ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
This article is part of the Research TopicMore than just Skin-Deep: Considering Ethnic, Racial, and Healthcare Disparity-based Factors in Pain Experience, Treatment, and GuidelinesView all 4 articles
Development of a modern standard Arabic version of the pain disability index: cross-cultural adaptation, psychometric, and validity data
Provisionally accepted
Leanne Cassidy1
Ehab W Hermena2Eric Francois3Amit Verma3,4Jaya Batra3,4
Omeesha Sanjay Krishnan5Davide DeMarco3Khalifa M Almenhali3Wadhha J Alobeidli3Wadhha Almuntheri3
Kelly Lynn Huffman3*- 1Institute for Healthier Living, Abu Dhabi, United Arab Emirates
- 2American University of Sharjah, Sharjah, United Arab Emirates
- 3Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- 4Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, United States
- 5University of Denver, Denver, United States
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The assessment and treatment of chronic pain rely heavily on patient self-report, making linguistically and culturally appropriate tools essential. However, no well validated Arabic language measures of pain related disability are widely available. The objective of this study was to create and validate a Modern Standard Arabic (MSA) version of the Pain Disability Index (PDI). This prospective cross-sectional study was conducted in a pain management clinic in a tertiary care center in the United Arab Emirates (UAE). The MSA PDI was developed using a forward-backward translation protocol by a team of native Arabic speakers from diverse backgrounds, reviewed by a professional translation company and pilot-tested with a small sample of patients. Participants completed the MSA PDI along with measures of depression (PHQ-8), anxiety (GAD-7), and current pain severity. A total of 423 Arabic-speaking adults participated (54.84% female, mean age of 43.71 ±13.53, most of whom were UAE nationals (88.41%). The mean PDI score was 31.29 (±17.64), indicating moderate pain-related disability. Over half of the sample met screening thresholds for moderate to severe pain (50.83%), depression (57.21%), or anxiety (38.77%). Factor analysis of the MSA PDI supported a unidimensional structure. The MSA PDI also demonstrated excellent internal consistency (α = .91). Construct validity was supported through a tiered multi-method approach (correlation, regression, and structural equation modeling), which showed moderate positive associations between pain severity, depression, anxiety and pain related disability. Overall, the MSA PDI
Keywords: Pain Disability Index, Modern Standard Arabic (MSA), Chronic Pain, Psychometricvalidation, Cross-cultural adaptation and validation, Patient reported clinical outcomes, healthdisparities, United Arab Emirates
Received: 19 Aug 2025; Accepted: 05 Nov 2025.
Copyright: © 2025 Cassidy, Hermena, Francois, Verma, Batra, Sanjay Krishnan, DeMarco, Almenhali, Alobeidli, Almuntheri and Huffman. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Kelly Lynn Huffman, kellynnh@gmail.com
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