Translation and psychometric evaluation of the Tamil Version of the Central Sensitization Inventory

Translation and psychometric evaluation of the Tamil Version of the Central Sensitization Inventory | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Translation and psychometric evaluation of the Tamil Version of the Central Sensitization Inventory Veeragoudhaman T.S., Thangamani Ramalingam Alagappan, Vinitha Arasu, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8850389/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The Central Sensitization Inventory (CSI) is a reliable and widely used self-reported questionnaire for assessing symptoms related to central sensitization (CS). This study aimed to cross-culturally adapt and translate the CSI into the Tamil language and to evaluate its psychometric properties. Methods: The Tamil version of the CSI was developed following recommended guidelines for translation and cultural adaptation. The final CSI-Tamil version was administered to 209 patients with chronic musculoskeletal conditions to assess its psychometric properties. Test-retest reliability was evaluated in a subsample of 96 participants. Exploratory factor analysis (EFA) was conducted to examine the factor structure of the CSI-Tamil. Results: The CSI-Tamil demonstrated good internal consistency, with a Cronbach’s alpha (α) value of 0.88. Test-retest reliability was acceptable, with an intraclass correlation coefficient (ICC) of 0.78. The mean age of the participants was 50.27 ± 11.86 years, and the majority presented with low back pain. Convergent validity demonstrated moderate positive correlations with the Numeric Pain Rating Scale (NPRS) and Beck Depression Inventory (BDI), and strong negative correlations with the World Health Organization Quality of Life (WHOQoL- BREF) scale. Exploratory factor analysis revealed a three-factor structure, supporting the multidimensional nature of the CSI-Tamil. Conclusion: The CSI-Tamil version was successfully cross-culturally adapted and translated and demonstrated acceptable psychometric properties. It can be used as a reliable and valid tool for clinical practice and research among Tamil-speaking populations. CSI-Tamil chronic musculoskeletal pain central sensitization cross-cultural adaptation Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Chronic pain stems from a multitude of factors that lead to on-going pain lasting over 3 to 6 months and affects an individual's overall quality of life[ 1 ]. Chronic pain is recognized by the World Health Organization as both a symptom and a disease, serving as a primary cause of disability and rising healthcare expenses. Understanding the multifaceted nature of chronic pain is crucial for effective management and improving patient outcomes[ 2 ].In numerous chronic conditions, the symptoms of central sensitization play a significant role in the progression of the overall symptoms, regardless of their underlying causes. Central sensitization (CS) is characterized by generalised hypersensitivity to both painful and non-painful stimuli and increased temporal summation of nociception. Proposed mechanisms of CS include altered sensory processing in the brain, dysfunction of pain-regulating pathways, changes in neuronal synapses, and decreased functioning of descending pain inhibitory mechanisms in the central nervous system[ 3 ]. Genetic predisposition, physical injury, and emotional distress have all been implicated in the development and maintenance of CS through irregular regulation of central nervous system pathways[ 3 ]. Persistent CS and its associated symptomatology can substantially limit both physical and psychological functioning, often resulting in functional disability and difficulty performing activities of daily living[ 3 , 4 ]. The Central Sensitization Inventory (CSI) is a 25 items self-reported assessment tool designed to assess and quantify symptoms believed to be related to CS. It has been shown to be a potentially useful tool in clinical practice for identifying when CS may be a contributing factor in a patient’s clinical presentation so that the most effect assessment and treatment can be initiated. Diagnoses of CSS are frequently associated with musculoskeletal disorders, irrespective of their origins being injury-related or non-injury-related[ 5 ]. There is no gold standard methodology for diagnosing CS. The presence of CS can only be determined to be more or less likely based on a patient’s self-reported symptomology, clinical markers, and mechanism-based classification systems[ 6 – 8 ].Objective measures (like quantitative magnetic resonance imaging) and semi-objective measures (like Quantitative Sensory Testing) can help identify signs of CS, but these methods can be costly and results can be inconclusive[ 9 ].The evaluation and diagnosis of CS mostly rely on quantitative sensory testing (QST). Although QST offers benefits in standardized and quantitative assessments of CS, it necessitates relatively costly equipment and is time- and labor-intensive, hence constraining its broad application[ 10 ]. The Central Sensitization Inventory (CSI), an indirect assessment tool specifically designed for Central Sensitization (CS), has been employed to assess CS symptoms[ 11 ]. The CSI has demonstrated robust psychometric properties, including test-retest reliability, internal consistency, and concurrent and predictive validity, in multiple studies using multiple language versions since it was first published in 2012 by Neblett.et.al.[ 12 – 14 ].Though some differences in the factor structure have been reported in previous studies, a large factor analysis in a multi-country pooled sample of 1987 subjects found substantial reliability for one general factor of “CS-related symptomology;” the authors concluded that only total CSI scores should be used and reported[ 15 ].Translated versions of the CSI, and additional resources, can be found at https://www.pridedallas.com/questionnaires/ . A Tamil version of the CSI may be a helpful resource for Tamil-speaking healthcare professionals and their patients. However, a Tamil version is currently unavailable. Therefore, the objectives of the present study were to translate and cross-culturally adapt the CSI into the Tamil language and to assess its reliability and validity. Methods This clinimetric study used a repeated cross sectional design and the developer of CSI questionnaire (Randy Neblett) approved the adaptation and translation of the original English version of CSI tool to Tamil language, India. Ethical approval was obtained from the SRM Medical College Hospital and Research Centre, Kattankulathur (Ref.no: 2340/IEC/2021). All the procedures of the study were conducted as per the declaration of Helsinki[16]. Adults presenting with varying chronic musculoskeletal painful conditions were screened for inclusion criteria and invited to participate in the study. All the participants confirmed their voluntary participation by signing the written informed consent before their participation in the study. The recruitment period lasted from December 2021 to April 2025. Participants and setting: The study involved 209 participants, with 163 female’s 46 males using convenient sampling recruited from physiotherapy outpatient unit, SRM Medical College Hospital and Research Centre (SRMMCHRC).Adults aged 18 years and above, native Tamil speakers, with diverse musculoskeletal conditions were included in the study. Patients medically diagnosed with low back pain, osteoarthritis, shoulder conditions, cervical pain, ankle and foot arthritis, wrist and elbow painful conditions were considered for inclusion in the study. Patients diagnosed with neuropsychological or psychiatric disorders were excluded from the study. The study adhered to recommended guidelines of practice as per COSMIN checklist to recruit a minimum of 5-10 participants per item[17]. And, the maximum recommendation of 10 participants per item was considered. Hence, this study aimed to recruiting 250 participants to improve the robustness of the findings [18]. Finally, 209 participants completed the CSI questionnaire once and 96 participants completed the re-test. Translation process: The translation and cultural adaptation of the CSI followed the process developed by Beaton et al[19]. This guideline consists of six stages: (1) forward translation, (2) synthesis, (3) backward translation, (4) expert community analysis, (5) pretesting, and (6) expert community review of the complete process (Fig.1). In the first phase, Forward Translation, two bilingual native Tamil translators were employed to convert the original English version of the CSI into Tamil. The forward translation of the original CSI version into Tamil was completed by a proficient translator with expertise in physiotherapy (FT1 & FT2). FT1&FT2, native Tamil speakers proficient in English, provided the medical perspectives. In the second phase, the translations were synthesized, and the reconciled version (FT1, FT2) was produced by compiling the translations from both FT1 and FT2. A consensus meeting was conducted among translators (FT1 and FT2) and a facilitator to examine and resolve differences between the two translated versions. In the third step, back translation, two bilingual back-translators generated the BT1 and BT2 versions. Proficient in Tamil and English, they individually converted the FT1&FT2 version back into its native language, English. To mitigate bias, the initial version of the CSI was concealed from both back-translators, whose primary language was English. Following the backward translation procedure, each translator provided a brief summary of the translation process. The committee members, comprising language specialists, the principal investigator, researchers, and both forward and back translators, convened for the fourth phase, the Expert Committee Review, to collaboratively evaluate all translated versions. The fifth step involved administering a pilot test of the pre-final CSI Tamil version with 15 individuals who have a history of chronic musculoskeletal disorders. The main aims were to evaluate the readability of the CSI Tamil questionnaire for all participants and to collect their feedback and suggestions. Upon completion of the pre-final questionnaire by participants, their input was integrated and recorded. The average duration to complete the CSI Tamil was 7.30 (± 0.40) minutes. Approximately one-quarter of the participants (n = 55) sought clarifications concerning items 4 and 24. In the sixth and last step, the Expert Committee assembled to address and resolve all feedback submitted by the participants. They subsequently completed the Tamil version of CSI, confirming that the scale was prepared for validity assessment. Instruments The CSI-Ta questionnaire consists of 25 items related to current health symptoms [20]. Each item is rated on a 5-point temporal Likert scale, including never (0), rarely (1), sometimes (2), often (3), and always (4). A cumulative score ranges from 0 (min) to 100 (max). A score ≥40/100 indicates presence of CS-related symptomology according to previous studies [12, 20–22]. The scores of CSI are categorized for the levels of severity as follows: Subclinical (0-29), Mild (30-39), Moderate (40-49), Severe (50-59), and Extreme (60-100). The numerical pain rating scale (NPRS) asks patients to provide three pain severity ratings, corresponding to current, best, and worst pain experienced over the past 24 hours. The average of the three ratings was used to represent the patient’s pain level over the past 24 hours[23, 24]. The World Health Organization Quality of Life- Brief (WHOQOL-BREF) Tamil version is a self-report measure with 2 general questions about perceived quality of life (QOL) and satisfaction with health and 24 specific questions assessing four QOL domains(0-100 score): Physical (7 items), Psychological (6 items), Social Relationships (3 items), and Environmental (8 items),with the higher score indicates better quality of life [25].The Beck Depression Scale is a 21-item widely used measure of self-reported depressive symptoms, with the higher scores (0-63) indicating diagnosis of major depressive disorder [26]. Statistical analysis Data were analyzed using IBM SPSS version 21.The descriptive statistics of the participants were presented as mean, SD, frequency and percentage. The normality and data distributions were evaluated using skewness, kurtosis, histograms, Q-Q plots, and the Kolmogorov-Smirnov and Shapiro-Wilk tests.Tamil version of CSI investigated for both reliability and validity testing. The intra class correlation coefficient (ICC agreement 2,1) was calculated using a two-way mixed effects model, with Cronbach’s alpha (α), to evaluate the test-retest reliability and internal consistency of the Tamil version of the CSI. Cronbach’s alpha values for the CSI-Ta greater than 0.70 are deemed acceptable, those beyond 0.80 are regarded as good, and those surpassing 0.90 are classified as exceptional [24–26]. Intraclass correlation coefficients (ICCs) and 95% confidence intervals (CIs) were calculated to assess test-retest reliability. ICCs below 0.40 were deemed low or undesirable; those ranging from 0.40 to 0.70 were classified as moderate; values from 0.70 to 0.90 were regarded as significant; and 'α' values beyond 0.90 were considered remarkable[27, 28]. Tamil, analysing its association with other established clinical variables and questionnaires. An Exploratory Factor Analysis (EFA) was conducted to assess the theoretical and dimensional attributes of the construct of CSI-Ta [32]. The criteria were determined using the Kaiser-Meyer-Olkin coefficient (KMO), an Eigenvalue exceeding 1, Bartlett’s test of sphericity, and a visual analysis of the scree plot. Floor and ceiling effects were assessed by analysing the frequency of participants achieving the minimum and maximum scores on the CSI-Ta total score. If the floor and ceiling effects did not exceed 15%, they were deemed ideal[33]. Results Demographic characteristics A total of 250 participants were eligible for the study, of which 215 were conveniently recruited. Six questionnaires containing illogical responses were removed from the final analysis. Flow of the study presented in Fig.2.To assess reliability, 96 participants completed the CSI-Tamil and other questionnaires again 7 days after the initial assessment. The mean age of the individuals who took part in the study and had chronic musculoskeletal diseases was 50.27 (±11.86) years. As in earlier validation studies of CSI, most of the participants were women (n = 163, 78%), whereas men made up approximately (n = 46, 22%) of the group. The mean chronicity of the ailment was 32.54 ±52.98. Most of the patients had either chronic low back pain or osteoarthritis of the knee, with rates of 29.2% and 28.2%, respectively (Table 1).The Overall CSI Tamil scores in subgroups were reported in the Table 2. The frequency distribution of CSI-Tamil severity levels and diagnoses is presented in the supplementary table. Table 1: Baseline data of the study participants (n=209) Variables Frequency (%) Age (years):mean(± SD) 50.27 (±11.86) Age 55 years & less 142 (67.9%) > 55 years 67 (32.1%) Sex Female 135 (64.6%) Male 74 (35.4%) Education No schooling 12 (5.75%) Primary 75 (35.9%) Secondary 71 (34%) Diploma 11 (5.3%) Degree and above 4 (19.1%) Marital status Married 181 (86.6%) Unmarried 19 (9.1%) Employment status In work 164 (78.5%) Retired 30 (14.4%) Unemployed 15 (7.2%) Chronic musculoskeletal conditions (Region) Low back 61 (29.2%) Knee 59 (28.2%) Shoulder 41 (19.6%) Cervical 35 (16.8%) Ankle and Foot 9 (4.3%) Elbow 2(1%) Wrist 2(1%) Duration of the condition 32.54 ±52.98 CSI_Total (0-100) 45.95 ±22.38 NPRS (0-10) 6.63 ±1.6 BDI_Total (0-63) 13.12 ±8.25 WHO QoL(Brief)_Total (0-100) 83.18 ±13.95 SD- Standard deviation, NPRS-Numerical Pain Rating Scale, CSI-Central Sensitization Inventory, BDI-Beck Depression Inventory,WHOQoL (Brief) – World Health Organization Quality of Life (Brief) Table 2: CSI-Tamil scores in subgroups Variables CSI total score P value Age 55 years & less 47.04 ±22.8 > 55 years 43.66 ±21.46 0.31 Sex Female 46.36 ±21.18 Male 45.23 ±24.55 0.09 Education No schooling 48.12 ±22.52 Primary 48.11 ±21.91 Secondary 44.46 ±23 Diploma 37.82 ±18.63 Degree and above 46.07 ±23.36 0.62 Marital status Married 45.91 ±22.92 Unmarried 45.68 ±21.65 0.96 Employment status In work 45.04 ±22.22 Retired 47.33 ±24.55 Unemployed 53.2 ±19.38 0.37 Values are expressed as means ± standard deviation. CSI Items with significant differences. p-value represents the comparison result of T-tests or ANOVA with Bonferroni correction. Ceiling and floor effects: No floor or ceiling effects were observed for the CSI total score, as no participants obtained the lowest or highest possible scores. A floor and ceiling effect is reported as supplementary table. Convergent Validity (Spearman Correlations) Spearman’s rank correlation was used to evaluate the convergent validity of the CSI-Tamil, since the data did not meet the assumptions of normality, comparing it with NPRS, WHOQoL, and BDI. The CSI total score demonstrated significant correlations with all clinical measures (Table 3). The Spearman’s Rho correlation revealed that the scores of the CSI-Tamil exhibited moderate positive correlations with pain intensity (p = 0.281, p < 0.01) as well as depressive symptoms (p = 0.425, p < 0.01). In contrast, a moderate negative correlation was found with quality of life (p = -0.357, p < 0.01). Table 3: Spearman’s correlation of the total scores of CSI-Tamil with NPRS, BDI, and WHO QoL (n = 209) Variables NPRS BDI WHOQoL CSI-Tamil NPRS - BDI .476 ** - WHOQoL -0.202 -0.465 - CSI-Tamil .281 ** .425 ** -0.357 - Internal Consistency and test retest reliability The adapted CSI demonstrated high internal consistency, with a Cronbach’s alpha (α) of 0.88. Analysis of alpha if item deleted confirmed that all 25 items contributed positively to the scale's overall reliability (Table 4). The intra-class coefficient for test-retest reliability based on the total scores of the first and second assessments was 0.78 (ICC 2, 1; 95% CI = 0.557–0.914; p < 0.001) Table 6. To visually demonstrate the agreement between test-retest reliability, a Bland-Altman plot was generated (Fig. 3). Table 4: Internal consistency of CSI Tamil, if item deleted Item-Total Statistics Scale Mean if Item Deleted Scale Variance if Item Deleted Corrected Item-Total Correlation Cronbach's Alpha if Item Deleted 1_CSI 43.43 466.11 0.638 0.922 2_CSI 43.19 483.77 0.294 0.927 3_CSI 43.85 466.95 0.565 0.923 4_CSI 44.50 464.35 0.556 0.923 5_CSI 44.33 463.99 0.570 0.923 6_CSI 43.97 465.54 0.568 0.923 7_CSI 44.08 456.38 0.631 0.922 8_CSI 43.69 457.34 0.657 0.922 9_CSI 43.51 456.29 0.646 0.922 10_CSI 43.99 465.59 0.544 0.924 11_CSI 44.54 462.01 0.606 0.923 12_CSI 43.64 471.03 0.467 0.925 13_CSI 43.86 460.14 0.642 0.922 14_CSI 44.50 466.92 0.530 0.924 15_CSI 43.85 453.69 0.726 0.921 16_CSI 43.72 463.40 0.649 0.922 17_CSI 43.54 461.20 0.669 0.922 18_CSI 43.50 471.09 0.435 0.925 19_CSI 44.48 464.09 0.547 0.924 20_CSI 44.28 465.51 0.478 0.925 21_CSI 44.07 464.20 0.522 0.924 22_CSI 43.58 468.30 0.477 0.925 23_CSI 43.90 465.79 0.515 0.924 24_CSI 43.94 461.89 0.535 0.924 25_CSI 43.36 473.83 0.472 0.925 Structural Validity (Factor Analysis) The results of exploratory factor analyses of the 25 items of the CSI-Tamil demonstrated 59.4% of the total variance in the principal component analysis using varimax rotation. The Kaiser-Meyer-Olkin (KMO) of sample adequacy was assessed by Bartlett’s test of sphericity and found to be statistically significant (KMO 0.79, χ² 1812.2 = 1812.233, df = 300, p-value 0.01). Three-factor components had eigenvalues greater than 1, and the EFA scree plot (Fig. 4) suggests the same. Factor 1 comprised primarily 9 items, especially musculoskeletal tension and sleep disturbances (e.g., Items 16, 8, and 15). Factor 2 comprised 8 items and captured the affective cognitive distress of the scale; items related to anxiety and mental distress loaded high on this domain (e.g., Items 19, 11, and 20). The last 8 items were loaded on factor 3, addressing the systemic sensitivity of the domain (e.g., items 9, 12, and 14) Table 5. All three factors reported high internal consistency with the cronbach’s α ranging from 0.891 - 0.921 and good to excellent temporal stability was observed over the measurement period (ICC = 0.811- 0.866) - presented in table 6. Table 5: Factor loading for CSI Tamil Factor Loadings Factor 1 Factor 2 Factor 3 Item# 16_CSI 0.897 Item# 8_CSI 0.86 Item# 15_CSI 0.784 Item# 1_CSI 0.71 Item# 17_CSI 0.604 Item# 13_CSI 0.601 Item# 2_CSI 0.534 Item# 3_CSI 0.529 Item# 6_CSI 0.501 Item# 19_CSI 0.887 Item# 11_CSI 0.672 Item# 20_CSI 0.611 Item# 10_CSI 0.569 Item# 21_CSI 0.499 Item# 4_CSI 0.455 Item# 5_CSI 0.415 Item# 7_CSI 0.401 Item# 9_CSI 0.566 Item# 12_CSI 0.521 Item# 14_CSI 0.492 Item# 18_CSI 0.452 Item# 22_CSI 0.431 Item# 23_CSI 0.416 Item# 24_CSI 0.403 Item# 25_CSI 0.401 KMO 0.79, χ² 1812.2 = 1812.233, Variance explained: 59.4% Table 6: Cronbach's alpha and Intra-class Correlation Coefficients of Test-Retest Reliability Item Questions Cronbach's α ICC Sum CSI total score 0.881 0.787 Factor1 Physical/Emotional Distress 0.902 0.823 Factor2 Physical Symptoms 0.891 0.811 Factor3 Autonomic Distress 0.921 0.866 Discussion The objective of the current study was to evaluate the psychometric properties of the Tamil version of Central Sensitization Inventory. The successful translation of the CSI Tamil will pave the way to screen and identify the symptoms and its treatment options in Tamil speaking individuals. This study finding demonstrates that the Tamil version of CSI is a reliable, valid and culturally relevant tool for the assessment of CS symptoms in Tamil-speaking populations. Translation of CSI-Tamil The Tamil version of CSI underwent a rigorous translation and adaptation process by adhering to established protocols. This process ensured the linguistic and conceptual equivalence of the CSI Tamil version with the original CSI, improving its applicability in chronic musculoskeletal patients in Tamil-speaking populations. This translation and adaptation process incorporated the comments from translators, bilingual experts, and patients who were involved in the pilot testing to enhance the cultural appropriateness of the translated version of CSI Tamil. No items were removed by the expert panel; only modifications were made in two items (Item 3 and Item 24) according to the pilot testing feedback to align better with the linguistic equivalence. Both the backward translators agreed that the translated version of CSI maintained the same conceptual meaning as the original CSI in English. Internal consistency of the CSI-Tamil The CSI Tamil demonstrated good internal consistency with a cronbach’s alpha of 0.88, indicating the higher homogeneity of the items. Similarly, the original CSI and studies conducted in other foreign languages demonstrated the ICC values typically range from 0.87 to 0.93[34–36]. The CSI Tamil demonstrated good test-retest reliability, with an ICC of 0.78, showing good consistency across time, especially in the absence of clinical change. Previous validation studies conducted across various languages and populations reported higher test retest ICC estimates between ≥0.88 to 0.965[37–39]. The Bland-Altman analysis further supported this stability by demonstrating good agreement between test and retest measurements, with minimal systematic bias. Convergent Validity The convergent validity of the CSI Tamil demonstrates significant correlations with pain intensity (NPRS), depressive symptoms (BDI), and quality of life (WHOQoL) for individuals. CSI scores demonstrate a moderate positive correlation with pain (ρ = 0.281) and depressive symptoms (ρ = 0.425) and a strong negative correlation with quality of life (ρ = −0.357), indicating that central sensitization symptoms highly impact the functional activities and quality of life. A moderate correlation of CSI scores with the pain intensity explains the understanding of central sensitization amplifying the pain perception. However, moderate correlations suggest that CSI captures the broader symptoms and is not limited to the nociceptive signal alone. This finding is consistent with previous validation studies reporting a distinct understanding of CS symptom burden and nociceptive signals[34, 40]. CSI scores are strongly associated with depressive symptoms owing to common neurobiological processes, including neurotransmitter imbalance, HPA axis dysregulation, and modified descending inhibitory circuits. Comparable results were documented in many validation studies, demonstrating that emotional discomfort is an essential component of central sensitization rather than a subsequent effect[41, 42]. A moderate negative correlation between CSI scores and quality of life underscores the impact of central sensitization on individuals' physical, psychological, and social functioning. These findings align with previous studies demonstrating that increased CSI scores impact daily functioning, sleep, and general well-being of individuals[43, 44]. The inverse correlation between quality of life and pain intensity clarifies the complex and comprehensive attributes of CSI Tamil, hence enhancing its effectiveness as a screening tool. Additionally this findings supports the convergent validity of the CSI Tamil questionnaire. Structural Validity Exploratory factor analysis supported the structural validity of the CSI-Tamil, identifying a three-factor solution that accounted for 59.4% of the total variance. Sampling adequacy was confirmed by a satisfactory KMO value (0.79) and a significant Bartlett’s test of sphericity, indicating that the data were appropriate for factor analysis. The extracted factors-representing musculoskeletal and sleep-related symptoms, affective-cognitive distress, and systemic sensitivity-are conceptually consistent with the multidimensional symptom profile of central sensitization. While the original CSI was proposed as a unidimensional screening tool, multiple validation studies have similarly identified two- or three-factor structures, reflecting cultural and clinical differences in symptom expression[36, 43, 45] . Importantly, the identified factor domains in the present study align with established theoretical models of central sensitization, which emphasize the interaction between physical symptoms, emotional distress, and widespread sensory hypersensitivity[46]. Floor and Ceiling Effects No flooring and ceiling effects were demonstrated in the overall CSI Tamil score, as no participants reported the lowest or highest possible scores in the scale. This finding is attributed to the multidimensional construct of the scale and is consistent with the previous literature[47]. In addition, floor or ceiling effects are deemed present when over 15% of respondents attain the minimum or maximum feasible score[48]. However, item-level floor and ceiling effects were captured as a result of symptom-specific prevalence within the participants. Similar item-level floor and ceiling patterns have been reported in other CSI adaptations and are generally interpreted as population-specific rather than indicative of scale limitation[36, 40]. Limitations and recommendations The study's limitations include that the results are derived from a small sample of people within primary care facilities in Chennai City, so the findings may not be generalized to other populations. The potential impact of treatment on CSI ratings, prior to data collection, must be taken into account. Questionnaires were administered exclusively to those with chronic musculoskeletal pain. Future research should investigate normative and healthy persons to address the discriminate validity of the CSI-Tamil. In alignment with prior CSI validation studies, a greater number of women than men were recruited, consistent with the higher prevalence of musculoskeletal pain disorders among women. The CSI-Tamil is suitable for initial screening and research purposes among Tamil-speaking communities. Nonetheless, further research employing confirmatory factor analysis, larger and more diverse samples, and evaluations of discriminant validity and responsiveness to change is necessary to enhance the psychometric evidence. Clinical and Research Implications The findings of this study reveal that CSI Tamil is a valid and reliable psychometrically sound tool for assessing CS symptoms. The CSI-Tamil can facilitate the early detection of people with increased central sensitization who may benefit from multimodal, bio psychosocial therapy. The existence of a validated Tamil version enhances chances for cross-cultural comparisons and the engagement of Tamil-speaking populations in pain research. Conclusion The Tamil version of the Central Sensitization Inventory demonstrates good psychometric properties and is a culturally appropriate tool for screening central sensitization-related symptoms in Tamil-speaking populations. The observed internal consistency and test-retest reliability are comparable to those reported in previous versions of the CSI. The CSI-Tamil may therefore be used to enhance patient care and support clinical and epidemiological research in Tamil-speaking settings. Abbreviations BDI- Beck Depression Inventory, CSI – Central sensitization inventory, EFA - Exploratory factor analysis, CS – Central sensitization, ICC - Intra-class Correlation Coefficient, NPRS – Numerical pain rating scale, KMO - Kaiser-Meyer-Olkin, MDC - Minimal Detectable Changes, SEM - Standard Error of Measurement, WHOQOL-BREF- World health organization quality of life brief. Declarations Competing interests The authors declare that they have no competing interests. Acknowledgment The authors would like to express their gratitude to the SRM Institute of Science and Technology, India and other individuals who provided support during the course of this project. Author’s contribution VTS AND TAR conceptualized the idea, VA, BJ, SM, JP and MF developed and designed the methodology, VA, SM, JP, and MF conducted the experiment and collected data, BJ,TAR, and TNS conducted data analysis and interpretation of results. TAR, VA, SM, and TNS wrote the initial draft. BJ, RN and VA reran analysis and critically reviewed the draft. TAR and VTS supervised and oversighted the research activity. All the authors read and approved the final version of the manuscript and the findings reported. References Nijs J, George SZ, Clauw DJ, et al. Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine. Lancet Rheumatol 2021; 3: e383–e392. Treede R-D, Rief W, Barke A, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain 2019; 160: 19–27. Nijs J, Polli A, Willaert W, et al. Central sensitisation: another label or useful diagnosis? Drug Ther Bull 2019; 57: 60–63. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet Lond Engl 2012; 380: 2163–2196. Neblett R, Hartzell MM, Williams M, et al. Use of the Central Sensitization Inventory (CSI) as a treatment outcome measure for patients with chronic spinal pain disorder in a functional restoration program. Spine J 2017; 17: 1819–1829. Blyth FM, Briggs AM, Schneider CH, et al. The Global Burden of Musculoskeletal Pain-Where to From Here? Am J Public Health 2019; 109: 35–40. Nijs J, Lahousse A, Kapreli E, et al. Nociplastic Pain Criteria or Recognition of Central Sensitization? Pain Phenotyping in the Past, Present and Future. J Clin Med 2021; 10: 3203. Smart K, Blake C, Staines A, et al. The Discriminative Validity of ‘Nociceptive,’ ‘ Peripheral Neuropathic,’ and ‘Central Sensitization’ as Mechanisms-based Classifications of Musculoskeletal Pain. Clin J Pain 2011; 27: 655–63. Shraim M, Massé-Alarie H, Hodges P. Methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a systematic review. Pain 2021; 162: 1007–1037. Neblett R, Sanabria-Mazo JP, Luciano JV, et al. Is the Central Sensitization Inventory (CSI) associated with quantitative sensory testing (QST)? A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 161: 105612. Nijs J, Leysen L, Vanlauwe J, et al. Treatment of central sensitization in patients with chronic pain: time for change? Expert Opin Pharmacother 2019; 20: 1–10. Neblett R. The central sensitization inventory: A user’s manual. J Appl Biobehav Res 2018; 23: e12123. Nijs J, Huysmans E. Clinimetrics: The Central Sensitisation Inventory: a useful screening tool for clinicians, but not the gold standard. J Physiother 2022; 68: 207. Scerbo T, Colasurdo J, Dunn S, et al. Measurement Properties of the Central Sensitization Inventory: A Systematic Review. Pain Pract Off J World Inst Pain 2018; 18: 544–554. Cuesta-Vargas AI, Neblett R, Chiarotto A, et al. Dimensionality and Reliability of the Central Sensitization Inventory in a Pooled Multicountry Sample. J Pain 2018; 19: 317–329. Goodyear MDE, Krleza-Jeric K, Lemmens T. The Declaration of Helsinki. BMJ 2007; 335: 624–625. Mokkink LB, Terwee CB, Knol DL, et al. The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol 2010; 10: 22. Tsang S, Royse CF, Terkawi AS. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi J Anaesth 2017; 11: S80–S89. Beaton DE, Bombardier C, Guillemin F, et al. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 2000; 25: 3186–3191. Neblett R, Cohen H, Choi Y, et al. The Central Sensitization Inventory (CSI): Establishing Clinically Significant Values for Identifying Central Sensitivity Syndromes in an Outpatient Chronic Pain Sample. J Pain 2013; 14: 438–445. Salaffi F, Farah S, Mariani C, et al. Validity of the Central Sensitization Inventory compared with traditional measures of disease severity in fibromyalgia. Pain Pract 2022; 22: 702–710. Düzce Keleş E, Birtane M, Ekuklu G, et al. Validity and reliability of the Turkish version of the central sensitization inventory. Arch Rheumatol 2021; 36: 518–526. Jensen MP, McFarland CA. Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain 1993; 55: 195–203. Broome ME. Measurement of pain: self-report strategies. J Pediatr Oncol Nurs Off J Assoc Pediatr Oncol Nurses 1991; 8: 131–133. WHOQOL-BREF| The World Health Organization, https://www.who.int/tools/whoqol/whoqol-bref (accessed 27 January 2026). Basker M, Moses PD, Russell S, et al. The psychometric properties of Beck Depression Inventory for adolescent depression in a primary-care paediatric setting in India. Child Adolesc Psychiatry Ment Health 2007; 1: 8. Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med 2016; 15: 155–163. Gliem J, Gliem R. Calculating, Interpreting, And Reporting Cronbach’s Alpha Reliability Coefficient For Likert-Type Scales. 2003 Midwest Res Pract Conf Adult Contin Community Educ . Jolliffe IT, Cadima J. Principal component analysis: a review and recent developments. Philos Transact A Math Phys Eng Sci 2016; 374: 20150202. Factor analysis and Psychometrika: Major developments | Psychometrika | Springer Nature Link, https://link.springer.com/article/10.1007/BF02293996 (accessed 27 January 2026). Stratford P. Getting more from the literature: estimating the Standard Error of Measurement from Reliability studies. Physiother Can. 2004;56. Zhang G, Preacher K. Factor Rotation and Standard Errors in Exploratory Factor Analysis. J Educ Behav Stat ; 40. Epub ahead of print 15 October 2015. DOI: 10.3102/1076998615606098. Quality criteria were proposed for measurement properties of health status questionnaires - ClinicalKey, https://www.clinicalkey.com/#!/content/playContent/1-s2.0 Mayer TG, Neblett R, Cohen H, et al. The development and psychometric validation of the central sensitization inventory. Pain Pract Off J World Inst Pain 2012; 12: 276–285. Xu C, Yao S, Wei W, et al. Cross-cultural adaptation and validation for central sensitization inventory: based on Chinese patients undergoing total knee arthroplasty for knee osteoarthritis. J Orthop Surg 2023; 18: 960. Cuesta-Vargas AI, Roldan-Jimenez C, Neblett R, et al. Cross-cultural adaptation and validity of the Spanish central sensitization inventory. SpringerPlus 2016; 5: 1837. Akhter MF, Bobos P, Otalike EG, et al. Psychometric properties of patient-reported outcome measures in chronic pain conditions with central sensitization- a systematic review and meta-analysis. J Patient-Rep Outcomes 2025; 9: 87. Xu C, Yao S, Wei W, et al. Cross-cultural adaptation and validation for central sensitization inventory: based on Chinese patients undergoing total knee arthroplasty for knee osteoarthritis. J Orthop Surg 2023; 18: 960. Cuesta-Vargas AI, Roldan-Jimenez C, Neblett R, et al. Cross-cultural adaptation and validity of the Spanish central sensitization inventory. SpringerPlus 2016; 5: 1837. Nishigami T, Tanaka K, Mibu A, et al. Development and psychometric properties of short form of central sensitization inventory in participants with musculoskeletal pain: A cross-sectional study. PLOS ONE 2018; 13: e0200152. Häuser W, Kosseva M, Üceyler N, et al. Emotional, physical, and sexual abuse in fibromyalgia syndrome: a systematic review with meta-analysis. Arthritis Care Res 2011; 63: 808–820. Meeus M, Nijs J. Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome. Clin Rheumatol 2007; 26: 465–473. Roldán-Jiménez C, Pérez-Cruzado D, Neblett R, et al. Central Sensitization in Chronic Musculoskeletal Pain Disorders in Different Populations: A Cross-Sectional Study. Pain Med 2020; 21: 2958–2963. Kregel J, Vuijk PJ, Descheemaeker F, et al. The Dutch Central Sensitization Inventory (CSI): Factor Analysis, Discriminative Power, and Test-Retest Reliability. Clin J Pain 2016; 32: 624–630. Neblett R, Cohen H, Choi Y, et al. The Central Sensitization Inventory (CSI): establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. J Pain 2013; 14: 438–445. Nijs J, Torres-Cueco R, van Wilgen CP, et al. Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization pain. Pain Physician 2014; 17: 447–457. Neblett R, Cohen H, Choi Y, et al. The Central Sensitization Inventory (CSI): establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. J Pain 2013; 14: 438–445. Terwee CB, Bot SDM, de Boer MR, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 2007; 60: 34–42. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted 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-8850389","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":589667473,"identity":"d2a7da09-0ea0-4ada-af5e-3fd4bfb758e6","order_by":0,"name":"Veeragoudhaman T.S.","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYDADfhCRwAAlE4jQISHZAFZsQIIWgwNg2oCBoHqD483HPvz4ZVNnfP7s0w0P/vxh4GfPMWB4uAOPljPHkmf29qVJmN1IN7uR2GbAINnzxoAh8QxuLZIzcowZeHsOA7Wwsd1IbDBgMLgBtCWxDY+W+e8/M/4FajHuP8Z2I+GPAYM9IS38EjzMzDw/DksYMKQBtbABbZEgpIUnzZhZtiFNcsYNoJbENmMeiTPPCg7g08LGfvgx45s/Nvz8QIfd/PFHTo6/PXnjw594tIABI5ICHhBxgIAGIPhDWMkoGAWjYBSMYAAAGdJQFg+9Ah4AAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-8365-3685","institution":"SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology (SRM IST), Kattankulathur, Chennai 603203, Tamil Nadu, India","correspondingAuthor":true,"prefix":"","firstName":"Veeragoudhaman","middleName":"","lastName":"T.S.","suffix":""},{"id":589669913,"identity":"b1a05513-e442-460e-be13-8aa78bba0214","order_by":1,"name":"Thangamani Ramalingam Alagappan","email":"","orcid":"","institution":"Sarvajanik College of Physiotherapy","correspondingAuthor":false,"prefix":"","firstName":"Thangamani","middleName":"Ramalingam","lastName":"Alagappan","suffix":""},{"id":589669914,"identity":"eb3494b5-f7fd-463e-89d2-efa99b18fdc3","order_by":2,"name":"Vinitha Arasu","email":"","orcid":"","institution":"SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology (SRM IST), Kattankulathur, Chennai 603203, Tamil Nadu, India","correspondingAuthor":false,"prefix":"","firstName":"Vinitha","middleName":"","lastName":"Arasu","suffix":""},{"id":589669915,"identity":"d5a13bbd-35f4-49b4-bee1-6954a9f418a8","order_by":3,"name":"Sowmiya.M","email":"","orcid":"","institution":"SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology (SRM IST), Kattankulathur, Chennai 603203, Tamil Nadu, India","correspondingAuthor":false,"prefix":"","firstName":"","middleName":"","lastName":"Sowmiya.M","suffix":""},{"id":589669917,"identity":"aedf2bc7-8d20-4669-927e-8d11e269a93e","order_by":4,"name":"Jothi Prasanna.K","email":"","orcid":"","institution":"Kalasalingam School of Physiotherapy","correspondingAuthor":false,"prefix":"","firstName":"Jothi","middleName":"","lastName":"Prasanna.K","suffix":""},{"id":589669918,"identity":"32df9728-39f4-4e6a-93fd-36b6baa23db8","order_by":5,"name":"Mariyam Farzana.S.F.","email":"","orcid":"https://orcid.org/0000-0003-3866-9351","institution":"SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology (SRM IST), Kattankulathur, Chennai 603203, Tamil Nadu, India","correspondingAuthor":false,"prefix":"","firstName":"Mariyam","middleName":"","lastName":"Farzana.S.F.","suffix":""},{"id":589669919,"identity":"26f688f6-240a-4dd6-82fb-6f04f49e866b","order_by":6,"name":"Suresh T.N","email":"","orcid":"","institution":"SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology (SRM IST), Kattankulathur, Chennai 603203, Tamil Nadu, India","correspondingAuthor":false,"prefix":"","firstName":"Suresh","middleName":"","lastName":"T.N","suffix":""},{"id":589748126,"identity":"b3748521-1d2d-4ba0-a94d-991c5a2b24c0","order_by":7,"name":"Balamurugan Janakiraman","email":"","orcid":"","institution":"SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology (SRM IST), Kattankulathur, Chennai 603203, Tamil Nadu, India","correspondingAuthor":false,"prefix":"","firstName":"Balamurugan","middleName":"","lastName":"Janakiraman","suffix":""},{"id":589669920,"identity":"fbf8b7fa-cd2f-47a4-855b-c09575684abb","order_by":8,"name":"Randy Neblett","email":"","orcid":"","institution":"PRIDE Research Foundation, Dallas, Texas","correspondingAuthor":false,"prefix":"","firstName":"Randy","middleName":"","lastName":"Neblett","suffix":""}],"badges":[],"createdAt":"2026-02-11 10:37:44","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":true,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8850389/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8850389/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102758937,"identity":"6fe2b788-3639-4166-bef4-4a62ad9dae66","added_by":"auto","created_at":"2026-02-16 10:12:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":29280,"visible":true,"origin":"","legend":"\u003cp\u003eCSI Tamil Translation Process\u003c/p\u003e","description":"","filename":"CSITranslationprocess.png","url":"https://assets-eu.researchsquare.com/files/rs-8850389/v1/f814cb0f2a52b578101e86f4.png"},{"id":102758932,"identity":"4302b2a2-9108-4ad3-92be-732f4b344455","added_by":"auto","created_at":"2026-02-16 10:12:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23812,"visible":true,"origin":"","legend":"\u003cp\u003eCSI Tamil flow of the study\u003c/p\u003e","description":"","filename":"CSIflowfinal.png","url":"https://assets-eu.researchsquare.com/files/rs-8850389/v1/6b31df0cdbf6ec7c8cfbc4d8.png"},{"id":102758923,"identity":"4bf1ef1a-e2db-4456-bb89-9330f68bec79","added_by":"auto","created_at":"2026-02-16 10:12:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":199061,"visible":true,"origin":"","legend":"\u003cp\u003eBland Altman\u003cstrong\u003e \u003c/strong\u003eplot of agreement between the test and re-test scores of CSI Tamil\u003c/p\u003e","description":"","filename":"BAPlotCSI.png","url":"https://assets-eu.researchsquare.com/files/rs-8850389/v1/e99d8b49fdebf79202372e50.png"},{"id":102758922,"identity":"88cf6981-43a3-4ffc-8187-59b21708c42c","added_by":"auto","created_at":"2026-02-16 10:12:10","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":129025,"visible":true,"origin":"","legend":"\u003cp\u003eScree plot indicating factor loading of CSI Tamil\u003c/p\u003e","description":"","filename":"ScreeplotCSI.png","url":"https://assets-eu.researchsquare.com/files/rs-8850389/v1/e93b8dbdd7d3ba4e4bd0f0f2.png"},{"id":102759192,"identity":"1e57e87a-2bda-49e1-9c13-9438187a5205","added_by":"auto","created_at":"2026-02-16 10:12:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1316545,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8850389/v1/5f7764f7-9b4a-422e-bade-fedef5ac02a5.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eTranslation and psychometric evaluation of the Tamil Version of the Central Sensitization Inventory\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eChronic pain stems from a multitude of factors that lead to on-going pain lasting over 3 to 6 months and affects an individual's overall quality of life[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Chronic pain is recognized by the World Health Organization as both a symptom and a disease, serving as a primary cause of disability and rising healthcare expenses. Understanding the multifaceted nature of chronic pain is crucial for effective management and improving patient outcomes[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].In numerous chronic conditions, the symptoms of central sensitization play a significant role in the progression of the overall symptoms, regardless of their underlying causes. Central sensitization (CS) is characterized by generalised hypersensitivity to both painful and non-painful stimuli and increased temporal summation of nociception. Proposed mechanisms of CS include altered sensory processing in the brain, dysfunction of pain-regulating pathways, changes in neuronal synapses, and decreased functioning of descending pain inhibitory mechanisms in the central nervous system[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGenetic predisposition, physical injury, and emotional distress have all been implicated in the development and maintenance of CS through irregular regulation of central nervous system pathways[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Persistent CS and its associated symptomatology can substantially limit both physical and psychological functioning, often resulting in functional disability and difficulty performing activities of daily living[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The Central Sensitization Inventory (CSI) is a 25 items self-reported assessment tool designed to assess and quantify symptoms believed to be related to CS. It has been shown to be a potentially useful tool in clinical practice for identifying when CS may be a contributing factor in a patient\u0026rsquo;s clinical presentation so that the most effect assessment and treatment can be initiated. Diagnoses of CSS are frequently associated with musculoskeletal disorders, irrespective of their origins being injury-related or non-injury-related[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere is no gold standard methodology for diagnosing CS. The presence of CS can only be determined to be more or less likely based on a patient\u0026rsquo;s self-reported symptomology, clinical markers, and mechanism-based classification systems[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].Objective measures (like quantitative magnetic resonance imaging) and semi-objective measures (like Quantitative Sensory Testing) can help identify signs of CS, but these methods can be costly and results can be inconclusive[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].The evaluation and diagnosis of CS mostly rely on quantitative sensory testing (QST). Although QST offers benefits in standardized and quantitative assessments of CS, it necessitates relatively costly equipment and is time- and labor-intensive, hence constraining its broad application[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The Central Sensitization Inventory (CSI), an indirect assessment tool specifically designed for Central Sensitization (CS), has been employed to assess CS symptoms[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe CSI has demonstrated robust psychometric properties, including test-retest reliability, internal consistency, and concurrent and predictive validity, in multiple studies using multiple language versions since it was first published in 2012 by Neblett.et.al.[\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].Though some differences in the factor structure have been reported in previous studies, a large factor analysis in a multi-country pooled sample of 1987 subjects found substantial reliability for one general factor of \u0026ldquo;CS-related symptomology;\u0026rdquo; the authors concluded that only total CSI scores should be used and reported[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].Translated versions of the CSI, and additional resources, can be found at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.pridedallas.com/questionnaires/\u003c/span\u003e\u003cspan address=\"https://www.pridedallas.com/questionnaires/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eA Tamil version of the CSI may be a helpful resource for Tamil-speaking healthcare professionals and their patients. However, a Tamil version is currently unavailable. Therefore, the objectives of the present study were to translate and cross-culturally adapt the CSI into the Tamil language and to assess its reliability and validity.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis clinimetric study used a repeated cross sectional design and the developer of CSI questionnaire (Randy Neblett) approved the adaptation and translation of the original English version of CSI tool to Tamil language, India. Ethical approval was obtained from the\u0026nbsp;SRM Medical College Hospital and Research Centre, Kattankulathur (Ref.no: 2340/IEC/2021). All the procedures of the study were conducted as per the declaration of Helsinki[16].\u003c/p\u003e\n\u003cp\u003eAdults presenting with varying chronic musculoskeletal painful conditions were screened for inclusion criteria and invited to participate in the study. All the participants confirmed their voluntary participation by signing the written informed consent before their participation in the study. The recruitment period lasted from December 2021 to April 2025.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and setting:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study involved 209 participants, with 163 female\u0026rsquo;s 46 males using convenient sampling recruited from physiotherapy outpatient unit, SRM Medical College Hospital and Research Centre (SRMMCHRC).Adults aged 18 years and above, native Tamil speakers, with diverse musculoskeletal conditions were included in the study. Patients medically diagnosed with low back pain, osteoarthritis, shoulder conditions, cervical pain, ankle and foot arthritis, wrist and elbow painful conditions were considered for inclusion in the study. Patients diagnosed with neuropsychological or psychiatric disorders were excluded from the study.\u003c/p\u003e\n\u003cp\u003eThe study adhered to recommended guidelines of practice as per COSMIN checklist to recruit a minimum of 5-10 participants per item[17]. And, the maximum recommendation of 10 participants per item was considered. Hence, this study aimed to recruiting 250 participants to improve the robustness of the findings [18]. Finally, 209 participants completed the CSI questionnaire once and 96 participants completed the re-test.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTranslation process:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe translation and cultural adaptation of the CSI followed the process developed by Beaton et al[19]. This guideline consists of six stages: (1) forward translation, (2) synthesis, (3) backward translation, (4) expert community analysis, (5) pretesting, and (6) expert community review of the complete process (Fig.1). In the first phase, Forward Translation, two bilingual native Tamil translators were employed to convert the original English version of the CSI into Tamil. The forward translation of the original CSI version into Tamil was completed by a proficient translator with expertise in physiotherapy (FT1 \u0026amp; FT2). FT1\u0026amp;FT2, native Tamil speakers proficient in English, provided the medical perspectives.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the second phase, the translations were synthesized, and the reconciled version (FT1, FT2) was produced by compiling the translations from both FT1 and FT2. A consensus meeting was conducted among translators (FT1 and FT2) and a facilitator to examine and resolve differences between the two translated versions. In the third step, back translation, two bilingual back-translators generated the BT1 and BT2 versions. Proficient in Tamil and English, they individually converted the FT1\u0026amp;FT2 version back into its native language, English. To mitigate bias, the initial version of the CSI was concealed from both back-translators, whose primary language was English. Following the backward translation procedure, each translator provided a brief summary of the translation process. The committee members, comprising language specialists, the principal investigator, researchers, and both forward and back translators, convened for the fourth phase, the Expert Committee Review, to collaboratively evaluate all translated versions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe fifth step involved administering a pilot test of the pre-final CSI Tamil version with 15\u0026nbsp;individuals who have a history of chronic musculoskeletal disorders. The main aims were to evaluate the readability of the CSI Tamil questionnaire for all participants and to collect their feedback and suggestions. Upon completion of the pre-final questionnaire by participants, their input was integrated and recorded. The average duration to complete the CSI Tamil was 7.30 (\u0026plusmn; 0.40) minutes. Approximately one-quarter of the participants (n\u0026thinsp;=\u0026thinsp;55) sought clarifications concerning items 4 and 24. In the sixth and last step, the Expert Committee assembled to address and resolve all feedback submitted by the participants. They subsequently completed the Tamil version of CSI, confirming that the scale was prepared for validity assessment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstruments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe CSI-Ta questionnaire consists of 25 items related to current health symptoms [20]. Each item is rated on a 5-point temporal Likert scale, including never (0), rarely (1), sometimes (2), often (3), and always (4). A cumulative score ranges from 0 (min) to 100 (max). A score \u0026ge;40/100 indicates presence of CS-related symptomology according to previous studies \u0026nbsp; \u0026nbsp;[12, 20\u0026ndash;22]. The scores of CSI are categorized for the levels of severity as follows: Subclinical (0-29), Mild (30-39), Moderate (40-49), Severe (50-59), and Extreme (60-100).\u003c/p\u003e\n\u003cp\u003eThe numerical pain rating scale (NPRS) asks patients to provide three pain severity ratings, corresponding to current, best, and worst pain experienced over the past 24 hours. The average of the three ratings was used to represent the patient\u0026rsquo;s pain level over the past 24 hours[23, 24]. The World Health Organization Quality of Life- Brief (WHOQOL-BREF) Tamil version is a self-report measure with 2 general questions about perceived quality of life (QOL) and satisfaction with health and 24 specific questions assessing four QOL domains(0-100 score): Physical (7 items), Psychological (6 items), Social Relationships (3 items), and Environmental (8 items),with the higher score indicates better quality of life [25].The Beck Depression Scale is a 21-item widely used measure of self-reported depressive symptoms, with the higher scores (0-63) indicating diagnosis of major depressive disorder [26].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using IBM SPSS version 21.The descriptive statistics of the participants were presented as mean, SD, frequency and percentage. The normality and data distributions were evaluated using skewness, kurtosis, histograms, Q-Q plots, and the Kolmogorov-Smirnov and Shapiro-Wilk tests.Tamil version of CSI investigated for both reliability and validity testing. The intra class correlation coefficient (ICC agreement 2,1) was calculated using a two-way mixed effects model, with Cronbach\u0026rsquo;s alpha (\u0026alpha;), to evaluate the test-retest reliability and internal consistency of the Tamil version of the CSI. Cronbach\u0026rsquo;s alpha values for the CSI-Ta greater than 0.70 are deemed acceptable, those beyond 0.80 are regarded as good, and those surpassing 0.90 are classified as exceptional [24\u0026ndash;26].\u003c/p\u003e\n\u003cp\u003eIntraclass correlation coefficients (ICCs) and 95% confidence intervals (CIs) were calculated to assess test-retest reliability. ICCs below 0.40 were deemed low or undesirable; those ranging from 0.40 to 0.70 were classified as moderate; values from 0.70 to 0.90 were regarded as significant; and \u0026apos;\u0026alpha;\u0026apos; values beyond 0.90 were considered remarkable[27, 28].\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1771231924.png\" width=\"742\" height=\"155\"\u003e\u003c/p\u003e\n\u003cp\u003eTamil, analysing its association with other established clinical variables and questionnaires.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAn Exploratory Factor Analysis (EFA) was conducted to assess the theoretical and dimensional attributes of the construct of CSI-Ta [32]. The criteria were determined using the Kaiser-Meyer-Olkin coefficient (KMO), an Eigenvalue exceeding 1, Bartlett\u0026rsquo;s test of sphericity, and a visual analysis of the scree plot. Floor and ceiling effects were assessed by analysing the frequency of participants achieving the minimum and maximum scores on the CSI-Ta total score. If the floor and ceiling effects did not exceed 15%, they were deemed ideal[33].\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eDemographic characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA total of 250 participants were eligible for the study, of which 215 were conveniently recruited. Six questionnaires containing illogical responses were removed from the final analysis. Flow of the study presented in Fig.2.To assess reliability, 96 participants completed the CSI-Tamil and other questionnaires again 7 days after the initial assessment. The mean age of the individuals who took part in the study and had chronic musculoskeletal diseases was 50.27 (\u0026plusmn;11.86) years. As in earlier validation studies of CSI, most of the participants were women (n\u0026thinsp;=\u0026thinsp;163, 78%), whereas men made up approximately (n\u0026thinsp;=\u0026thinsp;46, 22%) of the group. The mean chronicity of the ailment was 32.54\u0026nbsp;\u0026plusmn;52.98. Most of the patients had either chronic low back pain or osteoarthritis of the knee, with rates of 29.2% and 28.2%, respectively (Table 1).The Overall CSI Tamil scores in subgroups were reported in the Table 2. The frequency distribution of CSI-Tamil severity levels and diagnoses is presented in the supplementary table.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Baseline data of the study participants (n=209)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"475\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eAge (years):mean(\u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e50.27 (\u0026plusmn;11.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003e55 years \u0026amp; less\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e142 (67.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003e\u0026gt; 55 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e67 (32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e135 (64.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e74 (35.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eNo schooling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e12 (5.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e75 (35.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e71 (34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e11 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eDegree and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e4 (19.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e181 (86.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e19 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eEmployment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eIn work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e164 (78.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e30 (14.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e15 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eChronic musculoskeletal conditions (Region)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eLow back\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e61 (29.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eKnee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e59 (28.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eShoulder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e41 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eCervical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e35 (16.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eAnkle and Foot\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e9 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eElbow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e2(1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eWrist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e2(1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eDuration of the condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e32.54\u0026nbsp;\u0026plusmn;52.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eCSI_Total (0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e45.95\u0026nbsp;\u0026plusmn;22.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eNPRS (0-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e6.63 \u0026nbsp;\u0026plusmn;1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eBDI_Total (0-63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e13.12\u0026nbsp;\u0026plusmn;8.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67.7895%;\"\u003e\n \u003cp\u003eWHO QoL(Brief)_Total (0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32.2105%;\"\u003e\n \u003cp\u003e83.18\u0026nbsp;\u0026plusmn;13.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSD- Standard deviation, NPRS-Numerical Pain Rating Scale, CSI-Central Sensitization Inventory, BDI-Beck Depression Inventory,WHOQoL (Brief) \u0026ndash; World Health Organization Quality of Life (Brief)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: CSI-Tamil scores in subgroups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"474\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCSI total score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003e55 years \u0026amp; less\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e47.04\u0026nbsp;\u0026plusmn;22.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003e\u0026gt; 55 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e43.66\u0026nbsp;\u0026plusmn;21.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e46.36\u0026nbsp;\u0026plusmn;21.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e45.23\u0026nbsp;\u0026plusmn;24.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003eNo schooling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e48.12\u0026nbsp;\u0026plusmn;22.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e48.11\u0026nbsp;\u0026plusmn;21.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e44.46\u0026nbsp;\u0026plusmn;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e37.82\u0026nbsp;\u0026plusmn;18.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003eDegree and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e46.07\u0026nbsp;\u0026plusmn;23.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e45.91\u0026nbsp;\u0026plusmn;22.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e45.68\u0026nbsp;\u0026plusmn;21.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003eEmployment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003eIn work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e45.04\u0026nbsp;\u0026plusmn;22.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e47.33\u0026nbsp;\u0026plusmn;24.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45.3586%;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7004%;\"\u003e\n \u003cp\u003e53.2 \u0026nbsp;\u0026plusmn;19.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9409%;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eValues are expressed as means \u0026plusmn; standard deviation. CSI Items with significant differences. p-value represents the comparison result of T-tests or ANOVA with Bonferroni correction.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCeiling and floor effects:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNo floor or ceiling effects were observed for the CSI total score, as no participants obtained the lowest or highest possible scores. A floor and ceiling effect is reported as supplementary table.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConvergent Validity (Spearman Correlations)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSpearman\u0026rsquo;s rank correlation was used to evaluate the convergent validity of the CSI-Tamil, since the data did not meet the assumptions of normality, comparing it with NPRS, WHOQoL, and BDI. The CSI total score demonstrated significant correlations with all clinical measures (Table 3). The Spearman\u0026rsquo;s Rho correlation revealed that the scores of the CSI-Tamil exhibited moderate positive correlations with pain intensity (p = 0.281, p \u0026lt; 0.01) as well as depressive symptoms (p = 0.425, p \u0026lt; 0.01). In contrast, a moderate negative correlation was found with quality of life (p = -0.357, p \u0026lt; 0.01).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Spearman\u0026rsquo;s correlation of the total scores of CSI-Tamil with NPRS, BDI, and WHO QoL (n = 209)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"463\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.4622%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNPRS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7905%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBDI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0065%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQoL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0065%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCSI-Tamil\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.4622%;\"\u003e\n \u003cp\u003eNPRS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7905%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0065%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0065%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.4622%;\"\u003e\n \u003cp\u003eBDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e.476\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7905%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0065%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0065%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.4622%;\"\u003e\n \u003cp\u003eWHOQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e-0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7905%;\"\u003e\n \u003cp\u003e-0.465\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0065%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0065%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.4622%;\"\u003e\n \u003cp\u003eCSI-Tamil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.7343%;\"\u003e\n \u003cp\u003e.281\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7905%;\"\u003e\n \u003cp\u003e.425\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0065%;\"\u003e\n \u003cp\u003e-0.357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0065%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eInternal Consistency and test retest reliability\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe adapted CSI demonstrated high internal consistency, with a Cronbach\u0026rsquo;s alpha\u0026nbsp;(\u0026alpha;)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eof 0.88. Analysis of alpha if item deleted confirmed that all 25 items contributed positively to the scale\u0026apos;s overall reliability (Table 4). The intra-class coefficient for test-retest reliability based on the total scores of the first and second assessments was 0.78 (ICC 2, 1; 95% CI = 0.557\u0026ndash;0.914; p \u0026lt; 0.001) Table 6. To visually demonstrate the agreement between test-retest reliability, a Bland-Altman plot was generated (Fig. 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eInternal consistency of CSI Tamil, if item deleted\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"557\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem-Total Statistics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003eScale Mean if Item Deleted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003eScale Variance if Item Deleted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003eCorrected Item-Total Correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003eCronbach\u0026apos;s Alpha if Item Deleted\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e1_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e466.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.638\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e2_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e483.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.927\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e3_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e466.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.923\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e4_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e44.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e464.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.923\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e5_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e44.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e463.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.570\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.923\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e6_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e465.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.923\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e7_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e44.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e456.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e8_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e457.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.657\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e9_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e456.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.646\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e10_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e465.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e11_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e44.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e462.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.606\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.923\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e12_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e471.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e13_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e460.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e14_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e44.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e466.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.530\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e15_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e453.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.921\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e16_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e463.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.649\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e17_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e461.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e18_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e471.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e19_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e44.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e464.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.547\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e20_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e44.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e465.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e21_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e44.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e464.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.522\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e22_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e468.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.477\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e23_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e465.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e24_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e461.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2083%;\"\u003e\n \u003cp\u003e25_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e43.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.8779%;\"\u003e\n \u003cp\u003e473.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7235%;\"\u003e\n \u003cp\u003e0.472\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.5189%;\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eStructural Validity (Factor Analysis)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe results of exploratory factor analyses of the 25 items of the CSI-Tamil demonstrated 59.4% of the total variance in the principal component analysis using varimax rotation. The Kaiser-Meyer-Olkin (KMO) of sample adequacy was assessed by Bartlett\u0026rsquo;s test of sphericity and found to be statistically significant (KMO 0.79, \u0026chi;\u0026sup2; 1812.2 = 1812.233, df = 300, p-value 0.01). Three-factor components had eigenvalues greater than 1, and the EFA scree plot (Fig. 4) suggests the same. Factor 1 comprised primarily 9 items, especially musculoskeletal tension and sleep disturbances (e.g., Items 16, 8, and 15). Factor 2 comprised 8 items and captured the affective cognitive distress of the scale; items related to anxiety and mental distress loaded high on this domain (e.g., Items 19, 11, and 20). The last 8 items were loaded on factor 3, addressing the systemic sensitivity of the domain (e.g., items 9, 12, and 14) Table 5.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAll three factors reported high internal consistency with the cronbach\u0026rsquo;s \u0026alpha; ranging from 0.891 - 0.921 and good to excellent temporal stability was observed over the measurement period (ICC = 0.811- 0.866) - presented in table 6.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Factor loading for CSI Tamil\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"368\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eFactor Loadings\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 16_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e0.897\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 8_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 15_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e0.784\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 1_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 17_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e0.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 13_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e0.601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 2_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e0.534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 3_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e0.529\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 6_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e0.501\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 19_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e0.887\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 11_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e0.672\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 20_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e0.611\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 10_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e0.569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 21_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e0.499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 4_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e0.455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 5_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e0.415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 7_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e0.401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 9_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e0.566\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 12_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e0.521\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 14_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 18_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 22_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e0.431\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 23_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e0.416\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 24_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4239%;\"\u003e\n \u003cp\u003eItem# 25_CSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3804%;\"\u003e\n \u003cp\u003e0.401\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eKMO 0.79, \u0026chi;\u0026sup2; 1812.2 = 1812.233, Variance explained: 59.4%\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCronbach\u0026apos;s alpha and Intra-class Correlation Coefficients of Test-Retest Reliability\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"524\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43.619%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.0952%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCronbach\u0026apos;s \u0026alpha;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.1905%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eICC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003eSum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43.619%;\"\u003e\n \u003cp\u003eCSI total score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.0952%;\"\u003e\n \u003cp\u003e0.881\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.1905%;\"\u003e\n \u003cp\u003e0.787\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003eFactor1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43.619%;\"\u003e\n \u003cp\u003ePhysical/Emotional Distress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.0952%;\"\u003e\n \u003cp\u003e0.902\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.1905%;\"\u003e\n \u003cp\u003e0.823\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003eFactor2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43.619%;\"\u003e\n \u003cp\u003ePhysical Symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.0952%;\"\u003e\n \u003cp\u003e0.891\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.1905%;\"\u003e\n \u003cp\u003e0.811\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003eFactor3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43.619%;\"\u003e\n \u003cp\u003eAutonomic Distress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0952%;\"\u003e\n \u003cp\u003e0.921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.1905%;\"\u003e\n \u003cp\u003e0.866\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe objective of the current study was to evaluate the psychometric properties of the Tamil version of Central Sensitization Inventory. The successful translation of the CSI Tamil will pave the way to screen and identify the symptoms and its treatment options in Tamil speaking individuals. This study finding demonstrates that the Tamil version of CSI is a reliable, valid and culturally relevant tool for the assessment of CS symptoms in Tamil-speaking populations.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTranslation of CSI-Tamil\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Tamil version of CSI underwent a rigorous translation and adaptation process by adhering to established protocols. \u0026nbsp;This process ensured the linguistic and conceptual equivalence of the CSI Tamil version with the original CSI, improving its applicability in chronic musculoskeletal patients in Tamil-speaking populations. This translation and adaptation process incorporated the comments from translators, bilingual experts, and patients who were involved in the pilot testing to enhance the cultural appropriateness of the translated version of CSI Tamil. No items were removed by the expert panel; only modifications were made in two items (Item 3 and Item 24) according to the pilot testing feedback to align better with the linguistic equivalence. Both the backward translators agreed that the translated version of CSI maintained the same conceptual meaning as the original CSI in English.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInternal consistency of the CSI-Tamil\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe CSI Tamil demonstrated good internal consistency with a cronbach\u0026rsquo;s alpha of 0.88, indicating the higher homogeneity of the items. Similarly, the original CSI and studies conducted in other foreign languages demonstrated the ICC values typically range from 0.87 to 0.93[34\u0026ndash;36]. The CSI Tamil demonstrated good test-retest reliability, with an ICC of 0.78, showing good consistency across time, especially in the absence of clinical change. Previous validation studies conducted across various languages and populations reported higher test retest ICC estimates between \u0026ge;0.88 to 0.965[37\u0026ndash;39]. The Bland-Altman analysis further supported this stability by demonstrating good agreement between test and retest measurements, with minimal systematic bias.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConvergent Validity\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe convergent validity of the CSI Tamil demonstrates significant correlations with pain intensity (NPRS), depressive symptoms (BDI), and quality of life (WHOQoL) for individuals. CSI scores demonstrate a moderate positive correlation with pain (\u0026rho; = 0.281) and depressive symptoms (\u0026rho; = 0.425) and a strong negative correlation with quality of life (\u0026rho; = \u0026minus;0.357), indicating that central sensitization symptoms highly impact the functional activities and quality of life.\u003c/p\u003e\n\u003cp\u003eA moderate correlation of CSI scores with the pain intensity explains the understanding of central sensitization amplifying the pain perception. However, moderate correlations suggest that CSI captures the broader symptoms and is not limited to the nociceptive signal alone. This finding is consistent with previous validation studies reporting a distinct understanding of CS symptom burden and nociceptive signals[34, 40].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCSI scores are strongly associated with depressive symptoms owing to common neurobiological processes, including neurotransmitter imbalance, HPA axis dysregulation, and modified descending inhibitory circuits. Comparable results were documented in many validation studies, demonstrating that emotional discomfort is an essential component of central sensitization rather than a subsequent effect[41, 42].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA moderate negative correlation between CSI scores and quality of life underscores the impact of central sensitization on individuals\u0026apos; physical, psychological, and social functioning. These findings align with previous studies demonstrating that increased CSI scores impact daily functioning, sleep, and general well-being of individuals[43, 44]. The inverse correlation between quality of life and pain intensity clarifies the complex and comprehensive attributes of CSI Tamil, hence enhancing its effectiveness as a screening tool. Additionally this findings supports the convergent validity of the CSI Tamil questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStructural Validity\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eExploratory factor analysis supported the structural validity of the CSI-Tamil, identifying a three-factor solution that accounted for 59.4% of the total variance. Sampling adequacy was confirmed by a satisfactory KMO value (0.79) and a significant Bartlett\u0026rsquo;s test of sphericity, indicating that the data were appropriate for factor analysis. The extracted factors-representing musculoskeletal and sleep-related symptoms, affective-cognitive distress, and systemic sensitivity-are conceptually consistent with the multidimensional symptom profile of central sensitization.\u003c/p\u003e\n\u003cp\u003eWhile the original CSI was proposed as a unidimensional screening tool, multiple validation studies have similarly identified two- or three-factor structures, reflecting cultural and clinical differences in symptom expression[36, 43, 45] . Importantly, the identified factor domains in the present study align with established theoretical models of central sensitization, which emphasize the interaction between physical symptoms, emotional distress, and widespread sensory hypersensitivity[46].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFloor and Ceiling Effects\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNo flooring and ceiling effects were demonstrated in the overall CSI Tamil score, as no participants reported the lowest or highest possible scores in the scale. This finding is attributed to the multidimensional construct of the scale and is consistent with the previous literature[47].\u0026nbsp;In addition, floor or ceiling effects are deemed present when over 15% of respondents attain the minimum or maximum feasible score[48].\u003cbr\u003e\u0026nbsp;However, item-level floor and ceiling effects were captured as a result of symptom-specific prevalence within the participants.\u0026nbsp;Similar item-level floor and ceiling patterns have been reported in other CSI adaptations and are generally interpreted as population-specific rather than indicative of scale limitation[36, 40].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLimitations and recommendations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study\u0026apos;s limitations include that the results are derived from a small sample of people within primary care facilities in Chennai City, so the findings may not be generalized to other populations. The potential impact of treatment on CSI ratings, prior to data collection, must be taken into account.\u0026nbsp;Questionnaires were administered exclusively to those with chronic musculoskeletal pain. Future research should investigate normative and healthy persons to address the discriminate validity of the CSI-Tamil. In alignment with prior CSI validation studies, a greater number of women than men were recruited, consistent with the higher prevalence of musculoskeletal pain disorders among women.\u003c/p\u003e\n\u003cp\u003eThe CSI-Tamil is suitable for initial screening and research purposes among Tamil-speaking communities. Nonetheless, further research employing confirmatory factor analysis, larger and more diverse samples, and evaluations of discriminant validity and responsiveness to change is necessary to enhance the psychometric evidence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical and Research Implications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings of this study reveal that CSI Tamil is a valid and reliable psychometrically sound tool for assessing CS symptoms. The CSI-Tamil can facilitate the early detection of people with increased central sensitization who may benefit from multimodal, bio psychosocial therapy. The existence of a validated Tamil version enhances chances for cross-cultural comparisons and the engagement of Tamil-speaking populations in pain research.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe Tamil version of the Central Sensitization Inventory demonstrates good psychometric properties and is a culturally appropriate tool for screening central sensitization-related symptoms in Tamil-speaking populations. The observed internal consistency and test-retest reliability are comparable to those reported in previous versions of the CSI. The CSI-Tamil may therefore be used to enhance patient care and support clinical and epidemiological research in Tamil-speaking settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBDI- Beck Depression Inventory, CSI \u0026ndash; Central sensitization inventory, EFA - Exploratory factor analysis, CS \u0026ndash; Central sensitization, ICC - Intra-class Correlation Coefficient, NPRS \u0026ndash; Numerical pain rating scale, KMO - Kaiser-Meyer-Olkin, MDC - Minimal Detectable Changes, SEM - Standard Error of Measurement, WHOQOL-BREF- World health organization quality of life brief.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting interests \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their gratitude to the SRM Institute of Science and Technology, India and other individuals who provided support during the course of this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVTS AND TAR conceptualized the idea, VA, BJ, SM, JP and MF developed and designed the methodology, VA, SM, JP, and MF conducted the experiment and collected data, BJ,TAR, and TNS conducted data analysis and interpretation of results. TAR, VA, SM, and TNS wrote the initial draft. BJ, RN and VA reran analysis and critically reviewed the draft. TAR and VTS supervised and oversighted the research activity. All the authors read and approved the final version of the manuscript and the findings reported.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNijs J, George SZ, Clauw DJ, et al. Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine. \u003cem\u003eLancet Rheumatol\u003c/em\u003e 2021; 3: e383\u0026ndash;e392.\u003c/li\u003e\n\u003cli\u003eTreede R-D, Rief W, Barke A, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). \u003cem\u003ePain\u003c/em\u003e 2019; 160: 19\u0026ndash;27.\u003c/li\u003e\n\u003cli\u003eNijs J, Polli A, Willaert W, et al. Central sensitisation: another label or useful diagnosis? \u003cem\u003eDrug Ther Bull\u003c/em\u003e 2019; 57: 60\u0026ndash;63.\u003c/li\u003e\n\u003cli\u003eVos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. \u003cem\u003eLancet Lond Engl\u003c/em\u003e 2012; 380: 2163\u0026ndash;2196.\u003c/li\u003e\n\u003cli\u003eNeblett R, Hartzell MM, Williams M, et al. Use of the Central Sensitization Inventory (CSI) as a treatment outcome measure for patients with chronic spinal pain disorder in a functional restoration program. \u003cem\u003eSpine J\u003c/em\u003e 2017; 17: 1819\u0026ndash;1829.\u003c/li\u003e\n\u003cli\u003eBlyth FM, Briggs AM, Schneider CH, et al. The Global Burden of Musculoskeletal Pain-Where to From Here? \u003cem\u003eAm J Public Health\u003c/em\u003e 2019; 109: 35\u0026ndash;40.\u003c/li\u003e\n\u003cli\u003eNijs J, Lahousse A, Kapreli E, et al. Nociplastic Pain Criteria or Recognition of Central Sensitization? Pain Phenotyping in the Past, Present and Future. \u003cem\u003eJ Clin Med\u003c/em\u003e 2021; 10: 3203.\u003c/li\u003e\n\u003cli\u003eSmart K, Blake C, Staines A, et al. The Discriminative Validity of \u0026lsquo;Nociceptive,\u0026rsquo; \u0026lsquo; Peripheral Neuropathic,\u0026rsquo; and \u0026lsquo;Central Sensitization\u0026rsquo; as Mechanisms-based Classifications of Musculoskeletal Pain. \u003cem\u003eClin J Pain\u003c/em\u003e 2011; 27: 655\u0026ndash;63.\u003c/li\u003e\n\u003cli\u003eShraim M, Mass\u0026eacute;-Alarie H, Hodges P. Methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a systematic review. \u003cem\u003ePain\u003c/em\u003e 2021; 162: 1007\u0026ndash;1037.\u003c/li\u003e\n\u003cli\u003eNeblett R, Sanabria-Mazo JP, Luciano JV, et al. Is the Central Sensitization Inventory (CSI) associated with quantitative sensory testing (QST)? A systematic review and meta-analysis. \u003cem\u003eNeurosci Biobehav Rev\u003c/em\u003e 2024; 161: 105612.\u003c/li\u003e\n\u003cli\u003eNijs J, Leysen L, Vanlauwe J, et al. Treatment of central sensitization in patients with chronic pain: time for change? \u003cem\u003eExpert Opin Pharmacother\u003c/em\u003e 2019; 20: 1\u0026ndash;10.\u003c/li\u003e\n\u003cli\u003eNeblett R. The central sensitization inventory: A user\u0026rsquo;s manual. \u003cem\u003eJ Appl Biobehav Res\u003c/em\u003e 2018; 23: e12123.\u003c/li\u003e\n\u003cli\u003eNijs J, Huysmans E. Clinimetrics: The Central Sensitisation Inventory: a useful screening tool for clinicians, but not the gold standard. \u003cem\u003eJ Physiother\u003c/em\u003e 2022; 68: 207.\u003c/li\u003e\n\u003cli\u003eScerbo T, Colasurdo J, Dunn S, et al. Measurement Properties of the Central Sensitization Inventory: A Systematic Review. \u003cem\u003ePain Pract Off J World Inst Pain\u003c/em\u003e 2018; 18: 544\u0026ndash;554.\u003c/li\u003e\n\u003cli\u003eCuesta-Vargas AI, Neblett R, Chiarotto A, et al. Dimensionality and Reliability of the Central Sensitization Inventory in a Pooled Multicountry Sample. \u003cem\u003eJ Pain\u003c/em\u003e 2018; 19: 317\u0026ndash;329.\u003c/li\u003e\n\u003cli\u003eGoodyear MDE, Krleza-Jeric K, Lemmens T. The Declaration of Helsinki. \u003cem\u003eBMJ\u003c/em\u003e 2007; 335: 624\u0026ndash;625.\u003c/li\u003e\n\u003cli\u003eMokkink LB, Terwee CB, Knol DL, et al. The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. \u003cem\u003eBMC Med Res Methodol\u003c/em\u003e 2010; 10: 22.\u003c/li\u003e\n\u003cli\u003eTsang S, Royse CF, Terkawi AS. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. \u003cem\u003eSaudi J Anaesth\u003c/em\u003e 2017; 11: S80\u0026ndash;S89.\u003c/li\u003e\n\u003cli\u003eBeaton DE, Bombardier C, Guillemin F, et al. Guidelines for the process of cross-cultural adaptation of self-report measures. \u003cem\u003eSpine\u003c/em\u003e 2000; 25: 3186\u0026ndash;3191.\u003c/li\u003e\n\u003cli\u003eNeblett R, Cohen H, Choi Y, et al. The Central Sensitization Inventory (CSI): Establishing Clinically Significant Values for Identifying Central Sensitivity Syndromes in an Outpatient Chronic Pain Sample. \u003cem\u003eJ Pain\u003c/em\u003e 2013; 14: 438\u0026ndash;445.\u003c/li\u003e\n\u003cli\u003eSalaffi F, Farah S, Mariani C, et al. Validity of the Central Sensitization Inventory compared with traditional measures of disease severity in fibromyalgia. \u003cem\u003ePain Pract\u003c/em\u003e 2022; 22: 702\u0026ndash;710.\u003c/li\u003e\n\u003cli\u003eD\u0026uuml;zce Keleş E, Birtane M, Ekuklu G, et al. Validity and reliability of the Turkish version of the central sensitization inventory. \u003cem\u003eArch Rheumatol\u003c/em\u003e 2021; 36: 518\u0026ndash;526.\u003c/li\u003e\n\u003cli\u003eJensen MP, McFarland CA. Increasing the reliability and validity of pain intensity measurement in chronic pain patients. \u003cem\u003ePain\u003c/em\u003e 1993; 55: 195\u0026ndash;203.\u003c/li\u003e\n\u003cli\u003eBroome ME. Measurement of pain: self-report strategies. \u003cem\u003eJ Pediatr Oncol Nurs Off J Assoc Pediatr Oncol Nurses\u003c/em\u003e 1991; 8: 131\u0026ndash;133.\u003c/li\u003e\n\u003cli\u003eWHOQOL-BREF| The World Health Organization, https://www.who.int/tools/whoqol/whoqol-bref (accessed 27 January 2026).\u003c/li\u003e\n\u003cli\u003eBasker M, Moses PD, Russell S, et al. The psychometric properties of Beck Depression Inventory for adolescent depression in a primary-care paediatric setting in India. \u003cem\u003eChild Adolesc Psychiatry Ment Health\u003c/em\u003e 2007; 1: 8.\u003c/li\u003e\n\u003cli\u003eKoo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. \u003cem\u003eJ Chiropr Med\u003c/em\u003e 2016; 15: 155\u0026ndash;163.\u003c/li\u003e\n\u003cli\u003eGliem J, Gliem R. Calculating, Interpreting, And Reporting Cronbach\u0026rsquo;s Alpha Reliability Coefficient For Likert-Type Scales. \u003cem\u003e2003 Midwest Res Pract Conf Adult Contin Community Educ\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eJolliffe IT, Cadima J. Principal component analysis: a review and recent developments. \u003cem\u003ePhilos Transact A Math Phys Eng Sci\u003c/em\u003e 2016; 374: 20150202.\u003c/li\u003e\n\u003cli\u003eFactor analysis and Psychometrika: Major developments | Psychometrika | Springer Nature Link, https://link.springer.com/article/10.1007/BF02293996 (accessed 27 January 2026).\u003c/li\u003e\n\u003cli\u003eStratford P. Getting more from the literature: estimating the Standard Error of Measurement from Reliability studies. Physiother Can. 2004;56. \u003c/li\u003e\n\u003cli\u003eZhang G, Preacher K. Factor Rotation and Standard Errors in Exploratory Factor Analysis. \u003cem\u003eJ Educ Behav Stat\u003c/em\u003e; 40. Epub ahead of print 15 October 2015. DOI: 10.3102/1076998615606098.\u003c/li\u003e\n\u003cli\u003eQuality criteria were proposed for measurement properties of health status questionnaires - ClinicalKey, https://www.clinicalkey.com/#!/content/playContent/1-s2.0\u003c/li\u003e\n\u003cli\u003eMayer TG, Neblett R, Cohen H, et al. The development and psychometric validation of the central sensitization inventory. \u003cem\u003ePain Pract Off J World Inst Pain\u003c/em\u003e 2012; 12: 276\u0026ndash;285.\u003c/li\u003e\n\u003cli\u003eXu C, Yao S, Wei W, et al. Cross-cultural adaptation and validation for central sensitization inventory: based on Chinese patients undergoing total knee arthroplasty for knee osteoarthritis. \u003cem\u003eJ Orthop Surg\u003c/em\u003e 2023; 18: 960.\u003c/li\u003e\n\u003cli\u003eCuesta-Vargas AI, Roldan-Jimenez C, Neblett R, et al. Cross-cultural adaptation and validity of the Spanish central sensitization inventory. \u003cem\u003eSpringerPlus\u003c/em\u003e 2016; 5: 1837.\u003c/li\u003e\n\u003cli\u003eAkhter MF, Bobos P, Otalike EG, et al. Psychometric properties of patient-reported outcome measures in chronic pain conditions with central sensitization- a systematic review and meta-analysis. \u003cem\u003eJ Patient-Rep Outcomes\u003c/em\u003e 2025; 9: 87.\u003c/li\u003e\n\u003cli\u003eXu C, Yao S, Wei W, et al. Cross-cultural adaptation and validation for central sensitization inventory: based on Chinese patients undergoing total knee arthroplasty for knee osteoarthritis. \u003cem\u003eJ Orthop Surg\u003c/em\u003e 2023; 18: 960.\u003c/li\u003e\n\u003cli\u003eCuesta-Vargas AI, Roldan-Jimenez C, Neblett R, et al. Cross-cultural adaptation and validity of the Spanish central sensitization inventory. \u003cem\u003eSpringerPlus\u003c/em\u003e 2016; 5: 1837.\u003c/li\u003e\n\u003cli\u003eNishigami T, Tanaka K, Mibu A, et al. Development and psychometric properties of short form of central sensitization inventory in participants with musculoskeletal pain: A cross-sectional study. \u003cem\u003ePLOS ONE\u003c/em\u003e 2018; 13: e0200152.\u003c/li\u003e\n\u003cli\u003eH\u0026auml;user W, Kosseva M, \u0026Uuml;ceyler N, et al. Emotional, physical, and sexual abuse in fibromyalgia syndrome: a systematic review with meta-analysis. \u003cem\u003eArthritis Care Res\u003c/em\u003e 2011; 63: 808\u0026ndash;820.\u003c/li\u003e\n\u003cli\u003eMeeus M, Nijs J. Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome. \u003cem\u003eClin Rheumatol\u003c/em\u003e 2007; 26: 465\u0026ndash;473.\u003c/li\u003e\n\u003cli\u003eRold\u0026aacute;n-Jim\u0026eacute;nez C, P\u0026eacute;rez-Cruzado D, Neblett R, et al. Central Sensitization in Chronic Musculoskeletal Pain Disorders in Different Populations: A Cross-Sectional Study. \u003cem\u003ePain Med\u003c/em\u003e 2020; 21: 2958\u0026ndash;2963.\u003c/li\u003e\n\u003cli\u003eKregel J, Vuijk PJ, Descheemaeker F, et al. The Dutch Central Sensitization Inventory (CSI): Factor Analysis, Discriminative Power, and Test-Retest Reliability. \u003cem\u003eClin J Pain\u003c/em\u003e 2016; 32: 624\u0026ndash;630.\u003c/li\u003e\n\u003cli\u003eNeblett R, Cohen H, Choi Y, et al. The Central Sensitization Inventory (CSI): establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. \u003cem\u003eJ Pain\u003c/em\u003e 2013; 14: 438\u0026ndash;445.\u003c/li\u003e\n\u003cli\u003eNijs J, Torres-Cueco R, van Wilgen CP, et al. Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization pain. \u003cem\u003ePain Physician\u003c/em\u003e 2014; 17: 447\u0026ndash;457.\u003c/li\u003e\n\u003cli\u003eNeblett R, Cohen H, Choi Y, et al. The Central Sensitization Inventory (CSI): establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. \u003cem\u003eJ Pain\u003c/em\u003e 2013; 14: 438\u0026ndash;445.\u003c/li\u003e\n\u003cli\u003eTerwee CB, Bot SDM, de Boer MR, et al. Quality criteria were proposed for measurement properties of health status questionnaires. \u003cem\u003eJ Clin Epidemiol\u003c/em\u003e 2007; 60: 34\u0026ndash;42. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"SRM Institute of Science and Technology","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"CSI-Tamil, chronic musculoskeletal pain, central sensitization, cross-cultural adaptation","lastPublishedDoi":"10.21203/rs.3.rs-8850389/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8850389/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003eThe Central Sensitization Inventory (CSI) is a reliable and widely used self-reported questionnaire for assessing symptoms related to central sensitization (CS). This study aimed to cross-culturally adapt and translate the CSI into the Tamil language and to evaluate its psychometric properties.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eThe Tamil version of the CSI was developed following recommended guidelines for translation and cultural adaptation. The final CSI-Tamil version was administered to 209 patients with chronic musculoskeletal conditions to assess its psychometric properties. Test-retest reliability was evaluated in a subsample of 96 participants. Exploratory factor analysis (EFA) was conducted to examine the factor structure of the CSI-Tamil.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The CSI-Tamil demonstrated good internal consistency, with a Cronbach’s alpha (α) value of 0.88. Test-retest reliability was acceptable, with an intraclass correlation coefficient (ICC) of 0.78. The mean age of the participants was 50.27 ± 11.86 years, and the majority presented with low back pain. Convergent validity demonstrated moderate positive correlations with the Numeric Pain Rating Scale (NPRS) and Beck Depression Inventory (BDI), and strong negative correlations with the World Health Organization Quality of Life (WHOQoL- BREF) scale. Exploratory factor analysis revealed a three-factor structure, supporting the multidimensional nature of the CSI-Tamil.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The CSI-Tamil version was successfully cross-culturally adapted and translated and demonstrated acceptable psychometric properties. It can be used as a reliable and valid tool for clinical practice and research among Tamil-speaking populations.\u003c/p\u003e","manuscriptTitle":"Translation and psychometric evaluation of the Tamil Version of the Central Sensitization Inventory","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 10:09:45","doi":"10.21203/rs.3.rs-8850389/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"48fc8eb3-dd2a-4fb4-8fae-263a7e426049","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T10:09:48+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-16 10:09:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8850389","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8850389","identity":"rs-8850389","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}