Reliability and Validity of the Persian Version of the ATEMPT Questionnaire for Assessing Exercise Adherence in Patients With Musculoskeletal Pain

Abstract

Compliance with therapeutic exercises is an important factor determining the results in musculoskeletal pain patients; however, there are currently few tools available to assess compliance in a practical and valid manner. The Adherence to Exercise for Musculoskeletal Pain Tool (ATEMPT) is a short self-reporting questionnaire designed to determine the level of compliance with exercises in musculoskeletal pain patients. In this study, translation, cultural adaptation and preliminary evaluation of psychometric properties of the Persian version of the ATEMPT questionnaire have been performed. This pilot methodological study was carried out between July and December 2024 among patients with musculoskeletal problems. For translation, cultural adaptation, and testing of content validity, the 6-item questionnaire of the short form of the ATEMPT was translated into Persian via a forward-backward process and expert review. Content validity of the scale was evaluated by eight sports medicine specialists regarding CVR (Content Validity Ratio) and CVI (Content Validity Index). Face validity was tested in an interview with 30 patients. Cronbach’s alpha was used for analysis of internal consistency, while Intraclass Correlation Coefficient (ICC) was applied for test-retest reliability over 1 week. Convergent validity was determined through correlation with the Persian version of Exercise Adherence Rating Scale (EARS). Thirty patients participated in the study (36.7% males, 63.3% females; mean age of 50.35±13.39 years). The content validity of all items was excellent with CVR of 1.00, Item Level CVI (I-CVI) ranging from 0.875 to 1.00 and scale-level CVI using the average approach (S-CVI/Ave) of 0.98 for all items. The Persian version of the ATEMPT had good internal consistency with Cronbach’s alpha of 0.881 and good test-retest reliability with ICC of 0.880. There was a moderate relationship between the Persian ATEMPT and Persian EARS (r=0.54). The Persian version of the ATEMPT had satisfactory preliminary psychometric properties among patients with musculoskeletal conditions.