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. 2025 Jun 21:16:20406223251324812.
doi: 10.1177/20406223251324812. eCollection 2025.

Italian validation of the credibility/expectancy questionnaire in spinal pain: a useful tool for clinicians and physiotherapist (CEQ-I)

Teresa Paolucci  1 , Laura Belinda Rizzo  2 , Giulia Patacchia  3 , Chiara Sebastiani  3 , Luca Furcas  3 , Francesca Capuano  3 , Marco Paoloni  3 , Marta Di Nicola  4 , Letizia Pezzi  5 , Paola Borrelli  4
Affiliations

Italian validation of the credibility/expectancy questionnaire in spinal pain: a useful tool for clinicians and physiotherapist (CEQ-I)

Teresa Paolucci et al. Ther Adv Chronic Dis. .

Abstract

Background: The "credibility" and "expectation" regarding the treatment are important factors in the rehabilitation management of patients with spinal pain (SP).

Objectives: The aim of this study was to translate, culturally adapt, and validate an Italian version of the credibility/expectancy questionnaire (CEQ-I) by Devilly and Borkovec (CEQ) for its application in SP in rehabilitative care.

Design: Cross-sectional observational study.

Methods: Ninety-nine patients (N = 99; mean age of 56.9 years ± 16.3 SD) with acute or chronic SP were recruited from September 2023 to September 2024. To evaluate construct validity, exploratory factor analysis (EFA) was conducted using a matrix of polychoric correlations along with promax rotation. The internal consistency and stability of the scale were evaluated using Cronbach's alpha coefficient and test-retest analysis through the intraclass correlation coefficient (ICC). Pearson's analysis between CEQ and other scales (Numeric Rating Scale, NRS; Roland and Morris-Disability Questionnaire, RMDQ; Oswestry Disability Index, ODI; Neuropathic Pain Symptom Inventory, NPSI) was employed to assess external validity.

Results: Ninety-nine subjects were recruited. Test-retest reliability between two consecutive administrations of the CEQ showed an ICC of 0.90 (p < 0.001). The Kaiser-Meyer-Olkin (KMO) statistic was 0.81, indicating suitability for factor analysis. EFA revealed two factors-credibility and expectancy-accounting for 56.6% of the variance. Cronbach's alpha indicated high internal consistency (0.85). External validation using Pearson's correlation found no significant relationships between the CEQ subscale scores and NRS, RMDQ, ODI, and NPSI scales.

Conclusion: The CEQ-I is a valid Italian translation of CEQ that demonstrates acceptable psychometric properties in SP in a rehabilitative setting. However, we recommend further analysis of the construct definition of the CEQ-I.

Keywords: credibility; expectation; outcome measure; psychotherapy; rehabilitation; routine practice; validation.

Plain language summary

A practical tool for assessing spinal pain: the Italian validation of the credibility questionnaire (CEQ-I) In rehabilitative medicine, clinical scales and tests are indispensable tools for objectively and reliably measuring specific aspects concerning patients (e.g., strength, tone, pain, etc.). For their application in a population with a different language from that of origin, they must undergo formal approval (validation) through studies that meet international reference criteria. Our study aims to “validate” an important English scale in the clinical management of spinal pain, to facilitate clinical practice and research in the field. To do this, we asked 99 patients who visited the physiotherapy outpatient clinics at the research sites to respond to questions translated into Italian from the original English scale (CEQ scale by Devilly & Borkovec), which assesses the credibility and expectations of the patient regarding the rehabilitation treatment they are about to undergo. The study was conducted by applying statistical analysis to the data, which highlighted a strong correspondence between the questions asked and the expectations and feelings of the patients towards the prescribed therapies, as well as alignment with the original test. Therefore, we concluded that our translation is valid, providing a new tool that is easy to use and precise, to assist the Italian rehabilitation community in carrying out its work.

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Figures

Figure 1.
Figure 1.
Parallel analysis conducted on the six-item CEQ-I questionnaire. CEQ-I, Italian version of the credibility/expectancy questionnaire. (appendix: Figure 2).
Figure 2.
Figure 2.
CEQ Italian version (CEQ-I).
See this image and copyright information in PMC

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