Development and Validation of the Sleep Hygiene Scale for Chronic Back Pain (SHSCBP): Content Validity Using an Expert Panel and Exploratory Factor Analysis

Introduction: A bidirectional, reinforcing relationship exists between Chronic Low Back Pain (CLBP) and sleep disturbance. Pain alters sleep initiation and maintenance, while poor sleep exacerbates pain perception and functional impairment. This reciprocal dynamic underscores the need for a condition-specific sleep hygiene assessment to identify modifiable behaviours that drive both pain and sleep outcomes in CLBP, yet no validated instrument exists to assess sleep hygiene specifically in this population. Aim: To develop and validate a CLBP-specific sleep hygiene scale (SHS-CBP). Materials and Methods: This was a mixed-methods study conducted in the Musculoskeletal Physiotherapy outpatient department of Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana-Ambala, Haryana, India. The study was conducted from May 2025 to February 2026. Items were generated through an Extensive Literature Search (ELS), In-Depth Direct Interviews (IDDI, n=20), and expert consultation. Content validity was established using a nine-expert panel (I-CVI ≥0.78; S-CVI/Ave ≥0.90). Construct validity was assessed by Exploratory Factor Analysis (EFA) in 200 patients with CLBP and impaired sleep quality. Results: Thirteen items were generated and met content validity index (I-CVI range 0.89-1.00; S-CVI/Ave=0.957). Exploratory factor analysis produced three factors Presleep Consumption and Sleep Environment (PCSE), Active Daytime Self-Regulation (ADSR), and Pharmacological and Dietary Habits (PDH) accounting for 50.33% of common variance (KMO=0.619; Bartlett’s p<0.001). One item (alarm-setting) was dropped after factoring for poor communality, leaving a final 12-item scale (Cronbach’s α=0.85). Conclusion: The SHS-CBP is a content-valid, factorially supported instrument for assessing sleep hygiene in CLBP. Confirmatory factor analysis, test-retest reliability, internal consistency, convergent validity testing against established sleep and pain measures, and responsiveness evaluation are required before it can be recommended for routine clinical or research use.