Validation of the extended Nordic Musculoskeletal Questionnaire among healthcare professionals in Singapore

Abstract

Background: Work-related musculoskeletal disorders are highly prevalent among healthcare professionals and contribute to disability, reduced productivity and compromised patient care delivery. The Extended Nordic Musculoskeletal Questionnaire is a comprehensive tool used for gathering data on musculoskeletal symptoms and their impact, however its measurement properties have not been validated in Singapore. This study aimed to evaluate the reliability and validity of the extended Nordic Musculoskeletal Questionnaire in measuring musculoskeletal disorders (MSDs) among healthcare professionals in two community hospitals in Singapore. Methods: A total of 251 nurses and therapists working in two community hospitals were recruited in a cross-sectional study conducted between March 2024 and August 2024, following the Consensus-based Standards for selection of Health Measurement Instruments framework (COSMIN). Face validity was assessed through cognitive debriefing interviews (CDIs). Construct validity was assessed by testing 5 a priori hypotheses with the EQ-5D-5L instrument, using Spearman's correlation coefficients. Test-retest reliability was evaluated using kappa, observed proportion of agreement and intraclass correlation coefficient (ICC), while the internal consistency was determined using Cronbach's alpha. Results: Among 251 participants (mean age: 34.7, 83.6% females, 7.31 years of working experience), the NMQ-E demonstrated good internal consistency (Cronbach's alpha above 0.81), and excellent test-retest reliability [ICC = 0.987 (95% CI 0.974-0.994)] with moderate to almost perfect reliability (kappa = 0.64-0.95). All a priori were confirmed in convergent validity assessment. Item response rates exceeded 97%, indicating good feasibility. Conclusion: The NMQ-E is a valid and reliable instrument for assessing work-related musculoskeletal symptoms among healthcare professionals in community hospitals within Singapore. Its application may greatly support epidemiological surveillance and inform occupational health interventions in Singapore's healthcare setting.