Rotator cuff injuries account for 80% of primary care consultations for shoulder pain (1), and their incidence increases with age (2). These injuries, among other problems such as weakness and loss of function, can cause significant levels of pain that are crucial when deciding treatment strategies (3). Despite the development of many effective interventions to improve symptoms, around 30% of the patients report no significant change in pain-related outcomes, and psychosocial, occupational and lifestyle factors have been identified as possible reasons for this (1).

One of these factors is pain self-efficacy. Originally defined by Albert Bandura, self-efficacy is one’s confidence or belief in their capacity goal achievement or activity performance (4). Higher levels of self-efficacy are suggested as predictors of better prognosis in patients with musculoskeletal pain (5), less disability, pain, fatigue, or emotional distress (6). Self-efficacy, therefore, determines the willingness to persist when obstacles are faced, avoids shying away from a complicated task, and shows commitment to achieving a goal (7).

The assessment of self-efficacy, as it is a belief, must be self-administered. To assess self-efficacy, many tools have been developed. Some of them are specific to a condition, such as the Arthritis Self-Efficacy Scale (ASES) or the Chronic Disease Self-Efficacy Scale, and some are related to pain and altered pain states, such as the Chronic Pain Self-Efficacy Scale or the Pain Self-Efficacy Scale (PSEQ) (8, 9). When dealing with clinical settings involving musculoskeletal disorders, the PSEQ is the preferred scale used by clinicians (10). It is a short and comprehensive questionnaire composed with 10 items first developed in English, aimed to assess the confidence or ability people with pain have to achieve activities despite their pain (11). The PSEQ assesses several dimensions, including physical functioning, social interaction, and participation in activities of the daily living when pain is present (11).

Translated and adapted versions of the PSEQ have assessed its psychometric properties in several languages, such as Amharic (7), Arabic (12), Canadian-French (1), Catalan (13), Chinese-Hong Kong (14), Chinese-Mainland (15), Danish (16), Italian (17), Farsi (18), Japanese (19), Marathi (20), Mongolian (21), Portuguese-Brazilian (22), Portuguese-European (23), and Yoruba (24). All of these translations were performed rigorously, and several of them adapted items from the questionnaire to their culture. Despite this, a validated version of this questionnaire in Spanish is lacking, limiting its access to healthcare professionals who develop their practice in Spanish-speaking settings. Therefore, this study aimed to translate and culturally adapt the Spanish version of the PSEQ, and examine its psychometric properties.

107 participants completed the questionnaire. Researchers in charge of the translation reached an agreement during the translation and adaptation process of the PSEQ into Spanish (PSEQ-Sp) and in a Spanish context. None of the items of the original were removed during the translation process.

The aim of the present study was to translate and culturally adapt the Spanish version of the PSEQ, and examine its psychometric properties, being this the first study to perform such translation and analysis. Our results show that PSEQ-Sp has excellent test–retest reliability and excellent internal consistency. Also, our hypothesis stating that the PSEQ-Sp and the TSK were associated was confirmed, supporting the validity of the PSEQ-Sp.

The PSEQ is a relatively short and feasible questionnaire that can easily be administered during a regular assessment, and can provide valuable information to understand the patient’s clinical presentation from a biopsychosocial perspective. Authors have discussed its form and how can it be improved. For instance, respondents in the study conducted by Chala et al. (7) suggested to include every possible number in the scale, instead of including numbers only at every limit. However, authors in this study decided that such modification would have a significant influence in the performance of the scale, and opted not to conduct such modification.

The exploratory factor analysis yielded a one-factor solution, coinciding with previous studies (1, 11–19, 22, 23). Contrary to this, several studies did not report results for factorial analysis (20, 21, 24) and one study (7) showed a two-factor solution instead, alluding there may have been underlying factors in the cultural setting they assessed their translated version in Ethiopia. Also, the construct convergent validity of the PSEQ-Sp was assessed by performing a correlation analysis with the TSK. The moderate negative correlation found in our study between the PSEQ-Sp and the TSK is consistent with other studies that conducted the same analysis. Chiarotto et al. (17), Almutairi et al. (12), and Yang et al. (15) found moderate negative correlations of r = −0.48, −0.41, −0.45, respectively. All of these studies conducted their validity analysis in patients that suffered low back pain, unlike our study, but we can consider this positively, as the correlation between these tools seems to be consistent despite the clinical condition. However, our validity analysis could have been further developed by correlating the PSEQ with other tools that similar studies used, such as the Short-Form 36 (SF-36) assessing health-related quality of life (7, 12, 14, 18, 19, 23), or other indices of validity, such as discriminant (13), or factorial (7, 18) validity. Future studies could consider these analyses.

Both the Bland–Altman plot and ICC values showed excellent reliability levels for the PSEQ-Sp. Other studies have also used the ICC to establish correlation values for the PSEQ. The Arabic and Chinese-Hong Kong versions (12, 14) found average ICC correlation values of 0.79 and 0.75, respectively, and the Amharic, Canadian-French, Danish, Farsi, Italian, Japanese, and Marathi versions (1, 7, 16, 20) found high ICC correlation values that ranged from 0.80 to 0.96. However, we have to consider the possible incurring in a recall bias, as the high test–retest reliability might’ve been influenced by the interval between assessments.

The level of internal consistency of the PSEQ-Sp was excellent. Other language translations of the PSEQ have found excellent internal consistency levels too. The Amharic (7), Arabic (12), and Portuguese-Brazilian (22) versions had internal consistencies of α = 0.90, the Canadian-French (1) version of α = 0.91, the original English (11), Catalan (13), and Farsi (18) versions of α = 0.92, the Chinese-Hong Kong (14), and Marathi (20) versions of α = 0.93, the Italian (17), Japanese (19), and Mongolian (21) versions of α = 0.94, and the Chinese-Mainland (15) version of α = 0.95. The Portuguese-European (23) and Danish (16) versions had good levels of internal consistency, both α = 0.88. Only the Yoruba (24) version had inferior, but still acceptable levels of consistency of α = 0.79. Therefore, this tendency appears to be a psychometric property of the PSEQ across different languages and cultural contexts.

Limitations were also present in our study. First, results from this study are limited to patients suffering rotator cuff injuries, so conclusions should be interpreted cautiously. Also, our sample was of convenience, it was not randomly selected from the general population, meaning the generalizability cannot be assumed for all patients suffering rotator cuff injuries. Finally, we translated and cross-culturally adapted the PSEQ in Spain, and even though the version is easily understood by any Spanish speaker, cross-cultural adaptations to other Spanish-speaking countries, as the ones in South America, could report different results. Additional limitations to be considered include response biases, as our assessment was self-administered, and the potential recall bias on the test–retest assessment.

However, our study also presents strong points. This is the first translation of the PSEQ in Spanish, the world’s second most spoken native language, and the official language in 20 countries. Therefore, the development of the PSEQ-Sp could imply an important addition for so many clinicians and researchers. Future research could conduct cross-cultural adaptations of the PSEQ-Sp in different Spanish-speaking countries to explore potential variations in psychometric properties and cultural influences. Cross-cultural adaptations of the PSEQ-Sp in different Spanish-speaking countries to explore potential variations in psychometric properties and cultural influences.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by the Ethics Committee of University of Valencia (protocol code 2537824 and date of approval March 9, 2023). The patients/participants provided their written informed consent to participate in this study.

BP-D and MB-D contributed to the conception and design of the study. SP-M and IE-P organized the database. AR-R performed the statistical analysis. BP-D wrote the first draft of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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