The Arabic version of the Exercise Adherence Rating Scale: translation, cross-cultural adaptation and psychometric properties for Arab chronic low back patients

Objectives: To culturally adapt the Arabic version of the Exercise Adherence Rating Scale (EARS) and evaluate its psychometric properties in chronic low back pain patients (CLBP). Methods: This methodological study cross-culturally adapted EARS into Arabic (EARS-Ar) following recommended guidelines. Ninety-three CLBP outpatients were prescribed home-based exercises. Dimensionality of the EARS-Ar was assessed by Confirmatory Factor Analysis (CFA) and validity was assessed by comparing EARS-Ar with Fear-Avoidance Beliefs Questionnaire (FABQ), Numeric Pain Rating Scale (NPRS), and Roland Morris Disability Questionnaire (RMDQ). Internal consistency and test-retest reliability were evaluated. Responsiveness was examined using the receiver operating characteristic curve (AUC). Results: CFA confirmed dimensionality of the EARS-Ar. It had moderate negative correlations (rho= −0.42 to −0.62) with FABQ, NPRS, and RMDQ. EARS-Ar demonstrated excellent internal consistency (α = 0.97). Intraclass correlation coefficients were excellent (ICCs= 0.89-0.920) with acceptable corrected item correlations (rho= 0.56–0.77). Responsiveness of the EARs-Ar was good with significant moderate correlation (rho= 0.35) between the EARS-Ar change score and global rating of change (GRoC). A cutoff point of 12.5/24 was determined with moderate accuracy (AUC= 0.81, sensitivity= 81%, specificity= 41%). Conclusions: EARS-Ar showed good reliability, validity, and responsiveness, which renders it a reliable tool for evaluating exercise adherence behavior of CLBP patients.