Lviv clinical bulletin 2022, 1(37)-2(38): 21-27

Translation, Cross-Cultural Adaptation and Validation of the Central Sensitization Inventory for Patients with Rheumatoid Arthritis

M. Stanislavchuk, V. Bombela, Y. Shkarivskyy

National Pirogov Memorial Medical University, Vinnytsya

Introduction. Pain syndrome is one of the leading disabilitating factors in patients with rheumatoid arthritis (RA). Recently the heterogeneity of pathogenetic mechanisms of pain formation in the patients with joints inflammatory diseases has been demonstrated. The phenomenon of central sensitization is among the leading mechanisms of pain perception. In 2012 T. G. Mayer et al. created the Central Sensitization Inventory (CSI), which makes it possible rapid identification of patients whose symptoms may be related to the phenomenon of central sensitization. Currently the Ukrainian version of this questionnaire is not available.

The aim of the study. Our investigation was directed towards translation, cross-cultural adaptation, validation, and testing of Central Sensitization Inventory  Ukrainian version in rheumatoid arthritis patients.

Materials and methods. Translation and cross-cultural adaptation of CSI were carried out according to the standard Guidelines for the process of cross-cultural adaptation of self-report measures. 75 patients diagnosed with RA according to ACR/EULAR (2010) criteria and 15 control group patients were involved in the study.

RA activity was determined due to Disease Activity Score – 28 (DAS-28), the Simplified Disease Activity Index (SDAI), the Clinical Disease Activity Index (CDAI), and the functional ability of patients – by Health Assessment Questionnaire – Disability Index (HAQ-DI). Visual analog scoring (VAS) from 0 to 10 points were used to evaluate the intensity of pain.

Statistical analysis of the results was performed using the methods of variation statistics in the application package SPSS22 (© SPSS Inc.). The results are presented as the mean value with standard deviation (M ± SD).

Results. According to DAS-28, patients had a predominance of moderate and high disease activity (4.99 ± 0.87). Also, high RA activity in most patients was confirmed by CDAI (32.96 ± 9.46) and SDAI (35.90 ± 9.56). Impairment of functional ability in the examined patients according to the HAQ-DI index was 1.36 ± 0.70 points. Severe functional impairment (HAQ-DI > 2 points) was observed in 19 % of patients. The intensity of pain assessed in patients was 6,92 ± 1,55 points. The reliability of the Ukrainian-language version of the CSI questionnaire was evaluated by a “test-retest” with an interval of 7 days in 65 patients with RA. The obtained data demonstrated the high reliability of the CSI questionnaire – intraclass correlation coefficient was 0.914, and the L. Cronbach’s alpha coefficient was 0.914. The CSI questionnaire in RA patients demonstrated the phenomenon of central sensitization in this category of patients. The CSI value in our patients was 36.32 ± 14.67 versus 15.60 ± 12.10 in controls. At the same time, an indicator of more than 40 (central sensitization present) was detected in 40 % of patients.

Conclusions. Translation, cross-cultural adaptation and validation of the Central Sensitization Inventory questionnaire were accomplished. The Ukrainian version of the questionnaire showed sufficient reliability and internal consistency. This questionnaire can be useful in both – scientific purposes and clinical practice – regarding the Ukrainian-speaking population with rheumatoid arthritis.


  1. Aletaha D, Smolen J. The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): a review of their usefulness and validity in rheumatoid arthritis. Clin Exp Rheumatol. 2005;23(5 Suppl 39):S100-S108.
  2. Arya V, Malaviya A, Raja R. CDAI (clinical disease activity index) in rheumatoid arthritis: cut-off values for classification into different grades of disease activity. Indian J Rheumatol. 2007;2(3):91-94.
  3. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186-3191.
  4. Bobak C, Barr P, O’Malley A. Estimation of an inter-rater intra-class correlation coefficient that overcomes common assumption violations in the assessment of health measurement scales. BMC Med Res Methodol. 2018;18:93.
  5. Bruce B, Fries JF. The Stanford Health Assessment Questionnaire: dimensions and practical applications. Health Qual Life Outcomes. 2003;1:20.
  6. Bullock J, Rizvi S, Saleh AM, Ahmed SS, Do DP, Ansari RA et al. Rheumatoid Arthritis: A Brief Overview of the Treatment. Medical principles and practice: international journal of the Kuwait University. Health Science Centre. 2018;27(6):501-507.
  7. Cervero F. Spinal cord hyperexcitability and its role in pain and hyperalgesia. Exp Brain Res. 2009;196(1):129-137.
  8. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789-1858
  9. Klooster PM, de Graaf N, Vonkeman HE. Association between pain phenotype and disease activity in rheumatoid arthritis patients: a non-interventional, longitudinal cohort study. Arthritis Res Ther. 2019;21(1):257.
  10. Mayer TG, Neblett R, Cohen H, Howard KJ, Choi YH, Williams MJ et al. The development and psychometric validation of the central sensitization inventory. Pain Practice. 2012;12(4):276-285.
  11. Neblett R. The central sensitization inventory: A user’s manual. J Appl Behav Res. 2018;23:e12123.
  12. Nijs J, Lahousse A, Kapreli E, Bilika P, Saraçoğlu İ, Malfliet A et al. Nociplastic Pain Criteria or Recognition of Central Sensitization? Pain Phenotyping in the Past, Present and Future. J Clin Med. 2021;10(15):3203.
  13. Schober P, Boer C, Schwarte L. Correlation Coefficients: Appropriate Use and Interpretation. Anesth Anal. 2018;126(5):1763-1768.
  14. Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS et al. Rheumatoid arthritis. Nature reviews. 2018. Disease primers, 4, 18001.
  15. Taber KS. The Use of Cronbach’s Alpha When Developing and Reporting Research Instruments in Science Education. Res Sci Educ. 2018;48:1273-1296.
  16. van Riel PL, Renskers L. The Disease Activity Score (DAS) and the Disease Activity Score using 28 joint counts (DAS28) in the management of rheumatoid arthritis. Clin Exp Rheumatol. 2016;34(5 Suppl 101):S40-S44.
  17. Zhang A, Lee YC. Mechanisms for Joint Pain in Rheumatoid Arthritis (RA): from Cytokines to Central Sensitization. Curr Osteopor Rep. 2018;16(5):603-610.