of the
data and critical revision of the manuscript for important intellectual content; All authors provided nal
approval of the manuscript and take responsibility for the integrity of the work and agreed to submit the
article for publication.
Acknowledgements
The authors want to thank the experts, employers, and employees for their contribution to the work.
The diagram in the Delphi DOLBaPP questionnaire (copyrighted material) is used with permission.
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Tables
Table 1 Expert committee members characteristics.

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Expert Profession and expertise Gender
1 Language teacher Swedish, level gymnasium. Man
2 Professor emerita (radiology). Woman
3 Psychologist, University Senior lecturer. Man
4 Nurse Research and Development, currently working with telephone advice to the
public due to the Corona pandemic. Woman
5 Adjunct Professor of Orthopedics, Chief physician university hospital. Man
6 Associate Professor and Consultant in Orthopedic Surgery university hospital. Man
7 Occupational therapist working clinically. Woman
8 Associate Professor Occupational health, Ergonomist and Physiotherapist. Woman
9 Medical intern working clinically. Woman
10 Language teacher Swedish and Swedish for foreigners, level basic school,
gymnasium and adult education. Woman
11 Professor, Senior Consultant, Head and attending physician Rehabilitation
Medicine university hospital. Woman


Table 2 Background characteristics participants, n = 181

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Characteristics n (%)
Sex 
 Male 45 (24.9)
 Female 136 (75.1)
 Other -
Age group, years 
 18 – 25 23 (12.7)
 26 – 35 42 (23.2)
 36 – 45 33 (18.2)
 46 – 55 36 (19.9)
 56 – 65 47 (26.0)
Usual physical strenuousness of work 
 Very, very light 10 (5.5)
 Very light 30 (16.6)
 Light 52 (28.7)
 Somewhat strenuous 58 (32.0)
 Strenuous 24 (13.3)
 Very strenuous 7 (3.9)
 Very, very strenuous -

Table 3 Pre-test responses of the optimal Delphi Denitions of Low Back Pain Prevalence (DOLBaPP)
Swedish language version (n = 181)

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Item original English (Swedish adaptation) Number (%) of respondents
Yes / Ja
n (%)
No / Nej
n (%)
 
Q1. In the last 4 weeks, have you had
pain in your lower back? Please ignore
pain caused by menstruation or by an
illness accompanied by fever. (Har du haft
smärta i ländryggen (det område som markerats
på bilden) under de senaste 4 veckorna?
Undantag: Bortse från smärta i samband med
feber eller mens.)
103
(56.9) 78 (74.8)  
Q2. If yes, was this pain bad enough to
limit your usual activities or change your
daily routine for more than one day?
(Om ja, var smärtan så stark att den begränsade
dina vanliga aktiviteter eller gjorde att du ändrade
dina vardagliga rutiner under mer än en dag?)
25 (24.3) 77 (54.7)  Not
answered
1 (1.0)
Q3. In the last 4 weeks, have you had
pain that goes down the leg? (Har du haft smärta
som strålar ner i benet under de senaste 4
veckorna?)
35 (19.3) 146
(80.7)  
Q4. If yes, has this pain gone below the
knee? (Om ja, har den smärtan nått nedanför
knät?)
18 (51.4) 17 (48.6)  
On some
days
(Några
dagar)
On most
days
(De esta
dagar)
Every
day
(Varje
dag)

Q5. If you had pain in your lower back in
the last 4 weeks, how often did you have
the pain? (Om du har haft smärta i ländryggen
under de senaste 4 veckorna, hur ofta hade du
smärta?)
69 (67.0) 21 (20.4) 13
(12.6) 
Less than
3 months
(Mindre
än 3
månader)
3 months
or more,
but less
than 7
months
7
months
or more,
but less
than 3
3 years
or more
(3 år eller
mer)

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(3
månader
eller mer,
men
mindre än
7
månader)
years
(7
månader
eller mer,
men
mindre
än 3 år)
Q6. If you had low back pain in the last
4 weeks, how long was it since you had a whole
month without any low back
pain? (Please tick only one box). (Om du har haft
smärta i ländryggen under de senaste 4
veckorna, hur länge var det sedan det gick en hel
månad utan att du hade smärta? (Markera
endast ett svarsalternativ).)
31 (30.1) 29 (28.2) 15
(14.6) 25 (24.3)
(Not
answered
3 (2.9)
Mean
and
standard
deviation
(SD)
Median
[25-75%],
minimum
-
maximum
 
Q7. If you had low back pain in the last
4 weeks, please indicate what was the
usual intensity of your pain on a scale of
0 to 10, where 0 means “no pain” and 10
means “the worst pain imaginable”.
(Please circle your answer). (Om du har haft
smärta i ländryggen under de senaste 4
veckorna, hur mycket smärta hade du i allmänhet
på en skala från 0 till 10? 0 betyder ”Ingen
smärta” och 10 betyder ”Värsta tänkbara
smärta”. (Ringa in ditt svar.)).
4.3 (2.0) 4 [3-6]
0 - 8
 


Table 4 Participants’ evaluation of the questionnaire, n = 181

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Evaluation n (%)
Time to answer the questionnaire? 
 1 minute 41 (22.7)
 2 minutes 68 (37.6)
 3 minutes 42 (23.2)
 4 minutes 8 (4.4)
 5 minutes 21 (11.6)
 6 minutes -
 7 minutes 1 (0.6)
What do you think about the diagram accompanying question 1? 
 Easy to understand 173 (95.6)
 Partly dicult to understand 6 (3.3)
 Dicult to understand 2 (1.1)
Is a (are) question(s) unclear? 
 Yes 15 (8.3)
 No 166 (91.7)
Do you miss any question in the questionnaire? 
 Yes 26 (14.4)
 No 155 (85.6)

Figures

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Figure 1
Translation and cross-cultural adaptation method. Abbreviations: DoLBaPP, Denitions of Low Back Pain
Prevalence.

Page 19/19
Figure 2
Swedish Delphi Denitions of Low back pain (DOLBaPP-S) optimal questionnaire The body diagram was
rst published in Kuorinka et al. (1987),[30] and is used with the publisher’s permission.