Cross-cultural adaptation, reliability and validity of the Persian version of the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A)

Cross-Cultural Adaptation, Translation, and Validation of the Victorian Institute of Sport Assessment-Achilles Questionnaire (VISA-A) for Use With Arabic-Speaking Patients With Achilles Tendinopathy

Background

The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a validated instrument for assessing symptoms of Achilles tendinopathy (AT). However, there is a need to validate the Arabic version of the VISA-A (VISA-A-AR) in Arabic-speaking patients with AT.

Purpose

To validate the VISA-A-AR in Arabic patients with AT and evaluate its reliability and validity.

Study Design

Cohort study (diagnosis); Level of evidence, 3.

Methods

The translation and cultural adaptation of the VISA-A questionnaire into Arabic followed international guidelines. A total of 81 participants were recruited, including 45 patients diagnosed with AT and 36 healthy individuals. The AT group comprised male and female native Arabic speakers aged ≥18 years who were diagnosed with and had symptoms of AT. The inclusion criteria for the healthy group were the same, except that they must not have had AT at the time of the study or previously. The exclusion criteria were individuals with a partial or complete Achilles tendon rupture or prior Achilles tendon surgery. The internal consistency of the VISA-A-AR was assessed using the Cronbach α coefficient. Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC[3,1]). Construct validity was assessed through correlation analysis between VISA-A-AR scores and the Arabic versions of the Short Form-36 Health Survey (SF-36-AR) and the Numeric Pain Rating Scale (ANPRS). Differences in VISA-A-AR scores between patients with AT and healthy controls were analyzed using appropriate statistical tests.

Results

The VISA-A-AR demonstrated a high level of internal consistency (Cronbach α = 0.935) and excellent test-retest reliability (ICC[3,1] = 0.985). Significant positive correlations were observed between VISA-A-AR scores and SF-36-AR (r(43) = 0.838, P < .001), indicating good construct validity. In addition, VISA-A-AR scores showed a significant negative correlation with ANPRS (rS(43) = -0.835, P < .001). Furthermore, VISA-A-AR scores exhibited a significant difference between patients with AT (mean, 45.82 ± 16.65) and healthy controls (mean, 99.94 ± 0.33) (P < .001).

Conclusion

The findings of this study validate the VISA-A-AR as a reliable and valid tool for assessing symptoms of AT in Arabic-speaking patients.

TENDINopathy Severity assessment-Achilles (TENDINS-A): evaluation of reliability and validity in accordance with COSMIN recommendations

OBJECTIVE

To evaluate the construct validity (structural validity and hypothesis testing), reliability (test-retest reliability, measurement error and internal consistency) and minimal important change (MIC) of the 13-item TENDINopathy Severity assessment-Achilles (TENDINS-A).

METHODS

Participants with Achilles pain completed an online survey including: demographics, TENDINS-A, Foot and Ankle Outcome Score (FAOS) and Victorian Institute of Sport Assessment-Achilles (VISA-A). Exploratory factor analysis (EFA) assessed dimensionality. Confirmatory factor analysis (CFA) assessed structural validity (root mean square error of approximation (RMSEA); Comparative Fit Index (CFI); Tucker-Lewis Index (TLI); standardised root measure square (SRMS)). Correlations between TENDINS-A and the FAOS or VISA-A assessed hypothesis testing. Intraclass correlation (ICC) assessed test-retest reliability. Cronbach's alpha assessed internal consistency. SE of the measurement (SEM) assessed measurement error. A distribution-based approach assessed MIC.

RESULTS

79 participants (51% female) with a mean (SD) age=42.6 (13.0) years, height=175.0 (11.7) cm and body mass=82.0 (19.1) kg were included. EFA identified three meaningful factors, proposed as pain, symptoms and function. The best model identified using CFA for TENDINS-A had structural validity (RMSEA=0.101, CFI=0.959, TLI=0.947, SRMS=0.068), which included three factors (pain, symptoms and function), but excluded three items from the original TENDINS-A. TENDINS-A exhibited moderate positive correlation with FAOS (r=0.598, p<0.001) and a moderate negative correlation with VISA-A (r=-0.639, p<0.001). Reliability of the TENDINS-A was excellent (ICC=0.930; Cronbach's α=0.808; SEM=6.54 units), with an MIC of 12 units.

CONCLUSIONS

Our evaluation of the revised 10-item TENDINS-A determined it has construct validity and excellent reliability, compared with the VISA-A and FAOS which lack content and construct validity. The TENDINS-A is recommended as the preferred patient-reported outcome measure to assess disability in people with Achilles tendinopathy.

Validity and Reliability of the Parental Health Literacy Questionnaire for Caregivers of Children Aged 0 to 3 Years in China

Caregivers' health literacy plays a vital role in the quality of parenting and significantly impacts children's physical and psychological health. However, the instruments to assess the health literacy of caregivers of children aged 0 to 3 years are lacking. This study aimed to evaluate the reliability and validity of the Chinese Parental Health Literacy Questionnaire (CPHLQ) in China. We conducted a cross-sectional study. Six hundred and thirty-four caregivers of children aged 0 to 3 years were recruited from Shandong, Yunnan, and Shaanxi Provinces, representing the eastern, central, and western regions of China, between November 2020 and January 2021. The reliability was evaluated by internal consistency reliability and split-half reliability. The construct validity was determined by confirmatory factor analysis. Social determinants of parental health literacy were assessed by multivariate linear regression model. Results showed that CPHLQ had satisfactory reliability and acceptable construct validity. Mothers compared to other types of caregivers, higher education levels, and nuclear or extended families compared to other family compositions were significantly associated with higher parental health literacy. The study further demonstrated that CPHLQ is a reliable and valid instrument to measure the health literacy of caregivers of children aged 0 to 3 years in the Chinese population. It can be used as an evaluation tool for intervention research, to inform policy-making and future health education interventions of improving caregivers' health literacy.

The Victorian Sports Assessment Institute-Achilles Tendinopathy Questionnaire (VISA-A): Chinese cross-cultural adaptation and psychometric validation

Purpose

We aimed to create a standardized cross-cultural adaptation of the simplified Chinese version of VISA-A, test its reliability and validity and conduct exploratory factor analysis on the correlation between items.

Methods

According to international recommendations for the cross-cultural adaptation of questionnaires, after considering the opinions of patients, we translated and revised the English version to create a simplified Chinese version of the questionnaire. We recruited healthy subjects in the general specialty of one university (n = 90) and the physical education specialty of another university (n = 89), and we recruited patients with Achilles tendinopathy in a third group (n = 85). Reliability was evaluated by calculating test–retest reliability and internal consistency, validity was evaluated by exploring structural and criterion validity (correlation with the physical function and body pain items of the SF-36), and responsiveness was evaluated by calculating area under the receiver operating characteristic curve (AUC).

Results

The simplified Chinese version of the VISA-A had no ceiling or floor effects. Four common factors were extracted and explained by the exploratory factor analysis. The test–retest reliability (ICC = 0.97) and internal consistency (Cronbach’s alpha = 0.84) were adequate. The questionnaire had moderate correlations with the physical function and body pain items of the SF-36. The AUC was 0.9407.

Conclusion

The simplified Chinese version of the VISA-A had good reliability and validity and excellent responsiveness, but the factorial structure is not inconsistent with the dimensions of the original version. It can be used to assess and manage patients with Achilles tendinitis in the Chinese culture.

Evaluating the Validity and Reliability of the Persian Version of American Orthopedic Foot and Ankle Society Midfoot Scale

BACKGROUND

The use of a valid and reliable outcome scoring system is crucial for evaluating the result of different treatment interventions. The aims of this study were to translate and culturally adapt the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scoring system into the Persian language and assess its validity and reliability.

METHOD

In total, 57 patients with midfoot injuries were enrolled. Forward-backward translation and cultural adaptation methods were used to develop the Persian version of AOFAS midfoot scoring system. Reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach's alpha. The discriminant and convergent validities of the scoring system were assessed using the total score of the mental and physical component of SF-36.

RESULTS

The mean age of the participants was 46.2 ± 16.3 years. The intra-observer reliability of the totals core of the Persian version of AOFAS midfoot scoring system was 0.96 (confidence interval [CI]: 0.92-0.97) and the inter-observer reliability of the scoring system was 0.90 (CI: 0.86-0.95). The Persian version of AOFAS midfoot scoring system had acceptable convergence with physical component scoring system of SF-36 and its subscales (0.57); moreover, it had acceptable discriminant validity with the mental component of SF-36 and its subscales (0.36).

CONCLUSION

The Persian version of AOFAS midfoot is a reliable and valid instrument and could be used by Persian language clinicians and researchers.

LEVEL OF CLINICAL EVIDENCE

3.

Job requirements and physical demands (JRPD) questionnaire: cross-cultural adaptation and psychometric evaluation in Iranian Army personnel with chronic low back pain

BACKGROUND

Biomechanical risk factors have been identified as the main predisposing factor of chronic low back pain (CLBP), especially in Army personnel. The Job Requirements and Physical Demands (JRPD) questionnaire has been developed to assess the biomechanical exposures related to CLBP. Examining the biomechanical risk factors could prevent CLBP. This study aimed to translate and cross-culturally adapt the JRPD into Persian and assess its psychometric properties among Iranian male Army personnel with CLBP.

METHODS

In this cross-sectional study, the content validation of the JRPD was assessed after translating to Persian. The Persian JRPD was administered to 198 male Army personnel with CLBP, with an interval of 7 days, to assess test-retest reliability, including Cronbach's α, intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimal detectable change at 95% confidence interval (MDC_95%). Scores of the Persian JRPD were correlated with the scores of visual analog scale (VAS), Borg's category-ratio (CR10) scale, general health questionnaire-28 (GHQ-28), and physical functioning (PF₁ and PF₂) subscale of the 12-item short-form health survey (SF-12) to assess convergent validity using Spearman correlation for a priori hypotheses.

RESULTS

The Persian JRPD had good content validity evidenced by the higher content validity index (> 0.70). The questionnaire had a significant positive negligible to weak correlation with the VAS (rho = 0.27; p < 0.001), Borg's CR10 scale (rho = 0.19; p = 0.009), and the total score of GHQ-28 and its domains (rho ≤0.34; p < 0.05); and significant negative weak correlation with PF₂ (rho = - 0.27; p < 0.001) and significant negative moderate correlation with PF₁ (rho = - 0.35; p < 0.001), thus confirming the priori hypotheses (89%, 8/9). The internal consistency and ICC (α = 0.91; ICC = 0.80) were highly adequate, with SEM and MDC_95% of 7.91 and 21.3 respectively.

CONCLUSIONS

The JRPD was successfully adapted into Persian and had adequate psychometric properties in terms of content and convergent validity, internal consistency, and test-retest reliability. The questionnaire is found useable to assess the CLBP-related biomechanical exposures in Iranian male Army personnel.

Cross-Cultural Adaptation of Chinese Victorian Institute of Sports Assessment–Achilles (VISA-A) Questionnaire for Achilles Tendinopathy

Background:

Victorian Institute of Sports Assessment (VISA-A) is a patient-reported outcome for assessing symptoms severity associated with Achilles tendinopathy (AT). It is a valid and reliable tool that has been used widely for measuring and monitoring treatment outcomes for AT. This clinical measurement study aims to develop a Chinese version of the VISA-A questionnaire. The study objective is to adapt the VISA-A questionnaire cross-culturally and assess its psychometric property for Chinese-speaking individuals.

Methods:

VISA-A was translated and adapted cross-culturally according to international guidelines for self-reported questionnaires. During the establishment of Chinese VISA-A, there are 5 stages involved in the creation process, including translation, synthesis, reverse translation, review, and pretesting, which are performed by professionals in various fields, including orthopaedic surgeons, physiotherapists, and professional translators.

Results:

A total of 60 participants were recruited to complete the Chinese VISA-A and 36-Item Short Form Health Survey (SF-36) questionnaires. The overall test-retest reliability was 0.98 (intraclass correlation coefficient = 0.97-0.99). The correlation between Chinese VISA-A and physical function subscale ( r = 0.70) was strong and statistically significant. There were moderate correlations between Chinese VISA-A, limitations to role of physical function subscale ( r = 0.30), and bodily pain subscale ( r = 0.42), which were also statistically significant. There were statistically significant differences in Chinese VISA-A scores between healthy control and pathologic group ( P < .001), at-risk group, and pathologic group ( P < .001) respectively.

Conclusion:

Chinese VISA-A demonstrated good reliability and validity for measuring symptom severity in patients with AT. Chinese VISA-A can be recommended as a self-reported measure for monitoring symptoms severity and treatment progress of patients with Achilles tendinopathy. Level of Evidence: Level II, cohort study.

Cross-cultural adaptation and measurement properties of the VISA-A questionnaire for Chinese patients with Achilles Tendinopathy

OBJECTIVE

To culturally adapt the VISA-A into a simplified Chinese version (VISA-A-CHN) and test its measurement properties.

DESIGN

Methodological study; SETTING: Hospital and university laboratory.

PARTICIPANTS

240 subjects were divided into the healthy (n = 80), at-risk (n = 80), and tendinopathy groups (n = 80).

MAIN OUTCOMES MEASURES

The internal consistency, test-retest reliability, construct validity, and the floor and ceiling effect of the VISA-A-CHN.

RESULTS

The VISA-A-CHN showed adequate internal consistency (Cronbach's α = 0.73, 95% CI 0.63 to 0.81), excellent test-retest reliability (ICC_3A,1 = 0.97, 95%CI = 0.95 to 0.98), standard error of measurement of 2.2 points, minimum detectable change of 6.0 points, with no floor and ceiling effects. Two factors (pain/symptoms and physical function/activity) were extracted in exploratory factor analysis. There were moderate associations of VISA-A-CHN score with scores of Lower Extremity Functional Scale and SF-36 physical components (r_s = 0.53-0.74, P < 0.01) but low associations with SF-36 mental components (r_s = 0.12-0.22, P > 0.05). VISA-A-CHN mean score of Achilles tendinopathy group was significantly lower than those of healthy and at-risk groups (P < 0.01).

CONCLUSIONS

The VISA-A-CHN is equivalent to the original version in terms of language and measurement properties. It can be used as the outcome measure for Chinese patients with Achilles tendinopathy.