Cross-cultural adaptation and validation of the German Central Sensitization Inventory (CSI-GE)

Michel Klute; Marjan Laekeman; Katrin Kuss; Frank Petzke; Angela Dieterich; Andreas Leha; Randy Neblett; Steffen Ehrhardt; Joachim Ulma; Axel Schäfer

doi:10.1186/s12891-021-04481-5

Cross-cultural adaptation and validation of the German Central Sensitization Inventory (CSI-GE)

BMC Musculoskelet Disord. 2021 Aug 18;22(1):708. doi: 10.1186/s12891-021-04481-5.

Authors

Michel Klute¹, Marjan Laekeman², Katrin Kuss³, Frank Petzke⁴, Angela Dieterich⁵, Andreas Leha⁶, Randy Neblett⁷, Steffen Ehrhardt⁸, Joachim Ulma⁹, Axel Schäfer¹⁰

Affiliations

¹ Pain Clinic, Department of Anaesthesiology, University Medical Center, Georg August University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany. michel.klute@stud.uni-goettingen.de.
² Physiological Psychology, Otto-Friedrich- University of Bamberg, Bamberg, Germany.
³ Department of General Practice/Family Medicine, Philipps University Marburg, Marburg, Germany.
⁴ Pain Clinic, Department of Anaesthesiology, University Medical Center, Georg August University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
⁵ Physiotherapy, Faculty of Health, Safety, Society, Furtwangen University, Furtwangen, Germany.
⁶ Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.
⁷ PRIDE Research Foundation, Dallas, TX, USA.
⁸ Faculty of Social Sciences, City University of Applied Sciences, Bremen, Germany.
⁹ Clinic for Pain Medicine Bremen, Rotes-Kreuz-Krankenhaus Bremen, Bremen, Germany.
¹⁰ Faculty of Social Work and Health, University of Applied Science and Art, Hildesheim, Germany.

Abstract

Background: The Central Sensitization Inventory (CSI) is a screening tool designed to detect symptoms related to Central Sensitization (CS) and Central Sensitivity Syndromes (CSS) by measuring the degree of related phenomena. The objective of this study was to create a German, culturally-adapted version of the CSI and to test its psychometric properties.

Methods: A German version of the CSI (CSI-GE) was developed, culturally-adapted, and pretested for comprehensibility. The psychometric properties of the resulting version were validated in a clinical study with chronic pain and pain-free control subjects. To assess retest reliability, the CSI-GE was administered twice to a subgroup of patients. Structural validity was tested using factor analyses. To investigate construct validity a hypotheses testing approach was used, including (1) correlations between the CSI-GE and several other well-established questionnaires as well as (2) an investigation of the CSI-GE discriminative power between different subgroups of participants believed to have different degrees of CS.

Results: The CSI-GE showed excellent reliability, including high test-retest characteristics. Factor analyses confirmed a bi-factor dimensionality as has been determined previously. Analysing construct validity 6 out of 11 hypotheses (55%) were met. CSI-GE scores differentiated between subgroups according to expectations. Correlations between CSI-GE scores and other questionnaires suggested that none of the correlated constructs was identical, but there was overlap with other questionnaires based on symptom load. Several correlations did not fit with our current understanding of CS.

Conclusion: The CSI-GE appears to be a reliable tool for measuring CS/CSS-related symptomatology. Whether this implies that the CSI-GE measures the degree of CS within an individual subject remains unknown. The resulting score should be interpreted cautiously until further clarification of the construct.

Keywords: CSI; CSI-GE; Central sensitivity syndromes; Central sensitization; Central sensitization inventory; Chronic pain; Cross-cultural adaptation; Psychometric validation.

MeSH terms

Central Nervous System Sensitization*
Chronic Pain*
Cross-Cultural Comparison
Humans
Psychometrics
Reproducibility of Results
Surveys and Questionnaires