Work-Related Musculoskeletal Disorders (WRMD) are an important cause of morbidity and disability in industrialized countries, with major economic impact(1-4)
. Their management and prevention requires careful evaluation of workers’ occupational activities and work conditions, including both technical and organizational aspects of work(5-6)
Accordingly, Brazilian researchers have adapted various established instruments for the assessment of musculoskeletal problems in workers, including the Nordic Questionnaire(7)
, the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire(8)
and the Oswestry Disability Index(9)
. However, most of these questionnaires focus on specific anatomical regions, and do not cover the nature of work and the work conditions that might be associated with symptoms. The “Cultural and Psychosocial Influences on Disability (CUPID) questionnaire”(10)
is a wider ranging instrument, which ascertains demographic characteristics, a range of occupational physical activities, psychosocial aspects of work, musculoskeletal symptoms at multiple anatomical sites, associated disability for common everyday tasks, mental health, tendency to worry about common (non-musculoskeletal) somatic symptoms, and also beliefs about the nature and severity of WRMD(11)
The theoretical approach of the conception of the Questionnaire is based on the hypothesis that work-related musculoskeletal symptoms and resultant disability are influenced by cultural beliefs and expectations, as well as by physical activities and mental health”(10-11)
The CUPID questionnaire(10)
is in two parts: a baseline questionnaire, which can be used to collect data about workers in cross-sectional surveys, and a shorter follow-up questionnaire, which assesses the course and impact of symptoms at later follow-up.
The CUPID questionnaire is currently being used in an international multi-center study – “Cross-cultural Study of Musculoskeletal and Other Somatic Symptoms and Associated Disability”, with financial support from the Colt Foundation, aimed at comparing the prevalence of musculoskeletal symptoms and disability in workers carrying out similar physical activities in a variety of cultural settings. Brazil is taking part in this CUPID project with 21 other countries. As a prelude to data collection, it was necessary to translate the CUPID questionnaire into Brazilian Portuguese, and then check its validity and applicability by independent back-translation to English, and by piloting in a sample of Brazilian workers.
The importance of adapting the questionnaire for the Brazilian culture is guided by comprehensive and accurate diagnoses, which permit appropriate and effective proposals of preventive strategies to avoid work-related musculoskeletal symptoms and their resultant disability. Also, international data comparison highlights the influences of different cultures on the manifestation of the work-related musculoskeletal symptoms and disabilities. Therefore, England, Australia, Italy, England, New Zealand, Greece, South Africa and Brazil(12-13)
are conducting studies with nursing workers in this project. So, with a view to testing the capacity of the instrument to identify musculoskeletal symptoms and its relationships in different countries and cultures, a multi-center international was proposed, and Brazil is taking part in the CUPID Project with other 21 countries.
The cultural adaptation of the CUPID differs from other studies of the same type which propose to investigate the psychometric properties of the questionnaires, because they were designed as a Likert scale(14-17)
. CUPID is an instrument whose answers mostly offer a qualitative perspective. On the other hand, the questionnaire is very extensive, which makes it difficult to immediately apply other possible techniques for content validation. Therefore, this publication intends to contribute to the understanding of the cultural adaptation of this type of instrument on workers’ health, showing the steps followed for this purpose in detail.