Validation and cross-cultural adaptation of the Arabic version of the Pelvic Girdle Questionnaire

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Elkhateb, Shaimaa Elshemy, Asmaa Eid, Hanaa Aly, Mostafa Yosef, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6263774/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background : Pelvic Girdle Pain affects pregnant and postpartum women widely, causing distressing symptoms and activity limitations, which affects the quality of life and burdens the economy. The Pelvic Girdle Questionnaire (PGQ) is the only condition-specific standardised tool for assessing activity limitations and symptoms in people with PGP. It is simple to administer and can be used in research and clinical settings during pregnancy and postpartum. There is currently no version of the PGQ in Arabic. This study aimed to translate and culturally adapt the PGQ for the Arabic-speaking population and validate whether it retains its psychometric items like the original PGQ. Methods : This study was carried out in two phases. In the first phase, the PGQ was translated into Arabic and cross-culturally adapted following Beaton guidelines. Seventeen women were enrolled for the pilot test of this phase. In the second phase, 140 healthy pregnant and postpartum women with PGP answered the Arabic version of PGQ (Arabic-PGQ), the Oswestry Disability Index, and the Numeric Pain Rating Scale. These two additional instruments were to test the construct validity of the Arabic-PGQ. Also, floor and ceiling effects, internal consistency, and test-retest reliability and agreement of the Arabic-PGQ were analysed. Finally, the discrimination validity of the Arabic-PGQ to differentiate between women who need treatment for PGP and those who do not, and pregnant versus postpartum women with PGP was assessed. Results : The Arabic-PGQ showed good construct validity with a high correlation between the total score and the Oswestry Disability Index (0.637) and Numeric Pain Rating Scale (0.634). The Arabic-PGQ did not show floor or ceiling effects. It showed good internal consistency with a Cronbach alpha of 0.825 for the total score. Arabic-PGQ showed good reproducibility with test-retest reliability (interclass correlation coefficient> 0.8) and agreement (Minimal detectable change: 17.26%- 19.64%). Arabic-PGQ total score could discriminate between pregnant and postpartum women with PGP (Area under curve= 0.714, P-value< 0.001), but it could not differentiate between the treatment and non-treatment women (Area under curve=0.559, P-value: 0.269) pelvic girdle pain questionnaire validation studies cultural adaptation pregnancy postpartum period Arabic version disability evaluation reliability pain Figures Figure 1 Figure 2 Figure 3 Introduction Often confused with low back pain, pelvic girdle pain (PGP) is considered to be a different condition in terms of its aetiology and treatment. PGP is characterised by pain in the sacroiliac joints, symphysis pubis, and surrounding areas. [ 1 ] It occurs mainly in women during pregnancy and postpartum periods, with a reported worldwide prevalence between 4–76%, depending on the definition and diagnostic tools. [ 2 ] PGP is more prevalent in the second half of pregnancy, and it tends to improve after delivery. [ 3 ] Even though the aetiology of PGP is unclear, increased PGP during pregnancy has been related to mechanical and hormonal factors. Examples are altered pelvic joint stability and increased relaxin hormone that causes the laxity of the sacroiliac joints and symphysis pubis. PGP is provoked by everyday activities such as walking, standing, sitting, and lying down, [ 1 ] which limits most daily activities and working abilities, resulting in social- and economic burdens. [ 4 ] In Scandinavia, it is one of the most common reasons for pregnant women to take sick leave. [ 5 ] In one study, 75.3% of the Norwegian population had been on sick leave at some point during their pregnancy due to PGP, with a median duration of eight weeks. [ 6 ] Due to its unique features, relatively widespread occurrence, significant effect on quality of life and economic burden on society, PGP warrants particular focus. [ 4 ] To facilitate effective clinical management of PGP, it is imperative to employ diagnostic tools that are both reliable and valid. These tools should aid in diagnosing PGP and evaluating its impact on the functional limitations and symptomatology in affected women. The Pelvic Girdle Questionnaire (PGQ) represents the sole condition-specific instrument for PGP, applicable in both research and clinical contexts during pregnancy and postpartum. [ 7 ] Developed in 2011, the original Norwegian version of the PGQ demonstrated solid internal consistency, reliable test-retest stability, and both construct and discriminant validity, mainly when administered to pregnant and postpartum women. [ 7 , 8 ] To date, the PGQ has been translated into 12 languages and validated in most. [ 4 , 9 – 20 ] In Egypt and other Arab countries where a population of 445 million people lives, [ 21 ] PGP is obviously overlooked. Only one study about PGP among the Kuwaiti obstetric population was found in the literature, and it did not use a valid measure like PGQ to assess PGP. [ 22 ] Since Arabic is the native language of most people living in the Arab world, an Arabic version of the PGQ (Arabic-PGQ) is necessary. Adapting questionnaires to use in different cultural contexts necessitates precise translation and cultural modification. Opting to translate and culturally adapt an existing health-related quality-of-life instrument rather than developing a new one offers several advantages, including reduced time and cost and the facilitation of a standardised measure for international research. [ 4 ] As Beaton et al. outlined, the cross-cultural adaptation process involves translating and culturally modifying the questionnaire, ensuring equivalence between the original and the target culture while preserving content validity. This process concludes with content validity testing to examine the retention of the questionnaire’s psychometric properties post-adaptation. [ 23 ] Hence, this study aimed to translate, culturally adapt, and validate the PGQ for the Arabian population, ensuring its applicability and relevance in this specific cultural context. Methods Design: This study was divided into two distinct phases. The first phase involved the translation and cross-cultural adaptation of the PGQ, adhering to established international guidelines. [ 23 ] During this phase, a pilot cross-sectional study was conducted among 17 pregnant and postpartum women experiencing PGP to evaluate the preliminary Arabic-PGQ. The second phase focused on validating and investigating the reliability of the psychometric properties of the Arabic-PGQ. This cross-sectional study phase included a cohort of 140 women, either pregnant or in the postpartum period, all suffering from PGP. For data collection, women were interviewed and asked about the questionnaire items whilst present in the outpatient clinic setting. (Fig. 1 ) Ethical considerations: This study was approved by the Cairo University Faculty of Medicine research ethics committee, with approval number N-419-2022. Before participating in the study, all women provided written informed consent. Before starting this study, the author of the original PGQ (BS) was contacted to ensure no Arabic-PGQ was in process and to obtain approval and cooperation for working on this version of the PGQ. Instruments: The PGQ is a self-administered instrument comprising 25 items. It includes a 20-item activity subscale that evaluates the impact of PGP on various activities and a 5-item symptom subscale that assesses the symptoms’ severity. The questionnaire uses a four-point scale for each item, ranging from 0 to 3. To calculate the overall PGQ score, all item scores are summed up and then divided by the maximum possible score of 75 (60 for activity and 15 for symptoms). If an item is marked as "not applicable" or left unanswered, 3 points are subtracted from the total possible score. The final scores are converted into percentages, indicating disability levels from 0% (no disability) to 100% (severe disability). [ 7 ] Oswestry Disability Index (ODI) modified version 2.0 is one of the most commonly used tools in clinical practice for assessing low back pain. We utilised it in our study as a possible control in analysing the relevance of the PGQ and ODI. This version requires women to rate their perceived disability on a scale from 0 to 5 across ten domains: pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sexual life, social life, and travelling. The cumulative scores, with a maximum of 50, are doubled and expressed as a percentage. A score of 0% indicates no disability. The ODI percentages are categorised into various levels of disability: minimal or no disability (0–20%), moderate disability (20–40%), severe disability (40–60%), crippled (60–80%), or bed-bound/exaggerating symptoms (80–100%). [ 24 ] The 11-point Numeric Rating Scale (NRS), ranging from 0 to 10, is a globally used tool that assesses pain intensity. It is marked from 0 to 10, where 0 signifies the absence of pain and 10 indicates the most extreme pain imaginable. [ 25 ] Translation and cross-cultural adaptation (first phase): The translation of the questionnaire from English to Arabic was conducted following the established guidelines for questionnaire translation and cross-cultural adaptation that encompass six stages. [ 23 ] Stage 1: Translation Two native Arabic-speaking language experts who are fluent in English independently translated the questionnaire from English to Arabic. Stage 2: Synthesis The two initial translations were compared with each other and the original English version, and one translation was synthesised. Neither translator had prior experience with PGP or the questionnaire. Stage 3: Back-translation Two native English-speaking professional translators independently back-translated the Arabic version into English without referring to the original questionnaire. After being introduced to the questionnaire, any discrepancies identified were discussed and resolved, resulting in a consensus back-translation. Stage 4: Expert Committee A committee of psychometrics, linguistics, and PGP experts reviewed all translations and resolved any discrepancies. When translation challenges arose, the committee consulted the original English version to capture the true essence of the items. The original PGQ author was consulted for input on challenging translations and to ensure consistency with the original Norwegian version. Stage 5: Pre-testing The preliminary Arabic-PGQ was tested through a pilot study on 17 women experiencing PGP. All women (15 pregnant and two postpartum) were recruited from our obstetric outpatient clinics. All women were clinically diagnosed with PGP according to European guidelines. [ 1 ] While interviewing them to answer the questionnaire, they were asked about each item's clarity, rewording if they found it difficult to understand, relevance to their condition, and applicability in their everyday life. The expert committee then reconvened to discuss and resolve any identified issues and inconsistencies. Stage 6 The final Arabic-PGQ was reviewed and approved by the original PGQ author. Validation (second phase): The sample size was done according to the guidelines set by Kline et al., which suggest a ratio of 5 to 10 subjects for each item in the study. Thus, for a 25-item questionnaire, a minimum of 125 women were needed for this study. [ 26 ] A total of 147 pregnant and postpartum women suffering from PGP were recruited for the validation phase of the study using non-probability convenience sampling. The women visited the Cairo University Kasr Alainy Obstetrics and Gynecology Hospital obstetrics outpatient clinic between 9/2023 and 12/2023. Pain location was the main criterion for inclusion in our study. Women were asked about pelvic pain, and if they answered yes, they were asked to point at the most painful area of their body. Women were included in the study if they reported pain in the area within the red borders in the drawing provided by Ahlqvist et al. (Fig. 2 ), [ 27 ] which was not shown to them. Other inclusion criteria were the childbearing age (17–45) and the onset of PGP during pregnancy or within three weeks postpartum. An active straight leg raise test and posterior pelvic pain provocation test were performed on all women and their results were reported, [ 28 , 29 ] but positive test results were not among the inclusion criteria. Exclusion criteria for the study included hip osteoporosis and other skeletal disorders, history of surgery or tumor in the spine or pelvis, chronic pelvic pain secondary to vaginismus, spondylolisthesis or other significant rheumatic conditions, inflammatory disorders, prolapse or major urinary issues, challenges or inability to comprehend the questionnaires, and signs of severe medical and neurological conditions (such as weakness in the lower limbs, altered reflexes, pain radiating below the knee, or sensory loss corresponding to a specific spinal nerve). Data quality: The amounts of missing data at the item and scale levels of the instruments were compared. Floor and ceiling effects of the Arabic-PGQ were assessed by analysing the percentages of respondents who achieved the lowest (0%) or highest (100%) possible total scores. The floor or ceiling effect was considered if more than 15% of respondents achieved the lowest or highest possible total score, respectively. [ 30 ] Internal consistency: Cronbach's alpha was used to determine Arabic-PGQ's internal consistency, with alpha values between 0.70 and 0.95 indicating good internal consistency [ 30 ]. Construct validity: Our study measured the construct validity to determine how well the scores on the Arabic-PGQ reflect the disability in women with PGP. We used the same method postulated in the Swedish version of PGQ and utilised in the Chinese version of PGQ to evaluate the divergent and convergent validity of Arabic-PGQ. [ 11 , 12 ] Accordingly, we tested five hypotheses: 1) a strong correlation between the ODI and the Arabic-PGQ total scale scores 2) a strong correlation between the ODI and the Arabic-PGQ activity subscale scores; 3) a moderate correlation between the ODI and the Arabic-PGQ symptom subscale scores; 4) a strong correlation between NRS and the Arabic-PGQ total scale scores; 5) a strong correlation between NRS scores and the Arabic-PGQ symptoms subscale scores. If 75% or more of the hypotheses were confirmed, adequate construct validity was considered. [ 30 ] Spearman's correlation coefficients were utilised to examine the association between the PGQ and other instruments (ODI and NRS). Correlation coefficients below 0.3 were interpreted as indicative of a low correlation, between 0.3 and 0.6 as moderate correlation, and exceeding 0.6 as a high degree of correlation. [ 31 ] Discriminative validity: The ability of the Arabic-PGQ to distinguish between different groups, depending on their Arabic-PGQ total scale and individual subscales scores, was analysed using the area under the receiver operating characteristic (ROC) curve (AUC) for two conditions. First, to differentiate between women who reported they needed or would seek treatment for PGP and those who did not have such treatment needs. Second, to separate pregnant women from those in the postpartum period. The ROC curve scores, ranging from 0.50 (no discriminatory ability) to 1.0 (perfect discriminatory ability), measured the model's predictive accuracy. [ 32 ] The threshold for considering the AUC from the ROC curve as adequate was set at 0.70. [ 33 ] Test-retest reliability: To further verify the reliability of the Arabic-PGQ, a random group of the primarily recruited women for the second phase of the study filled out the Arabic-PGQ again seven to ten days after the date of primary completion. [ 30 ] Before retesting them, the eligibility criteria were re-checked. Test-retest reliability was assessed with a 2-way random-effects model, [ 32 ] and ICC value above 0.80 indicated good reproducibility. The test-retest agreement was expressed as the minimal detectable change (MDC) at the individual level (MDC ind ) and at the group level (MDC group ). MDC was assessed using the standard error of measurement (SEM), and both were computed using formulas detailed in the literature. The MDC reflects the smallest change in score that, with P-value < 0.05, can be interpreted as a ‘‘real’’ change, above measurement error. [ 30 ] Statistical analysis: Data analysis was conducted utilising version 29.0 of the SPSS statistical software (SPSS Inc., Chicago, IL, USA). Quantitative variables were presented as means and standard deviations or medians and interquartile ranges according to the normality of data distribution. Qualitative variables were presented as frequencies and percentages. Results Translation and cross-cultural adaptation (first phase): The expert committee (stage four) discussed several cross-cultural adaptations before the pilot testing of the prefinal Arabic-PGQ. The Arabic translation of some words in the English original PGQ seemed very unfamiliar or unnatural and could be misunderstood. These include words like “problematic” in the introduction question of the PGQ and the head question of the 20-tem activity subscale, “have” in item 19 (have a normal sex life), “experience” in the head question of the 5-item symptom subscale, “given way” in item 23, and the scale measures like “to a small extent”; “to some extent”; “to a large extent”; “some”; “considerable”. We replaced them, respectively, with Arabic translations of the words “difficult”, “practice”, “feel”, “suddenly and severely weakened”, and “mild”; “moderate”; “severe”; “mild”; “severe”. We did this after contacting the original PGQ author to make sure these replacements would not change the medical or technical aspects of the disabilities they were intended to measure, and we got her approval. During the pilot study (stage five), most women said that they would not normally “stand for more than 60 minutes” or “walk for more than 60 minutes” (items 3 and 8), especially after they became pregnant or gave labour. Similarly, fewer women said that they no longer “carry heavy objects” or “push something with one foot” (items 12 and 20). So, we asked them how difficult it would be if they were to do these actions, and we recorded the reported score. According to the original PGQ author, “A self-reported questionnaire may not be about what you are actually doing but what you think would happen if you did”. Items 14, “push a shopping cart”, and 15 “, run”, did not apply to most women as they do not usually do shopping in the supermarkets or run on purpose. After discussing these with the original PGQ author, we decided to change them to “push something with your hands” and “walk fast”, respectively, similar to the Nepali version of PGQ. [ 13 ] Item 16, “carry out sporting activities”, did not apply to most women, but we did not change this as there was the option of the “not applicable” box. In stage four of the first phase of this study, the Arabic translation of item 17, “lie down”, was changed to another Arabic synonym, “الاستلقاء” which was found to be more understandable to the women than the previous Arabic translation ", الاضطجاع". The Arabic translation in item 23, “suddenly and severely weakened”, was not understandable by most women in the pilot study. We tried different rewordings to deliver the same meaning. The Arabic translation of “failed to carry you” was the most understandable for this item (23). So, we decided to change this in the final Arabic-PGQ. (Appendix 1) All these changes were made after approval of the original PGQ author to ensure they carried the same meanings and would not affect the validity of the questionnaire. Table 1 summarises the expert committee review and pre-final Arabic-PGQ study results. Table 1 Expert committee review and pilot study results. Item Not applicable Not understandable Modification How problematic is it for you because of your pelvic girdle pain to…… How difficult is it for you because of your pelvic girdle pain to…… To what extent do you find it problematic to carry out…. (..../ to small extent/ to some extent/ to large extent) To what extent do you find it difficult to carry out…. (.../ mild/ moderate/ severe) 1. Dress yourself 2. Stand for less than 10 min 3. Stand for more than 60 min 12 4. Bend down 5. Sit for less than 10 min 6. Sit for more than 60 min 7. Walk for less than 10 min 8. Walk for more than 60 min 16 9. Climb up and down the stairs 10. Do housework 11. Carry light objects 12. Carry heavy objects 6 13. Get up/sit down 14. Push a shopping cart 11 Push something with your hands 15. Run 14 Walk fast 16. Carry out sporting activities 17 17. Lie down 14 Another Arabic synonym to lie down (الاستلقاء) 18. Roll over in bed 1 19. Have a normal sex life 2 Practice a normal sex life 20. Push something with one foot 3 How much pain do you experience: (../ some/ moderate/ considerable) How much pain do you feel: (../ mild/ moderate/ severe) 21. Pain in the morning 22. Pain in the evening To what extent because of pelvic girdle pain: (..../ to small extent/ to some extent/ to large extent) To what extent because of pelvic girdle pain: (.../ mild/ moderate/ severe) 23. Has your leg/have your legs given way? 5 11 Has your leg/have your legs suddenly and severely weakened Your leg/ legs failed to carry you 24. Do you do things more slowly? 25. Is your sleep interrupted? Validation (second phase): Seven of the 147 women recruited for this study phase were excluded because they met one or more of the exclusion criteria. The 17 women of the pilot study were also excluded. Finally, 140 women were included in the validation part of the study and the final analysis. Table 2 summarises the characteristics of women included in this study phase and the clinical outcomes. Table 2 Characteristics and clinical outcomes of the participants in the validation part of the study Variable (unit of measurement) Mean (SD) or number (%) Age (years) 27.24 (5.79) BMI (KG/ M2) 30: 10 (7.1%) 68 (48.6%) 39 (27.9%) 23 (16.4%) Residence: Urban Rural 85 (60.8%) 65 (39.2%) Working during pregnancy Yes No 14 (10%) 126 (90%) Educational level No education Primary school degree Seconadry scool degree High school degree/ Professional diploma University degree Postgraduate degree 16 (11.4%) 22 (15.7%) 32 (22.9%) 46 (32.9%) 23 (16.4%) 1 (0.7%) Parity 0 1 2 3 or more 51 (36.4%) 35 (25%) 25 (17.9%) 29 (20.8%) Hisotry of PGP pre-pregnancy Yes No 23 (16.4%) 117 (83.6%) Weight gain during pregnnacy (valid: n = 110) (KGs) 7.45 (3.6) Pregnant Postpartum Gestational age (weeks) Pain duration (weeks) Time since delivery (weeks) Pain duration (weeks) 33.3 (5) 6.29 (3.4) 3.47 (3.36) 9.71 (6.28) Current status Pregnant Postpartum 123 (87.9%) 17 (12.1%) Need medical treatment for PGP Yes No 31 (22.1%) 109 (87.9%) Active straight leg raise test on right side Positive Negative 25 (17.9%) 115 (82.1%) Active straight leg raise test on left side Positive Negative 23 (16.4%) 117 (82.6%) Posterior pelvic pain provocation test on right side Positive Negative 37 (26.4%) 103 (73.6%) Posterior pelvic pain provocation test on left side Positive Negative 37 (26.4%) 103 (73.6%) SD: standard deviation. BMI: body-mass-index. PGP: pelvic girdle pain. Table 3 summarises the instruments' scores. None of the instruments demonstrated ceiling or floor effects, whether considering the overall score or the individual subscales of the PGQ. Table 3 Outcome of the Pelvic Girdle Questionnaire and other instruments in the validation phase of the study Outcome (n = 140) Mean (SD); min-max Number (%) of women with lowest scores Number (%) of women with highest scores PGQ total score % 64.3 (14.2); 30.6–93.3 1 (0.7%) 2 (1.4%) PGQ activity subscale score % 62.4 (14.4); 26.6–93.3 1 (0.7%) 1 (0.7%) PGQ symptoms subscale score % 71.7 (14.2); 13.3–100 1 (0.7%) 7 (5%) ODI score % 49.5 (14.7); 18–86 2 (1.4%) 1 (0.7%) NRS score % 69.7 (15.6); 40–100 7 (5%) 10 (7.1%) SD: standard deviation. PGQ: Pelvic Girdle Questionnaire. ODI: Oswestry Disability Index. NRS: Numeric Rating Scale For item 16, 58 women reported it was “not applicable”. For item 19, 17 women reported the same. There is no other missing data for the rest of the Arabic-PGQ items, ODI, and NRS. The internal consistency for the Arabic-PGQ total scale and activity subscale was good (α = 0.825 and 0.774), but it was lower when calculated for the symptoms subscale ( α = 0.651). (Table 4 ) Table 4 missing data and internal consistency for the Arabic version of the PGQ Instrument and items Number of women with missing data Mean Standard deviation Correlated itam- total correlation Cronbach’s alpha/ Cronbach’s alpha if item is deleted PGQ total scale score 47.26 10.62 0.825 PGQ activity subscale score 36.50 8.59 0.774 1. Dress yourself 0 1.11 1.13 0.399 0.759 2. Stand for less than 10 min 0 1.05 0.95 0.548 0.753 3. Stand for more than 60 min 0 2.76 0.61 0.444 0.762 4. Bend down 0 2.05 0.90 0.423 0.761 5. Sit for less than 10 min 0 0.89 0.93 0.479 0.757 6. Sit for more than 60 min 0 2.49 0.91 0.332 0.765 7. Walk for less than 10 min 0 1.01 0.93 0.517 0.755 8. Walk for more than 60 min 0 2.77 0.63 0.306 0.768 9. Climb up and down the stairs 0 2.22 0.93 0.504 0.758 10. Do housework 0 1.99 0.89 0.353 0.764 11. Carry light objects 0 0.40 0.57 0.113 0.775 12. Carry heavy objects 0 2.61 0.77 0.335 0.764 13. Get up/sit down 0 1.57 1.04 0.293 0.767 14. Push object with hand 0 0.94 1.08 0.361 0.762 15. Walk fast 0 2.78 0.55 0.250 0.771 16. Carry out sporting activities 58 1.66 1.43 0.124 0.793 17. Lie down 0 1.87 1.09 0.246 0.776 18. Roll over in bed 0 1.85 1.14 0.346 0.767 19. practice a normal sex life 17 2.00 1.10 0.249 0.771 20. Push something with one foot 0 1.61 1.19 0.484 0.754 PGQ symptom subscale score 10.76 2.88 0.651 21. Pain in the morning 0 1.47 1.08 0.353 0.640 22. Pain in the evening 0 2.46 0.73 0.351 0.633 23. Has your leg/have your legs failed to carry you? 0 1.88 1.05 0.603 0.526 24. Do you do things more slowly? 0 2.47 0.70 0.432 0.600 25. Is your sleep interrupted? 0 2.48 0.81 0.426 0.580 PGQ: pelvic girdle questionnaire Table 5 shows the correlation between the Arabic-PGQ total, activity subscale, symptoms subscale, ODI, and NRS scores. Regarding construct validity, four out of five (80%) prior hypotheses were confirmed (Table 6 ). Table 5 Spearman’s correlation analysis among the pelvic girdle questionnaire, Oswestry disability index and numeric rating scale (n = 140) ODI NRS PGQ activity PGQ symptoms PGQ total ODI 1.000 NRS .333 1.000 PGQ activity .612 .590 1.000 PGQ symptoms .519 .578 .611 1.000 PGQ total .637 .634 .976 .756 1.000 PGQ: Pelvic Girdle Questionnaire. ODI: Oswestry Disability Index. NRS: Numeric Rating Scale. Table 6 Five a priori formulated hypotheses and correlation coefficient values for construct validity (n = 140) Hypothesis Instruments compared Spearman’s correlation coeffcient Hypothesis Confirmed? High correlation between PGQ total score and ODI PGQ total-ODI 0.637 Yes High correlation between PGQ activity subscale and ODI PGQ activity subscale-ODI 0.612 Yes Moderate correlation between PGQ symptom subscale and ODI PGQ symptom subscale-ODI 0.519 Yes High correlation between PGQ total score and NRS PGQ total-NRS 0.634 Yes High correlation between PGQ symptom subscale and NRS PGQ symptom subscale-NRS 0.578 No PGQ: Pelvic Girdle Questionnaire. ODI: Oswestry Disability Index. NRS: Numeric Rating Scale. For the translated questionnaire's discriminative validity, the Arabic-PGQ total scale and activity subscale scores could significantly differentiate between pregnant and postpartum women (Fig. 3 ). However, they could not significantly discriminate between women who reported needing treatment for PGP and those who did not. The symptoms subscale score could not differentiate between the two groups for the two conditions (Table 7 ). Table 7 Comparison of instrument scores according to status and treatment needs by ROC curve analysis. Pregnancy Treatment need Item AUC 95% CI P-value AUC 95% CI P-value PGQ total 0.714 0.632–0.787 < 0.001 0.559 0.473–0.643 0.269 PGQ activity subscale 0.718 0.635–0.79 < 0.001 0.55 0.464–0.635 0.347 PGQ symptoms subscale 0.658 0.573–0.736 0.023 0.559 0.473–0.643 0.267 PGQ: pelvic girdle questionnaire. AUC: area under the curve. CI: confidence interval. Finally, test-retest reliability measurement for a random sample of 62 women who repeated the Arabic-PGQ seven to ten days after the date of primary testing showed good reproducibility (ICC > 0.8) and acceptable agreement (MDC ind : 17.26%- 19.64%) for the Arabic-PGQ total scale and individual subscales scores. Arabic-PGQ test and retest scores, ICCs, SEMs, and MDCs are summarised in Table 8 . Table 8 Test-Retest Scores, Measurement Error, and Intraclass Correlation Coef!cient of the Arabic-OGQ Arabic-PGQ Test score % mean (SD) Retest score % mean (SD) Difference mean (SD) SEM MDC ind MDC group ICC (95% CI) Total 64.3 (14.2) 68 (15.9) 3.7 (8.81) 6.23% 17.26% 2.19% 0.851 (0.741–0.913) Activity subscale 62.4 (14.4) 66.4 (16.8) 4 (9.85) 6.96% 19.20% 2.43% 0.808 (0.675–0.886) Symptoms subscale 71.7 (14.2) 73.9 (19.1) 2.2 (10.04) 7.09% 19.64% 2.49% 0.890 (0.815–0.934) ICC: intraclass correlation coefficient. PGQ: Pelvic Girdle Questionnaire. SD: standard deviation. MDC ind : minimal detectable change at the individual level. MDC group : minimal detectable change at the group level. SEM: standard error measurement Discussion Through cross-cultural adaptation and validation, [ 23 ] the Arabic-PGQ was developed to evaluate its applicability in assessing PGP among Arabic-speaking women. The study revealed that Arabic-speaking women experiencing PGP could easily comprehend and respond to the culturally adapted questionnaire. The good internal consistency, construct validity, and reliability in the test-retest analysis proved the validity of the Arabic-PGQ. This makes it a dependable tool for assessing PGP in Arabic-speaking women. In the translation and cross-cultural adaptation phase, a few modifications and rewordings were necessary to ensure the PGQ’s applicability to Arabic culture. Still, most expressions and meanings of the Arabic version were equivalent to the original PGQ. [ 7 ] No floor or ceiling effects were present in our study, which indicates that our questionnaire can distinguish patients with the lowest or highest possible scores. The original, as well as most translated PGQ validation studies, had similar results. [ 7 – 14 , 16 , 18 ] Only the Brazilian PGQ study had a ceiling effect (24%). [ 15 ] The Arabic-PGQ study mean scores for the total scale and individual subscales (62.4–71.7%) were higher than the original PGQ (57.9–58.8%) and all its translated versions’ validation studies that reported their scores (27.2–59.4%). [ 8 , 10 – 13 , 15 – 18 , 20 ] High parity was a common finding in the studies with the highest scores like our study and the original PGQ study (38.7 and 46%, respectively, multipara), [ 8 ]. In comparison, low parity was found in the studies with the lowest scores like the French and Nepali versions (8.6 and 11%, respectively, multipara). [ 10 , 13 ] The internal consistency for our study's total scale, activity subscale, and symptoms subscale (Cronbach alpha = 0.825, 0.77, and 0.65; respectively) is comparable to the activity and symptoms subscale results of the original PGQ (0.86 and 0.68). [ 8 ] Our results are lower in comparison with the Spanish (0.961, 0.961, and 0.960), Japanese (0.96, 0.96, and 0.96), and the Swedish versions of PGQ (0.96, 0.95, and 0.82). [ 9 , 11 , 18 ] However, a consistency coefficient higher than 0.95 has been associated with redundancy among questionnaire items. [ 30 ] The Arabic-PGQ symptoms subscale scored lower than the activity one, which is a similar finding in most PGQ translated versions’ validation studies and even the original PGQ. [ 8 , 9 , 11 – 13 , 17 ] This has been attributed to the limited number of items in the symptoms subscale of the PGQ. [ 13 ] The symptoms subscale scored higher than the total scale and activity subscale only in the Iranian version of PGQ. [ 20 ] The Arabic-PGQ used the same method and showed a construct validity similar to that of the Swedish and Chinese versions of PGQ (80% of hypotheses confirmed). [ 11 , 12 ] Because we did not use the NRS for the PGP concerns instrument used in the Swedish version of PGQ, we tested the same hypotheses as the Chinese PGQ study. [ 11 , 12 ] The Arabic-PGQ total scale and activity subscale scores could differentiate between pregnant and postpartum women with PGP, while the symptoms subscale could not (AUC = 0.714, 718, and 0.658). This was similar to the results of the original PGQ (AUC = 0.713, 0.722, and 0.679), where the symptoms subscale could not differentiate between them either. [ 8 ] Postpartum women included in our study were only 17/140 (12.1%), which weakens its reliability to use for this purpose. Postpartum women are less in our study because women rarely visit our center postpartum as the primary health care units provide contraception and sometimes check wounds postpartum. Failure to discriminate between pregnant and postpartum women with PGQ was a common finding in the Spanish and Chinese versions of the PGQ. [ 9 , 12 ] Unlike the Chinese and Swedish versions of the PGQ, [ 11 , 12 ] our study failed to discriminate between treatment and non-treatment groups of women with PGP. This might be explained by the fact that all women included in our study came to the center for antenatal care and not for PGP care and that most women in the treatment group were not actually on treatment but they would need treatment for the pain. Subjective variance in the report of needing treatment or not might explain why the scores in the treatment group were not significantly higher than those in the non-treatment group, especially with the remarkably different social-cultural background of our study population (17.1% have a university degree or higher education, 10% working during pregnancy, and 39.2% from rural areas) than the Chinese and Swedish studies’ populations (96.2% and 68.4%, respectively, have a university degree or higher education). [ 11 , 12 ] To test the reliability of the Arabic-PGQ, a random sub-sample of 62 women was retested seven to ten days after the first testing. The results showed a high level of consistency for the total scale and the individual subscales scores, as reflected by the ICC values > 0.8. This demonstrates the high reliability and stability of the Arabic-PGQ. Similar results were reported for the original and most translated versions of the PGQ [ 7 – 9 , 12 , 14 – 17 , 20 ]. The test-retest agreement in our study is comparable to that in the original, Brazilian, Brazilian-Portuguese, and Nepali versions of PGQ, [ 7 , 8 , 13 , 15 , 16 ] and most self-reported questionnaires (MDC ind :10–35%). [ 8 ] Low MDCs (< 10%) was reported only in the Iranian version of PGQ, [ 20 ] while low SEMs without reporting the MDCs were reported in the Spanish and Chinese PGQ studies. [ 9 , 11 ] One strength of our study is that we followed the guidelines for the translation and cross-cultural adaptation process, [ 23 ] for calculating the sample size, [ 26 ] and for validating the study. [ 27 – 30 ] The low non-response rate for all items in all instruments used in our study was also remarkable. Limitations: First, the study recruited subjects from one tertiary center, and women referred to this center had similar socio-economic and cultural backgrounds. This could have affected the overall scores, the discriminatory validity of the Arabic-PGQ, and its generalizability to Arabic-speaking communities with different backgrounds. Although some of the population in the Arab world has the same demographics, [ 21 ] future research may recruit women from different centers and with diverse backgrounds to confirm the reliability of the Arabic-PGQ. Second, we did not include a positive active straight leg raise test and/ or posterior pelvic pain provocation test as an inclusion criteria/ion in our study. This is because, during our pilot study, some women complained of severe PGP while the tests were negative on one or both sides of the pelvis. Also, as some of our researchers were practising doing the tests, they found the tests were sometimes positive in women who were not complaining of PGP. After discussing with the original PGQ author, we decided to make the pain location the main inclusion criterion in our study and report the results of the tests as secondary outcomes. We are unsure if this has affected the Arabic-PGQ scores. We did not do statistical analysis to correlate the tests’ results with the Arabic-PGQ scores and other outcomes. Future studies about the Arabic-PGQ may include a positive test as an inclusion criterion and compare their results with our results. Finally, the French and the Swedish versions of the PGQ did not include positive tests as an inclusion criterion for all patients either. [ 4 , 11 ] One rationale for this was that self-reported PGP correlates well with the clinically examined PGP. [ 11 , 34 ] Finally, like the Nepali version of PGQ, and since our study population has socio-economic and educational backgrounds similar to Nepal's, interviewing was the appropriate data collection method for our study. [ 13 ] There is no evidence of bias with this data collection method in self-reported questionnaires. [ 35 ] Moreover, it reduced the non-response rate. In conclusion, PGQ is an objective, standardised, and internationally recognised method of PGP assessment in pregnant and postpartum women. PGP is underdiagnosed and, therefore, undermanaged in Arabic-speaking communities. Creating this Arabic version of the PGQ provides Arabic-speaking clinical settings with a valid, reliable, and easy-to-understand PGP assessment tool. This improves patient care and facilitates an evidence-based clinical practice in Arabic-speaking communities and contributes to global research. Declarations Ethical approval and consent to participate: This study was approved by the Cairo University Faculty of Medicine research ethics committee, with approval number N-419-2022. Before participating in the study, all women provided written informed consent. Consent for publication: Before participating in the study, all women provided written informed consent that included information that their data would be used in publication. Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests Funding: No/ self-funding Authors' contributions: IE and BS provided the concept/idea/design. SE, AE, and HA provided data collection. IE and MY provided data analysis. IE and BS provided manuscript writing. All authors read and approved the final manuscript. Acknowledgement: We thank Prof. Mona Selim Faggal, Prof. Rania Elkhateb, Dr. Islam Ali, Dr. Islam Youssef, Menna Sherif, and Yassin Elmahgoub for assistance and cooperation in the different steps of the translation and cross-cultural adaptation process (phase one). Authors’ information: 1 Department of Obstetrics and Gynecology, Cairo University Students’ Hospital, Cairo, Egypt. 2 Department of Obstetrics and Gynaecology, Cairo University Kasr Alainy Teaching Hospital, Cairo, Egypt. 3 Department of Community Medicine, Ain Shams University Faculty of Medicine, Ain Shams University, Cairo, Egypt. 4 Division of Orthopaedic Surgery, Oslo University Hospital, Kirkeveien 166, NO-0407, Oslo, Norway. References Vleeming A, Albert HB, Östgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17:794–819. Kanakaris NK, Roberts CS, Giannoudis PV. Pregnancy-related pelvic girdle pain: an update. BMC Med. 2011;9:1–5. Wu WH, Meijer OG, Uegaki K, Mens JM, Van Dieen JH, Wuisman PI, Östgaard HC. Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. Eur Spine J. 2004;13:575–89. Girard M-P, Marchand A-A, Stuge B, Ruchat S-M, Descarreaux M. Cross-cultural Adaptation of the Pelvic Girdle Questionnaire for the French-Canadian Population. J Manipulative Physiol Ther. 2016;39(7):494–9. Gutke A, Olsson CB, Vollestad N, Öberg B, Nilsson Wikmar L, Stendal Robinson H. Association between lumbopelvic pain, disability and sick leave during pregnancy-a comparison of three Scandinavian cohorts. J Rehabil Med. 2014;46(5):468–74. Dørheim SK, Bjorvatn B, Eberhard-Gran M. Sick leave during pregnancy: a longitudinal study of rates and risk factors in a Norwegian population. BJOG: Int J Obstet Gynecol. 2013;120(5):521–30. Stuge B, Garratt A, Krogstad Jenssen H, Grotle M. The pelvic girdle questionnaire: a condition-specific instrument for assessing activity limitations and symptoms in people with pelvic girdle pain. Phys Ther. 2011;91(7):1096–108. Grotle M, Garratt AM, Krogstad Jenssen H, Stuge B. Reliability and construct validity of self-report questionnaires for patients with pelvic girdle pain. Phys Ther. 2012;92(1):111–23. Rejano-Campo M, Ferrer-Peña R, Urraca-Gesto MA, Gallego-Izquierdo T, Pecos-Martín D, Stuge B, et al. Transcultural adaptation and psychometric validation of a Spanish-language version of the Pelvic Girdle Questionnaire. Health Qual Life Outcomes. 2017;15(1):30. Girard M-P, O’Shaughnessy J, Doucet C, Lardon E, Stuge B, Ruchat S-M, et al. Validation of the French-Canadian Pelvic Girdle Questionnaire. J Manipulative Physiol Ther. 2018;41(3):234–41. Gutke A, Stuge B, Elden H, Sandell C, Asplin G, Fagevik Olsén M. The Swedish version of the pelvic girdle questionnaire, cross-cultural adaptation and validation. Disabil Rehabil. 2020;42(7):1013–20. Cong H, Liu H, Sun Y, Gao J, Liu J, Ma L, et al. Cross-cultural adaptation, reliability, and validity of a Chinese version of the pelvic girdle questionnaire. BMC Pregnancy Childbirth. 2021;21(1):470. Acharya RS, Tveter AT, Grotle M, Khadgi B, Koju R, Eberhard-Gran M, et al. Cross-Cultural Adaptation and Validation of the Nepali Version of the Pelvic Girdle Questionnaire. J Manipulative Physiol Ther. 2020;43(3):257–65. Kalsoom F, Ikram M, Noor R, Abdulhameed S, Bashir MS. Translation and validation of the Pelvic Girdle Questionnaire in the Urdu language. Int Urogynecol J. 2023. Simões L, Teixeira-Salmela LF, Magalhães L, Stuge B, Laurentino G, Wanderley E, et al. Analysis of Test-Retest Reliability, Construct Validity, and Internal Consistency of the Brazilian Version of the Pelvic Girdle Questionnaire. J Manipulative Physiol Ther. 2018;41(5):425–33. Fagundes FM, de Cabral L. Cross-cultural adaptation of the Pelvic Girdle Questionnaire (PGQ) into Brazilian Portuguese and clinimetric testing of the PGQ and Roland Morris questionnaire in pregnancy pelvic pain. Braz J Phys Ther. 2019;23(2):132–9. Yelvar GD, Çırak Y, Demir YP, Türkyılmaz ES. Cultural adaptation, reliability and validity of the pelvic girdle questionnaire in pregnant women. Ankara Med J. 2019;19(3):513–23. Sakamoto A, Hoshi K, Gamada K. Transcultural Reliability and Validity of the Japanese-Language Version of the Pelvic Girdle Questionnaire. J Manipulative Physiol Ther. 2020;43(1):68–77. Starzec M, Truszczyńska-Baszak A, Stuge B, Tarnowski A, Rongies W. Cross-cultural Adaptation of the Pelvic Girdle Questionnaire for the Polish Population. J Manipulative Physiol Ther. 2018;41(8):698–703. Rashidi Fakari F, Kariman N, Ozgoli G, Ghare Naz MS, Ghasemi V, Rashidi Fakari F, et al. Iranian version of Pelvic Girdle Questionnaire: Psychometric properties and cultural adaptation. J Res Med Sci. 2019;24:43. Arab development portal. https://www.arabdevelopmentportal.com . Accessed 5 September 2024. Al-Sayegh NA, Salem M, Dashti LF, Al-Sharrah S, Kalakh S, Al-Rashidi R. Pregnancy-related lumbopelvic pain: prevalence, risk factors, and profile in Kuwait. Pain Med. 2012;13(8):1081–7. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186–91. Fairbank JC, Pynsent PB. The Oswestry disability index. Spine. 2000;25(22):2940–53. Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Breivik Hals EK, Kvarstein G, Stubhaug A. Assessment of pain. Br J Anaesth. 2008;101(1):17–24. Kline RB. Principles and Practice of Structural Equation Modeling. 3rd ed. New York: Guilford Press; 2010. p. 422. Ahlqvist K, Bjelland EK, Pingel R, Schlager A, Peterson M, Olsson CB, Nilsson-Wikmar L, Kristiansson P. Generalized joint hypermobility and the risk of pregnancy‐related pelvic girdle pain: Is body mass index of importance?—A prospective cohort study. Acta Obstet Gynecol Scand. 2023;102(10):1259–68. Mens JM, Vleeming A, Snijders CJ, Koes BW, Stam HJ. Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy. Spine. 2001;26(10):1167–71. Östgaard HC, Zetherström G, Roos-Hansson E. The posterior pelvic pain provocation test in pregnant women. Eur Spine J. 1994;3:258–60. Terwee CB, Bot SDM, de Boer MR, van der Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34–42. Andresen EM. Criteria for assessing the tools of disability outcomes research. Arch Phys Med Rehabil. 2000;81(Supplement 2):S15–20. Altman DG. Practical Statistics for Medical Research. London: Chapman&Hall/CRC; 1990. pp. 358–9. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63:737–45. Fagevik Olsén M, Gutke A, Elden H, Nordenman C, Fabricius L, Gravesen M, Lind A, Kjellby-Wendt G. Self-administered tests as a screening procedure for pregnancy-related pelvic girdle pain. Eur Spine J. 2009;18:1121–9. Rutherford C, Costa D, Mercieca-Bebber R, Rice H, Gabb L, King M. Mode of administration does not cause bias in patient-reported outcome results: a meta-analysis. Qual Life Res. 2016;25:559–74. Additional Declarations No competing interests reported. Supplementary Files Appendix1ArabicPGQ.pdf Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 11 Mar, 2026 Reviews received at journal 18 May, 2025 Reviewers agreed at journal 10 May, 2025 Reviews received at journal 04 May, 2025 Reviewers agreed at journal 29 Apr, 2025 Reviewers invited by journal 20 Apr, 2025 Editor invited by journal 24 Mar, 2025 Editor assigned by journal 24 Mar, 2025 Submission checks completed at journal 24 Mar, 2025 First submitted to journal 19 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6263774","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":445673659,"identity":"18fffcd3-93a3-40a8-bff4-6a0b7f10bab2","order_by":0,"name":"Islam T. 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University","correspondingAuthor":false,"prefix":"","firstName":"Mostafa","middleName":"","lastName":"Yosef","suffix":""},{"id":445673664,"identity":"688dffd6-12e9-477e-97eb-1eda8acd9229","order_by":5,"name":"Britt Stuge","email":"","orcid":"","institution":"Oslo University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Britt","middleName":"","lastName":"Stuge","suffix":""}],"badges":[],"createdAt":"2025-03-19 17:53:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6263774/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6263774/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81087507,"identity":"e3e58e93-3d42-4a1d-99cf-a2054215a4a9","added_by":"auto","created_at":"2025-04-22 06:25:42","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1010139,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the study design.\u003c/p\u003e","description":"","filename":"Figure1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6263774/v1/1dd868f5825f2df2149c8527.jpeg"},{"id":81087514,"identity":"990867db-a7ff-485c-9543-40f967140680","added_by":"auto","created_at":"2025-04-22 06:25:42","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":47986,"visible":true,"origin":"","legend":"\u003cp\u003ePelvic girdle pain was defined as pain indicated within the red borders (not shown to women) (used with permission from Ahlqvist)\u003c/p\u003e","description":"","filename":"Figure2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6263774/v1/edb1e221feeb2dbdcceedf14.jpeg"},{"id":81087512,"identity":"635a50b7-4402-411e-b550-40339a2c2bc1","added_by":"auto","created_at":"2025-04-22 06:25:42","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":42248,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve analysis to assess ability of Arabic-PGQ to discriminate between pregnant and postpartum women.\u003c/p\u003e","description":"","filename":"Figure3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6263774/v1/03a15ada259bb266e388edf1.jpeg"},{"id":81088711,"identity":"854a9f6b-601c-4e61-b2b7-e92d0f409fbc","added_by":"auto","created_at":"2025-04-22 06:41:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2280942,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6263774/v1/5785727b-9f76-4a35-a5c5-e58a612ad8e7.pdf"},{"id":81087732,"identity":"8e6eb187-1d3a-42f6-bad9-3d872791f7b1","added_by":"auto","created_at":"2025-04-22 06:33:42","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":93202,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1ArabicPGQ.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6263774/v1/5d8b4dc3b1c3af8f69d696ef.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Validation and cross-cultural adaptation of the Arabic version of the Pelvic Girdle Questionnaire","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOften confused with low back pain, pelvic girdle pain (PGP) is considered to be a different condition in terms of its aetiology and treatment. PGP is characterised by pain in the sacroiliac joints, symphysis pubis, and surrounding areas. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] It occurs mainly in women during pregnancy and postpartum periods, with a reported worldwide prevalence between 4–76%, depending on the definition and diagnostic tools. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] PGP is more prevalent in the second half of pregnancy, and it tends to improve after delivery. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eEven though the aetiology of PGP is unclear, increased PGP during pregnancy has been related to mechanical and hormonal factors. Examples are altered pelvic joint stability and increased relaxin hormone that causes the laxity of the sacroiliac joints and symphysis pubis. PGP is provoked by everyday activities such as walking, standing, sitting, and lying down, [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] which limits most daily activities and working abilities, resulting in social- and economic burdens. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] In Scandinavia, it is one of the most common reasons for pregnant women to take sick leave. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] In one study, 75.3% of the Norwegian population had been on sick leave at some point during their pregnancy due to PGP, with a median duration of eight weeks. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Due to its unique features, relatively widespread occurrence, significant effect on quality of life and economic burden on society, PGP warrants particular focus. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eTo facilitate effective clinical management of PGP, it is imperative to employ diagnostic tools that are both reliable and valid. These tools should aid in diagnosing PGP and evaluating its impact on the functional limitations and symptomatology in affected women. The Pelvic Girdle Questionnaire (PGQ) represents the sole condition-specific instrument for PGP, applicable in both research and clinical contexts during pregnancy and postpartum. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Developed in 2011, the original Norwegian version of the PGQ demonstrated solid internal consistency, reliable test-retest stability, and both construct and discriminant validity, mainly when administered to pregnant and postpartum women. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] To date, the PGQ has been translated into 12 languages and validated in most. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e–\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn Egypt and other Arab countries where a population of 445\u0026nbsp;million people lives, [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] PGP is obviously overlooked. Only one study about PGP among the Kuwaiti obstetric population was found in the literature, and it did not use a valid measure like PGQ to assess PGP. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] Since Arabic is the native language of most people living in the Arab world, an Arabic version of the PGQ (Arabic-PGQ) is necessary.\u003c/p\u003e \u003cp\u003eAdapting questionnaires to use in different cultural contexts necessitates precise translation and cultural modification. Opting to translate and culturally adapt an existing health-related quality-of-life instrument rather than developing a new one offers several advantages, including reduced time and cost and the facilitation of a standardised measure for international research. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAs Beaton et al. outlined, the cross-cultural adaptation process involves translating and culturally modifying the questionnaire, ensuring equivalence between the original and the target culture while preserving content validity. This process concludes with content validity testing to examine the retention of the questionnaire’s psychometric properties post-adaptation. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] Hence, this study aimed to translate, culturally adapt, and validate the PGQ for the Arabian population, ensuring its applicability and relevance in this specific cultural context.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eDesign:\u003c/p\u003e\u003cp\u003eThis study was divided into two distinct phases. The first phase involved the translation and cross-cultural adaptation of the PGQ, adhering to established international guidelines. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] During this phase, a pilot cross-sectional study was conducted among 17 pregnant and postpartum women experiencing PGP to evaluate the preliminary Arabic-PGQ. The second phase focused on validating and investigating the reliability of the psychometric properties of the Arabic-PGQ. This cross-sectional study phase included a cohort of 140 women, either pregnant or in the postpartum period, all suffering from PGP. For data collection, women were interviewed and asked about the questionnaire items whilst present in the outpatient clinic setting. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003eEthical considerations:\u003c/p\u003e\u003cp\u003e This study was approved by the Cairo University Faculty of Medicine research ethics committee, with approval number N-419-2022. Before participating in the study, all women provided written informed consent. Before starting this study, the author of the original PGQ (BS) was contacted to ensure no Arabic-PGQ was in process and to obtain approval and cooperation for working on this version of the PGQ.\u003c/p\u003e\u003cp\u003eInstruments:\u003c/p\u003e\u003cp\u003eThe PGQ is a self-administered instrument comprising 25 items. It includes a 20-item activity subscale that evaluates the impact of PGP on various activities and a 5-item symptom subscale that assesses the symptoms’ severity. The questionnaire uses a four-point scale for each item, ranging from 0 to 3. To calculate the overall PGQ score, all item scores are summed up and then divided by the maximum possible score of 75 (60 for activity and 15 for symptoms). If an item is marked as \"not applicable\" or left unanswered, 3 points are subtracted from the total possible score. The final scores are converted into percentages, indicating disability levels from 0% (no disability) to 100% (severe disability). [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eOswestry Disability Index (ODI) modified version 2.0 is one of the most commonly used tools in clinical practice for assessing low back pain. We utilised it in our study as a possible control in analysing the relevance of the PGQ and ODI. This version requires women to rate their perceived disability on a scale from 0 to 5 across ten domains: pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sexual life, social life, and travelling. The cumulative scores, with a maximum of 50, are doubled and expressed as a percentage. A score of 0% indicates no disability. The ODI percentages are categorised into various levels of disability: minimal or no disability (0–20%), moderate disability (20–40%), severe disability (40–60%), crippled (60–80%), or bed-bound/exaggerating symptoms (80–100%). [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThe 11-point Numeric Rating Scale (NRS), ranging from 0 to 10, is a globally used tool that assesses pain intensity. It is marked from 0 to 10, where 0 signifies the absence of pain and 10 indicates the most extreme pain imaginable. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eTranslation and cross-cultural adaptation (first phase):\u003c/p\u003e\u003cp\u003e The translation of the questionnaire from English to Arabic was conducted following the established guidelines for questionnaire translation and cross-cultural adaptation that encompass six stages. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eStage 1: Translation\u003c/p\u003e\u003cp\u003eTwo native Arabic-speaking language experts who are fluent in English independently translated the questionnaire from English to Arabic.\u003c/p\u003e\u003cp\u003eStage 2: Synthesis\u003c/p\u003e\u003cp\u003eThe two initial translations were compared with each other and the original English version, and one translation was synthesised. Neither translator had prior experience with PGP or the questionnaire.\u003c/p\u003e\u003cp\u003eStage 3: Back-translation\u003c/p\u003e\u003cp\u003eTwo native English-speaking professional translators independently back-translated the Arabic version into English without referring to the original questionnaire. After being introduced to the questionnaire, any discrepancies identified were discussed and resolved, resulting in a consensus back-translation.\u003c/p\u003e\u003cp\u003eStage 4: Expert Committee\u003c/p\u003e\u003cp\u003eA committee of psychometrics, linguistics, and PGP experts reviewed all translations and resolved any discrepancies. When translation challenges arose, the committee consulted the original English version to capture the true essence of the items. The original PGQ author was consulted for input on challenging translations and to ensure consistency with the original Norwegian version.\u003c/p\u003e\u003cp\u003eStage 5: Pre-testing\u003c/p\u003e\u003cp\u003eThe preliminary Arabic-PGQ was tested through a pilot study on 17 women experiencing PGP. All women (15 pregnant and two postpartum) were recruited from our obstetric outpatient clinics. All women were clinically diagnosed with PGP according to European guidelines. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] While interviewing them to answer the questionnaire, they were asked about each item's clarity, rewording if they found it difficult to understand, relevance to their condition, and applicability in their everyday life. The expert committee then reconvened to discuss and resolve any identified issues and inconsistencies.\u003c/p\u003e\u003cp\u003eStage 6\u003c/p\u003e\u003cp\u003eThe final Arabic-PGQ was reviewed and approved by the original PGQ author.\u003c/p\u003e\u003cp\u003eValidation (second phase):\u003c/p\u003e\u003cp\u003e The sample size was done according to the guidelines set by Kline et al., which suggest a ratio of 5 to 10 subjects for each item in the study. Thus, for a 25-item questionnaire, a minimum of 125 women were needed for this study. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eA total of 147 pregnant and postpartum women suffering from PGP were recruited for the validation phase of the study using non-probability convenience sampling. The women visited the Cairo University Kasr Alainy Obstetrics and Gynecology Hospital obstetrics outpatient clinic between 9/2023 and 12/2023.\u003c/p\u003e\u003cp\u003ePain location was the main criterion for inclusion in our study. Women were asked about pelvic pain, and if they answered yes, they were asked to point at the most painful area of their body. Women were included in the study if they reported pain in the area within the red borders in the drawing provided by Ahlqvist et al. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] which was not shown to them. Other inclusion criteria were the childbearing age (17–45) and the onset of PGP during pregnancy or within three weeks postpartum. An active straight leg raise test and posterior pelvic pain provocation test were performed on all women and their results were reported, [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] but positive test results were not among the inclusion criteria.\u003c/p\u003e\u003cp\u003eExclusion criteria for the study included hip osteoporosis and other skeletal disorders, history of surgery or tumor in the spine or pelvis, chronic pelvic pain secondary to vaginismus, spondylolisthesis or other significant rheumatic conditions, inflammatory disorders, prolapse or major urinary issues, challenges or inability to comprehend the questionnaires, and signs of severe medical and neurological conditions (such as weakness in the lower limbs, altered reflexes, pain radiating below the knee, or sensory loss corresponding to a specific spinal nerve).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003eData quality:\u003c/p\u003e\u003cp\u003eThe amounts of missing data at the item and scale levels of the instruments were compared. Floor and ceiling effects of the Arabic-PGQ were assessed by analysing the percentages of respondents who achieved the lowest (0%) or highest (100%) possible total scores. The floor or ceiling effect was considered if more than 15% of respondents achieved the lowest or highest possible total score, respectively. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eInternal consistency:\u003c/p\u003e\u003cp\u003eCronbach's alpha was used to determine Arabic-PGQ's internal consistency, with alpha values between 0.70 and 0.95 indicating good internal consistency [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eConstruct validity:\u003c/p\u003e\u003cp\u003eOur study measured the construct validity to determine how well the scores on the Arabic-PGQ reflect the disability in women with PGP. We used the same method postulated in the Swedish version of PGQ and utilised in the Chinese version of PGQ to evaluate the divergent and convergent validity of Arabic-PGQ. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Accordingly, we tested five hypotheses: 1) a strong correlation between the ODI and the Arabic-PGQ total scale scores 2) a strong correlation between the ODI and the Arabic-PGQ activity subscale scores; 3) a moderate correlation between the ODI and the Arabic-PGQ symptom subscale scores; 4) a strong correlation between NRS and the Arabic-PGQ total scale scores; 5) a strong correlation between NRS scores and the Arabic-PGQ symptoms subscale scores. If 75% or more of the hypotheses were confirmed, adequate construct validity was considered. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] Spearman's correlation coefficients were utilised to examine the association between the PGQ and other instruments (ODI and NRS). Correlation coefficients below 0.3 were interpreted as indicative of a low correlation, between 0.3 and 0.6 as moderate correlation, and exceeding 0.6 as a high degree of correlation. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eDiscriminative validity:\u003c/p\u003e\u003cp\u003eThe ability of the Arabic-PGQ to distinguish between different groups, depending on their Arabic-PGQ total scale and individual subscales scores, was analysed using the area under the receiver operating characteristic (ROC) curve (AUC) for two conditions. First, to differentiate between women who reported they needed or would seek treatment for PGP and those who did not have such treatment needs. Second, to separate pregnant women from those in the postpartum period. The ROC curve scores, ranging from 0.50 (no discriminatory ability) to 1.0 (perfect discriminatory ability), measured the model's predictive accuracy. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] The threshold for considering the AUC from the ROC curve as adequate was set at 0.70. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eTest-retest reliability:\u003c/p\u003e\u003cp\u003eTo further verify the reliability of the Arabic-PGQ, a random group of the primarily recruited women for the second phase of the study filled out the Arabic-PGQ again seven to ten days after the date of primary completion. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] Before retesting them, the eligibility criteria were re-checked. Test-retest reliability was assessed with a 2-way random-effects model, [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and ICC value above 0.80 indicated good reproducibility. The test-retest agreement was expressed as the minimal detectable change (MDC) at the individual level (MDC\u003csub\u003eind\u003c/sub\u003e) and at the group level (MDC\u003csub\u003egroup\u003c/sub\u003e). MDC was assessed using the standard error of measurement (SEM), and both were computed using formulas detailed in the literature. The MDC reflects the smallest change in score that, with P-value \u0026lt; 0.05, can be interpreted as a ‘‘real’’ change, above measurement error. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e\u003ch2\u003eStatistical analysis:\u003c/h2\u003e\u003cp\u003eData analysis was conducted utilising version 29.0 of the SPSS statistical software (SPSS Inc., Chicago, IL, USA). Quantitative variables were presented as means and standard deviations or medians and interquartile ranges according to the normality of data distribution. Qualitative variables were presented as frequencies and percentages.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTranslation and cross-cultural adaptation (first phase):\u003c/p\u003e \u003cp\u003eThe expert committee (stage four) discussed several cross-cultural adaptations before the pilot testing of the prefinal Arabic-PGQ. The Arabic translation of some words in the English original PGQ seemed very unfamiliar or unnatural and could be misunderstood. These include words like \u0026ldquo;problematic\u0026rdquo; in the introduction question of the PGQ and the head question of the 20-tem activity subscale, \u0026ldquo;have\u0026rdquo; in item 19 (have a normal sex life), \u0026ldquo;experience\u0026rdquo; in the head question of the 5-item symptom subscale, \u0026ldquo;given way\u0026rdquo; in item 23, and the scale measures like \u0026ldquo;to a small extent\u0026rdquo;; \u0026ldquo;to some extent\u0026rdquo;; \u0026ldquo;to a large extent\u0026rdquo;; \u0026ldquo;some\u0026rdquo;; \u0026ldquo;considerable\u0026rdquo;. We replaced them, respectively, with Arabic translations of the words \u0026ldquo;difficult\u0026rdquo;, \u0026ldquo;practice\u0026rdquo;, \u0026ldquo;feel\u0026rdquo;, \u0026ldquo;suddenly and severely weakened\u0026rdquo;, and \u0026ldquo;mild\u0026rdquo;; \u0026ldquo;moderate\u0026rdquo;; \u0026ldquo;severe\u0026rdquo;; \u0026ldquo;mild\u0026rdquo;; \u0026ldquo;severe\u0026rdquo;. We did this after contacting the original PGQ author to make sure these replacements would not change the medical or technical aspects of the disabilities they were intended to measure, and we got her approval.\u003c/p\u003e \u003cp\u003eDuring the pilot study (stage five), most women said that they would not normally \u0026ldquo;stand for more than 60 minutes\u0026rdquo; or \u0026ldquo;walk for more than 60 minutes\u0026rdquo; (items 3 and 8), especially after they became pregnant or gave labour. Similarly, fewer women said that they no longer \u0026ldquo;carry heavy objects\u0026rdquo; or \u0026ldquo;push something with one foot\u0026rdquo; (items 12 and 20). So, we asked them how difficult it would be if they were to do these actions, and we recorded the reported score. According to the original PGQ author, \u0026ldquo;A self-reported questionnaire may not be about what you are actually doing but what you think would happen if you did\u0026rdquo;. Items 14, \u0026ldquo;push a shopping cart\u0026rdquo;, and 15 \u0026ldquo;, run\u0026rdquo;, did not apply to most women as they do not usually do shopping in the supermarkets or run on purpose. After discussing these with the original PGQ author, we decided to change them to \u0026ldquo;push something with your hands\u0026rdquo; and \u0026ldquo;walk fast\u0026rdquo;, respectively, similar to the Nepali version of PGQ. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] Item 16, \u0026ldquo;carry out sporting activities\u0026rdquo;, did not apply to most women, but we did not change this as there was the option of the \u0026ldquo;not applicable\u0026rdquo; box. In stage four of the first phase of this study, the Arabic translation of item 17, \u0026ldquo;lie down\u0026rdquo;, was changed to another Arabic synonym, \u0026ldquo;الاستلقاء\u0026rdquo; which was found to be more understandable to the women than the previous Arabic translation \", الاضطجاع\". The Arabic translation in item 23, \u0026ldquo;suddenly and severely weakened\u0026rdquo;, was not understandable by most women in the pilot study. We tried different rewordings to deliver the same meaning. The Arabic translation of \u0026ldquo;failed to carry you\u0026rdquo; was the most understandable for this item (23). So, we decided to change this in the final Arabic-PGQ. (Appendix 1) All these changes were made after approval of the original PGQ author to ensure they carried the same meanings and would not affect the validity of the questionnaire. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarises the expert committee review and pre-final Arabic-PGQ study results.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExpert committee review and pilot study results.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot understandable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModification\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow problematic is it for you because of your pelvic girdle pain to\u0026hellip;\u0026hellip;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHow difficult is it for you because of your pelvic girdle pain to\u0026hellip;\u0026hellip;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo what extent do you find it problematic to carry out\u0026hellip;. (..../ to small extent/ to some extent/ to large extent)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTo what extent do you find it difficult to carry out\u0026hellip;. (.../ mild/ moderate/ severe)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Dress yourself\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Stand for less than 10 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Stand for more than 60 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Bend down\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Sit for less than 10 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Sit for more than 60 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Walk for less than 10 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Walk for more than 60 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Climb up and down the stairs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. Do housework\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. Carry light objects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. Carry heavy objects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13. Get up/sit down\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14. Push a shopping cart\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePush something with your hands\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15. Run\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWalk fast\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16. Carry out sporting activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17. Lie down\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAnother Arabic synonym to lie down (الاستلقاء)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18. Roll over in bed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19. Have a normal sex life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePractice a normal sex life\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20. Push something with one foot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow much pain do you experience: (../ some/ moderate/ considerable)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHow much pain do you feel: (../ mild/ moderate/ severe)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21. Pain in the morning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22. Pain in the evening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo what extent because of pelvic girdle pain: (..../ to small extent/ to some extent/ to large extent)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTo what extent because of pelvic girdle pain: (.../ mild/ moderate/ severe)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23. Has your leg/have your legs given way?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHas your leg/have your legs suddenly and severely weakened\u003c/p\u003e \u003cp\u003eYour leg/ legs failed to carry you\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24. Do you do things more slowly?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25. Is your sleep interrupted?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eValidation (second phase):\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSeven of the 147 women recruited for this study phase were excluded because they met one or more of the exclusion criteria. The 17 women of the pilot study were also excluded. Finally, 140 women were included in the validation part of the study and the final analysis. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarises the characteristics of women included in this study phase and the clinical outcomes.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics and clinical outcomes of the participants in the validation part of the study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable (unit of measurement)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean (SD) or number (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.24 (5.79)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (KG/ M2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;19:\u003c/p\u003e \u003cp\u003e19\u0026ndash;25:\u003c/p\u003e\u003cp\u003e25\u0026ndash;30:\u003c/p\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (7.1%)\u003c/p\u003e \u003cp\u003e68 (48.6%)\u003c/p\u003e \u003cp\u003e39 (27.9%)\u003c/p\u003e \u003cp\u003e23 (16.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85 (60.8%)\u003c/p\u003e \u003cp\u003e65 (39.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (10%)\u003c/p\u003e \u003cp\u003e126 (90%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo education\u003c/p\u003e \u003cp\u003ePrimary school degree\u003c/p\u003e \u003cp\u003eSeconadry scool degree\u003c/p\u003e \u003cp\u003eHigh school degree/ Professional diploma\u003c/p\u003e \u003cp\u003eUniversity degree\u003c/p\u003e \u003cp\u003ePostgraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (11.4%)\u003c/p\u003e \u003cp\u003e22 (15.7%)\u003c/p\u003e \u003cp\u003e32 (22.9%)\u003c/p\u003e \u003cp\u003e46 (32.9%)\u003c/p\u003e \u003cp\u003e23 (16.4%)\u003c/p\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e3 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (36.4%)\u003c/p\u003e \u003cp\u003e35 (25%)\u003c/p\u003e \u003cp\u003e25 (17.9%)\u003c/p\u003e \u003cp\u003e29 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHisotry of PGP pre-pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (16.4%)\u003c/p\u003e \u003cp\u003e117 (83.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWeight gain during pregnnacy (valid: n\u0026thinsp;=\u0026thinsp;110) (KGs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.45 (3.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnant\u003c/p\u003e \u003cp\u003ePostpartum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGestational age (weeks)\u003c/p\u003e \u003cp\u003ePain duration (weeks)\u003c/p\u003e \u003cp\u003eTime since delivery (weeks)\u003c/p\u003e \u003cp\u003ePain duration (weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.3 (5)\u003c/p\u003e \u003cp\u003e6.29 (3.4)\u003c/p\u003e \u003cp\u003e3.47 (3.36)\u003c/p\u003e \u003cp\u003e9.71 (6.28)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePregnant\u003c/p\u003e \u003cp\u003ePostpartum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123 (87.9%)\u003c/p\u003e \u003cp\u003e17 (12.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeed medical treatment for PGP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (22.1%)\u003c/p\u003e \u003cp\u003e109 (87.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive straight leg raise test on right side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (17.9%)\u003c/p\u003e \u003cp\u003e115 (82.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive straight leg raise test on left side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (16.4%)\u003c/p\u003e \u003cp\u003e117 (82.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosterior pelvic pain provocation test on right side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (26.4%)\u003c/p\u003e \u003cp\u003e103 (73.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosterior pelvic pain provocation test on left side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (26.4%)\u003c/p\u003e \u003cp\u003e103 (73.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSD: standard deviation. BMI: body-mass-index. PGP: pelvic girdle pain.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarises the instruments' scores. None of the instruments demonstrated ceiling or floor effects, whether considering the overall score or the individual subscales of the PGQ.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOutcome of the Pelvic Girdle Questionnaire and other instruments in the validation phase of the study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome (n\u0026thinsp;=\u0026thinsp;140)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD); min-max\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber (%) of women with lowest scores\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber (%) of women with highest scores\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGQ total score %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64.3 (14.2); 30.6\u0026ndash;93.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGQ activity subscale score %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62.4 (14.4); 26.6\u0026ndash;93.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGQ symptoms subscale score %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71.7 (14.2); 13.3\u0026ndash;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eODI score %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49.5 (14.7); 18\u0026ndash;86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNRS score %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69.7 (15.6); 40\u0026ndash;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSD: standard deviation. PGQ: Pelvic Girdle Questionnaire. ODI: Oswestry Disability Index. NRS: Numeric Rating Scale\u003c/p\u003e \u003cp\u003eFor item 16, 58 women reported it was \u0026ldquo;not applicable\u0026rdquo;. For item 19, 17 women reported the same. There is no other missing data for the rest of the Arabic-PGQ items, ODI, and NRS. The internal consistency for the Arabic-PGQ total scale and activity subscale was good (α\u0026thinsp;=\u0026thinsp;0.825 and 0.774), but it was lower when calculated for the symptoms subscale ( α\u0026thinsp;=\u0026thinsp;0.651). (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003emissing data and internal consistency for the Arabic version of the PGQ\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstrument and items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of women with missing data\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCorrelated itam- total correlation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCronbach\u0026rsquo;s alpha/ Cronbach\u0026rsquo;s alpha if item is deleted\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePGQ total scale score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e47.26\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e10.62\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.825\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePGQ activity subscale score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e36.50\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e8.59\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.774\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Dress yourself\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Stand for less than 10 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.548\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.753\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Stand for more than 60 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.762\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Bend down\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.423\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.761\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Sit for less than 10 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.757\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Sit for more than 60 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Walk for less than 10 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.755\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Walk for more than 60 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.768\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Climb up and down the stairs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.758\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. Do housework\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.764\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. Carry light objects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.775\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. Carry heavy objects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.764\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13. Get up/sit down\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.767\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14. Push object with hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.762\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15. Walk fast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16. Carry out sporting activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17. Lie down\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.776\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18. Roll over in bed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.767\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19. practice a normal sex life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20. Push something with one foot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.484\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.754\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePGQ symptom subscale score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e10.76\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2.88\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.651\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21. Pain in the morning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.640\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22. Pain in the evening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.633\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23. Has your leg/have your legs failed to carry you?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.603\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.526\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24. Do you do things more slowly?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.600\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25. Is your sleep interrupted?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.580\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003ePGQ: pelvic girdle questionnaire\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the correlation between the Arabic-PGQ total, activity subscale, symptoms subscale, ODI, and NRS scores. Regarding construct validity, four out of five (80%) prior hypotheses were confirmed (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpearman\u0026rsquo;s correlation analysis among the pelvic girdle questionnaire, Oswestry disability index and numeric rating scale (n\u0026thinsp;=\u0026thinsp;140)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eODI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNRS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePGQ activity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePGQ symptoms\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePGQ total\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eODI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGQ activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGQ symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGQ total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.756\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePGQ: Pelvic Girdle Questionnaire. ODI: Oswestry Disability Index. NRS: Numeric Rating Scale.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFive a priori formulated hypotheses and correlation coefficient values for construct validity (n\u0026thinsp;=\u0026thinsp;140)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypothesis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInstruments compared\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpearman\u0026rsquo;s correlation\u003c/p\u003e \u003cp\u003ecoeffcient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHypothesis\u003c/p\u003e \u003cp\u003eConfirmed?\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh correlation between PGQ total score and ODI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePGQ total-ODI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh correlation between PGQ activity subscale and ODI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePGQ activity subscale-ODI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate correlation between PGQ symptom subscale and ODI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePGQ symptom subscale-ODI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh correlation between PGQ total score and NRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePGQ total-NRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh correlation between PGQ symptom subscale and NRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePGQ symptom subscale-NRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePGQ: Pelvic Girdle Questionnaire. ODI: Oswestry Disability Index. NRS: Numeric Rating Scale.\u003c/p\u003e \u003cp\u003eFor the translated questionnaire's discriminative validity, the Arabic-PGQ total scale and activity subscale scores could significantly differentiate between pregnant and postpartum women (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, they could not significantly discriminate between women who reported needing treatment for PGP and those who did not. The symptoms subscale score could not differentiate between the two groups for the two conditions (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of instrument scores according to status and treatment needs by ROC curve analysis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ePregnancy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eTreatment need\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGQ total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.714\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.632\u0026ndash;0.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.559\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.473\u0026ndash;0.643\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.269\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGQ activity subscale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.635\u0026ndash;0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.464\u0026ndash;0.635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.347\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGQ symptoms subscale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.573\u0026ndash;0.736\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.559\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.473\u0026ndash;0.643\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.267\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePGQ: pelvic girdle questionnaire. AUC: area under the curve. CI: confidence interval.\u003c/p\u003e \u003cp\u003eFinally, test-retest reliability measurement for a random sample of 62 women who repeated the Arabic-PGQ seven to ten days after the date of primary testing showed good reproducibility (ICC\u0026thinsp;\u0026gt;\u0026thinsp;0.8) and acceptable agreement (MDC\u003csub\u003eind\u003c/sub\u003e: 17.26%- 19.64%) for the Arabic-PGQ total scale and individual subscales scores. Arabic-PGQ test and retest scores, ICCs, SEMs, and MDCs are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTest-Retest Scores, Measurement Error, and Intraclass Correlation Coef!cient of the Arabic-OGQ\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArabic-PGQ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTest score % mean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetest score % mean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDifference mean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSEM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMDC\u003csub\u003eind\u003c/sub\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMDC\u003csub\u003egroup\u003c/sub\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eICC (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64.3 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68 (15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.7 (8.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17.26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.19%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.851 (0.741\u0026ndash;0.913)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActivity subscale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62.4 (14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.4 (16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (9.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.96%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e19.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.43%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.808 (0.675\u0026ndash;0.886)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSymptoms subscale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71.7 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.9 (19.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.2 (10.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.09%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e19.64%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.49%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.890 (0.815\u0026ndash;0.934)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eICC: intraclass correlation coefficient. PGQ: Pelvic Girdle Questionnaire. SD: standard deviation. MDC\u003csub\u003eind\u003c/sub\u003e: minimal detectable change at the individual level. MDC\u003csub\u003egroup\u003c/sub\u003e: minimal detectable change at the group level. SEM: standard error measurement\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThrough cross-cultural adaptation and validation, [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] the Arabic-PGQ was developed to evaluate its applicability in assessing PGP among Arabic-speaking women. The study revealed that Arabic-speaking women experiencing PGP could easily comprehend and respond to the culturally adapted questionnaire. The good internal consistency, construct validity, and reliability in the test-retest analysis proved the validity of the Arabic-PGQ. This makes it a dependable tool for assessing PGP in Arabic-speaking women.\u003c/p\u003e \u003cp\u003eIn the translation and cross-cultural adaptation phase, a few modifications and rewordings were necessary to ensure the PGQ\u0026rsquo;s applicability to Arabic culture. Still, most expressions and meanings of the Arabic version were equivalent to the original PGQ. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eNo floor or ceiling effects were present in our study, which indicates that our questionnaire can distinguish patients with the lowest or highest possible scores. The original, as well as most translated PGQ validation studies, had similar results. [\u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12 CR13\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] Only the Brazilian PGQ study had a ceiling effect (24%). [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] The Arabic-PGQ study mean scores for the total scale and individual subscales (62.4\u0026ndash;71.7%) were higher than the original PGQ (57.9\u0026ndash;58.8%) and all its translated versions\u0026rsquo; validation studies that reported their scores (27.2\u0026ndash;59.4%). [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] High parity was a common finding in the studies with the highest scores like our study and the original PGQ study (38.7 and 46%, respectively, multipara), [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In comparison, low parity was found in the studies with the lowest scores like the French and Nepali versions (8.6 and 11%, respectively, multipara). [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe internal consistency for our study's total scale, activity subscale, and symptoms subscale (Cronbach alpha\u0026thinsp;=\u0026thinsp;0.825, 0.77, and 0.65; respectively) is comparable to the activity and symptoms subscale results of the original PGQ (0.86 and 0.68). [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Our results are lower in comparison with the Spanish (0.961, 0.961, and 0.960), Japanese (0.96, 0.96, and 0.96), and the Swedish versions of PGQ (0.96, 0.95, and 0.82). [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] However, a consistency coefficient higher than 0.95 has been associated with redundancy among questionnaire items. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] The Arabic-PGQ symptoms subscale scored lower than the activity one, which is a similar finding in most PGQ translated versions\u0026rsquo; validation studies and even the original PGQ. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] This has been attributed to the limited number of items in the symptoms subscale of the PGQ. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] The symptoms subscale scored higher than the total scale and activity subscale only in the Iranian version of PGQ. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe Arabic-PGQ used the same method and showed a construct validity similar to that of the Swedish and Chinese versions of PGQ (80% of hypotheses confirmed). [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Because we did not use the NRS for the PGP concerns instrument used in the Swedish version of PGQ, we tested the same hypotheses as the Chinese PGQ study. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe Arabic-PGQ total scale and activity subscale scores could differentiate between pregnant and postpartum women with PGP, while the symptoms subscale could not (AUC\u0026thinsp;=\u0026thinsp;0.714, 718, and 0.658). This was similar to the results of the original PGQ (AUC\u0026thinsp;=\u0026thinsp;0.713, 0.722, and 0.679), where the symptoms subscale could not differentiate between them either. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Postpartum women included in our study were only 17/140 (12.1%), which weakens its reliability to use for this purpose. Postpartum women are less in our study because women rarely visit our center postpartum as the primary health care units provide contraception and sometimes check wounds postpartum. Failure to discriminate between pregnant and postpartum women with PGQ was a common finding in the Spanish and Chinese versions of the PGQ. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Unlike the Chinese and Swedish versions of the PGQ, [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] our study failed to discriminate between treatment and non-treatment groups of women with PGP. This might be explained by the fact that all women included in our study came to the center for antenatal care and not for PGP care and that most women in the treatment group were not actually on treatment but they would need treatment for the pain. Subjective variance in the report of needing treatment or not might explain why the scores in the treatment group were not significantly higher than those in the non-treatment group, especially with the remarkably different social-cultural background of our study population (17.1% have a university degree or higher education, 10% working during pregnancy, and 39.2% from rural areas) than the Chinese and Swedish studies\u0026rsquo; populations (96.2% and 68.4%, respectively, have a university degree or higher education). [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eTo test the reliability of the Arabic-PGQ, a random sub-sample of 62 women was retested seven to ten days after the first testing. The results showed a high level of consistency for the total scale and the individual subscales scores, as reflected by the ICC values\u0026thinsp;\u0026gt;\u0026thinsp;0.8. This demonstrates the high reliability and stability of the Arabic-PGQ. Similar results were reported for the original and most translated versions of the PGQ [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The test-retest agreement in our study is comparable to that in the original, Brazilian, Brazilian-Portuguese, and Nepali versions of PGQ, [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and most self-reported questionnaires (MDC\u003csub\u003eind\u003c/sub\u003e:10\u0026ndash;35%). [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Low MDCs (\u0026lt;\u0026thinsp;10%) was reported only in the Iranian version of PGQ, [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] while low SEMs without reporting the MDCs were reported in the Spanish and Chinese PGQ studies. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOne strength of our study is that we followed the guidelines for the translation and cross-cultural adaptation process, [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] for calculating the sample size, [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and for validating the study. [\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] The low non-response rate for all items in all instruments used in our study was also remarkable.\u003c/p\u003e \u003cp\u003eLimitations: First, the study recruited subjects from one tertiary center, and women referred to this center had similar socio-economic and cultural backgrounds. This could have affected the overall scores, the discriminatory validity of the Arabic-PGQ, and its generalizability to Arabic-speaking communities with different backgrounds. Although some of the population in the Arab world has the same demographics, [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] future research may recruit women from different centers and with diverse backgrounds to confirm the reliability of the Arabic-PGQ.\u003c/p\u003e \u003cp\u003eSecond, we did not include a positive active straight leg raise test and/ or posterior pelvic pain provocation test as an inclusion criteria/ion in our study. This is because, during our pilot study, some women complained of severe PGP while the tests were negative on one or both sides of the pelvis. Also, as some of our researchers were practising doing the tests, they found the tests were sometimes positive in women who were not complaining of PGP. After discussing with the original PGQ author, we decided to make the pain location the main inclusion criterion in our study and report the results of the tests as secondary outcomes. We are unsure if this has affected the Arabic-PGQ scores. We did not do statistical analysis to correlate the tests\u0026rsquo; results with the Arabic-PGQ scores and other outcomes. Future studies about the Arabic-PGQ may include a positive test as an inclusion criterion and compare their results with our results. Finally, the French and the Swedish versions of the PGQ did not include positive tests as an inclusion criterion for all patients either. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] One rationale for this was that self-reported PGP correlates well with the clinically examined PGP. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eFinally, like the Nepali version of PGQ, and since our study population has socio-economic and educational backgrounds similar to Nepal's, interviewing was the appropriate data collection method for our study. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] There is no evidence of bias with this data collection method in self-reported questionnaires. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] Moreover, it reduced the non-response rate.\u003c/p\u003e \u003cp\u003eIn conclusion, PGQ is an objective, standardised, and internationally recognised method of PGP assessment in pregnant and postpartum women. PGP is underdiagnosed and, therefore, undermanaged in Arabic-speaking communities. Creating this Arabic version of the PGQ provides Arabic-speaking clinical settings with a valid, reliable, and easy-to-understand PGP assessment tool. This improves patient care and facilitates an evidence-based clinical practice in Arabic-speaking communities and contributes to global research.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical approval and consent to participate:\u0026nbsp;\u003cbr\u003eThis study was approved by the Cairo University Faculty of Medicine research ethics committee, with approval number N-419-2022. Before participating in the study, all women provided written informed consent.\u003c/p\u003e\n\u003cp\u003eConsent for publication:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBefore participating in the study, all women provided written informed consent that included information that their data would be used in publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials:\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests:\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003eFunding:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo/ self-funding\u003c/p\u003e\n\u003cp\u003eAuthors' contributions:\u003c/p\u003e\n\u003cp\u003eIE and BS provided the concept/idea/design. SE, AE, and HA provided data collection. IE and MY provided data analysis. IE and BS provided manuscript writing. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgement:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe thank Prof. Mona Selim Faggal, Prof. Rania Elkhateb, Dr. Islam Ali, Dr. Islam Youssef, Menna Sherif, and Yassin Elmahgoub for assistance and cooperation in the different steps of the translation and cross-cultural adaptation process (phase one).\u003c/p\u003e\n\u003cp\u003eAuthors’ information:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u0026nbsp;\u003c/sup\u003eDepartment of Obstetrics and Gynecology, Cairo University Students’ Hospital, Cairo, Egypt. \u003csup\u003e2\u0026nbsp;\u003c/sup\u003eDepartment of Obstetrics and Gynaecology, Cairo University Kasr Alainy Teaching Hospital, Cairo, Egypt. \u003csup\u003e3\u003c/sup\u003e Department of Community Medicine, Ain Shams University Faculty of Medicine, Ain Shams University, Cairo, Egypt. \u003csup\u003e4\u0026nbsp;\u003c/sup\u003eDivision of Orthopaedic Surgery, Oslo University Hospital, Kirkeveien 166, NO-0407, Oslo, Norway.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVleeming A, Albert HB, \u0026Ouml;stgaard HC, Sturesson B, Stuge B. 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Association between lumbopelvic pain, disability and sick leave during pregnancy-a comparison of three Scandinavian cohorts. J Rehabil Med. 2014;46(5):468\u0026ndash;74.\u003c/li\u003e\n\u003cli\u003eD\u0026oslash;rheim SK, Bjorvatn B, Eberhard-Gran M. Sick leave during pregnancy: a longitudinal study of rates and risk factors in a Norwegian population. BJOG: Int J Obstet Gynecol. 2013;120(5):521\u0026ndash;30.\u003c/li\u003e\n\u003cli\u003eStuge B, Garratt A, Krogstad Jenssen H, Grotle M. The pelvic girdle questionnaire: a condition-specific instrument for assessing activity limitations and symptoms in people with pelvic girdle pain. Phys Ther. 2011;91(7):1096\u0026ndash;108.\u003c/li\u003e\n\u003cli\u003eGrotle M, Garratt AM, Krogstad Jenssen H, Stuge B. Reliability and construct validity of self-report questionnaires for patients with pelvic girdle pain. 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Cross-cultural adaptation, reliability, and validity of a Chinese version of the pelvic girdle questionnaire. BMC Pregnancy Childbirth. 2021;21(1):470.\u003c/li\u003e\n\u003cli\u003eAcharya RS, Tveter AT, Grotle M, Khadgi B, Koju R, Eberhard-Gran M, et al. Cross-Cultural Adaptation and Validation of the Nepali Version of the Pelvic Girdle Questionnaire. J Manipulative Physiol Ther. 2020;43(3):257\u0026ndash;65.\u003c/li\u003e\n\u003cli\u003eKalsoom F, Ikram M, Noor R, Abdulhameed S, Bashir MS. Translation and validation of the Pelvic Girdle Questionnaire in the Urdu language. Int Urogynecol J. 2023.\u003c/li\u003e\n\u003cli\u003eSim\u0026otilde;es L, Teixeira-Salmela LF, Magalh\u0026atilde;es L, Stuge B, Laurentino G, Wanderley E, et al. Analysis of Test-Retest Reliability, Construct Validity, and Internal Consistency of the Brazilian Version of the Pelvic Girdle Questionnaire. J Manipulative Physiol Ther. 2018;41(5):425\u0026ndash;33.\u003c/li\u003e\n\u003cli\u003eFagundes FM, de Cabral L. Cross-cultural adaptation of the Pelvic Girdle Questionnaire (PGQ) into Brazilian Portuguese and clinimetric testing of the PGQ and Roland Morris questionnaire in pregnancy pelvic pain. Braz J Phys Ther. 2019;23(2):132\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eYelvar GD, \u0026Ccedil;ırak Y, Demir YP, T\u0026uuml;rkyılmaz ES. Cultural adaptation, reliability and validity of the pelvic girdle questionnaire in pregnant women. Ankara Med J. 2019;19(3):513\u0026ndash;23.\u003c/li\u003e\n\u003cli\u003eSakamoto A, Hoshi K, Gamada K. Transcultural Reliability and Validity of the Japanese-Language Version of the Pelvic Girdle Questionnaire. J Manipulative Physiol Ther. 2020;43(1):68\u0026ndash;77.\u003c/li\u003e\n\u003cli\u003eStarzec M, Truszczyńska-Baszak A, Stuge B, Tarnowski A, Rongies W. Cross-cultural Adaptation of the Pelvic Girdle Questionnaire for the Polish Population. J Manipulative Physiol Ther. 2018;41(8):698\u0026ndash;703.\u003c/li\u003e\n\u003cli\u003eRashidi Fakari F, Kariman N, Ozgoli G, Ghare Naz MS, Ghasemi V, Rashidi Fakari F, et al. Iranian version of Pelvic Girdle Questionnaire: Psychometric properties and cultural adaptation. J Res Med Sci. 2019;24:43.\u003c/li\u003e\n\u003cli\u003eArab development portal. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.arabdevelopmentportal.com\u003c/span\u003e\u003c/span\u003e. Accessed 5 September 2024.\u003c/li\u003e\n\u003cli\u003eAl-Sayegh NA, Salem M, Dashti LF, Al-Sharrah S, Kalakh S, Al-Rashidi R. Pregnancy-related lumbopelvic pain: prevalence, risk factors, and profile in Kuwait. Pain Med. 2012;13(8):1081\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eBeaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186\u0026ndash;91.\u003c/li\u003e\n\u003cli\u003eFairbank JC, Pynsent PB. The Oswestry disability index. Spine. 2000;25(22):2940\u0026ndash;53.\u003c/li\u003e\n\u003cli\u003eBreivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Breivik Hals EK, Kvarstein G, Stubhaug A. Assessment of pain. Br J Anaesth. 2008;101(1):17\u0026ndash;24.\u003c/li\u003e\n\u003cli\u003eKline RB. Principles and Practice of Structural Equation Modeling. 3rd ed. New York: Guilford Press; 2010. p. 422.\u003c/li\u003e\n\u003cli\u003eAhlqvist K, Bjelland EK, Pingel R, Schlager A, Peterson M, Olsson CB, Nilsson-Wikmar L, Kristiansson P. Generalized joint hypermobility and the risk of pregnancy‐related pelvic girdle pain: Is body mass index of importance?\u0026mdash;A prospective cohort study. Acta Obstet Gynecol Scand. 2023;102(10):1259\u0026ndash;68.\u003c/li\u003e\n\u003cli\u003eMens JM, Vleeming A, Snijders CJ, Koes BW, Stam HJ. Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy. Spine. 2001;26(10):1167\u0026ndash;71.\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;stgaard HC, Zetherstr\u0026ouml;m G, Roos-Hansson E. The posterior pelvic pain provocation test in pregnant women. Eur Spine J. 1994;3:258\u0026ndash;60.\u003c/li\u003e\n\u003cli\u003eTerwee CB, Bot SDM, de Boer MR, van der Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34\u0026ndash;42.\u003c/li\u003e\n\u003cli\u003eAndresen EM. Criteria for assessing the tools of disability outcomes research. Arch Phys Med Rehabil. 2000;81(Supplement 2):S15\u0026ndash;20.\u003c/li\u003e\n\u003cli\u003eAltman DG. Practical Statistics for Medical Research. London: Chapman\u0026amp;Hall/CRC; 1990. pp. 358\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eMokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63:737\u0026ndash;45.\u003c/li\u003e\n\u003cli\u003eFagevik Ols\u0026eacute;n M, Gutke A, Elden H, Nordenman C, Fabricius L, Gravesen M, Lind A, Kjellby-Wendt G. Self-administered tests as a screening procedure for pregnancy-related pelvic girdle pain. Eur Spine J. 2009;18:1121\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eRutherford C, Costa D, Mercieca-Bebber R, Rice H, Gabb L, King M. Mode of administration does not cause bias in patient-reported outcome results: a meta-analysis. Qual Life Res. 2016;25:559\u0026ndash;74.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"pelvic girdle pain, questionnaire, validation studies, cultural adaptation, pregnancy, postpartum period, Arabic version, disability evaluation, reliability, pain","lastPublishedDoi":"10.21203/rs.3.rs-6263774/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6263774/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Pelvic Girdle Pain affects pregnant and postpartum women widely, causing distressing symptoms and activity limitations, which affects the quality of life and burdens the economy. The Pelvic Girdle Questionnaire (PGQ) is the only condition-specific standardised tool for assessing activity limitations and symptoms in people with PGP. It is simple to administer and can be used in research and clinical settings during pregnancy and postpartum. There is currently no version of the PGQ in Arabic. This study aimed to translate and culturally adapt the PGQ for the Arabic-speaking population and validate whether it retains its psychometric items like the original PGQ.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This study was carried out in two phases. In the first phase, the PGQ was translated into Arabic and cross-culturally adapted following Beaton guidelines. Seventeen women were enrolled for the pilot test of this phase. In the second phase, 140 healthy pregnant and postpartum women with PGP answered the Arabic version of PGQ (Arabic-PGQ), the Oswestry Disability Index, and the Numeric Pain Rating Scale. These two additional instruments were to test the construct validity of the Arabic-PGQ. Also, floor and ceiling effects, internal consistency, and test-retest reliability and agreement of the Arabic-PGQ were analysed. Finally, the discrimination validity of the Arabic-PGQ to differentiate between women who need treatment for PGP and those who do not, and pregnant versus postpartum women with PGP was assessed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The Arabic-PGQ showed good construct validity with a high correlation between the total score and the Oswestry Disability Index (0.637) and Numeric Pain Rating Scale (0.634). The Arabic-PGQ did not show floor or ceiling effects. It showed good internal consistency with a Cronbach alpha of 0.825 for the total score. Arabic-PGQ showed good reproducibility with test-retest reliability (interclass correlation coefficient\u0026gt; 0.8) and agreement (Minimal detectable change: 17.26%- 19.64%). Arabic-PGQ total score could discriminate between pregnant and postpartum women with PGP (Area under curve= 0.714, P-value\u0026lt; 0.001), but it could not differentiate between the treatment and non-treatment women (Area under curve=0.559, P-value: 0.269)\u003c/p\u003e","manuscriptTitle":"Validation and cross-cultural adaptation of the Arabic version of the Pelvic Girdle Questionnaire","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-22 06:25:37","doi":"10.21203/rs.3.rs-6263774/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-11T19:54:22+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-18T05:51:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62648981679398204683621565408641996349","date":"2025-05-10T12:43:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-04T12:06:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"228158006874230975854325878820306869033","date":"2025-04-29T20:00:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-20T05:02:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-24T11:44:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-24T06:46:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-24T06:45:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-03-19T17:43:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"92ad106a-3015-4570-85f8-1a96ec5183df","owner":[],"postedDate":"April 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-31T23:08:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-22 06:25:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6263774","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6263774","identity":"rs-6263774","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}