Reliability and validity of the Turkish version of the pain attention and awareness questionnaire for nonspecific musculoskeletal pain.

BACKGROUND

Reliable and valid assessments of pain vigilance and awareness are crucial for understanding and treating pain within cognitive-behavioral frameworks, such as the fear-Avoidance Model. While the Pain Vigilance and Awareness Questionnaire (PVAQ) is a widely used tool for this purpose, no culturally adapted and validated version exists for the Turkish-speaking population, creating an instrumental and clinical gap.

OBJECTIVE

This study aimed to translate, culturally adapt, and comprehensively evaluate the psychometric properties of the Turkish version of the PVAQ in a sample of patients with nonspecific musculoskeletal pain.

METHODS

An instrumental, cross-sectional study was conducted. The PVAQ was translated and adapted into Turkish according to established guidelines. A sample of 131 patients with low back, neck, or shoulder pain completed the PVAQ-T, the Pain Catastrophizing Scale (PCS), the Tampa Scale for Kinesiophobia (TSK), the Hospital Anxiety and Depression Scale (HADS), and a visual analog scale (VAS) for pain intensity. Reliability was assessed via internal consistency (Cronbach’s alpha) and test-retest reliability (intraclass correlation coefficient - ICC). Construct validity was examined via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Criterion validity was evaluated through Pearson correlations with the PCS, TSK, and HADS.

RESULTS

The PVAQ-T demonstrated acceptable internal consistency (Cronbach’s α = 0.83) and good test-retest reliability (ICC = 0.918). EFA supported a two-factor structure (vigilance and awareness), explaining 62.3% of the variance. CFA indicated that the original 16-item model had a suboptimal fit (CFI = 0.807; GFI = 0.732; SRMR = 0.060; RMSEA = 0.138, and χ²/df = 3.46). Following the removal of items 4 and 12 based on exploratory and item-level findings, some fit indices showed modest improvement (CFI = 0.836; GFI = 0.768; SRMR = 0.006), whereas others remained unchanged or worsened (RMSEA = 0.144; χ²/df = 3.69). The PVAQ-T total score showed moderately to strongly, statistically significant (p < 0.001) correlations with the PCS (r = 0.681), TSK (r = 0.694), HADS-Anxiety (r = 0.491), and HADS-Depression (r = 0.416) scores, supporting its criterion validity.

CONCLUSION

Within a Turkish sample of individuals with nonspecific musculoskeletal pain, the 14-item Turkish version of the PVAQ demonstrates adequate reliability and validity for assessing pain-related attention and awareness. While the two-factor structure was supported at the exploratory level, confirmatory findings suggest that results should be interpreted with caution. The PVAQ-TR may be a useful instrument for research and clinical assessment of pain-related attentional processes, highlighting the importance of cultural adaptation and empirical evaluation of psychometric instruments.