Translation, Adaptation and Cross Language Validation of Tinnitus Handicap Inventory in Urdu

Validation of a Moroccan Arabic Version of the Tinnitus Handicap Inventory (THI-M)

OBJECTIVE

Cultural adaptation of the tinnitus handicap inventory questionnaire to the Moroccan dialect version.

METHOD

We conducted a prospective study over a 3 years period (January 2017-January 2020) in the Otolaryngology Department of Casablanca University hospital. Translation was produced by a forward-backward procedure with analysis of the psychometric properties of the Moroccan version of the tinnitus handicap inventory.

RESULTS

The final Moroccan version of Tinnitus Handicap Inventory (THI) was given to 83 otosclerosis patients suffering from tinnitus. They filled the questionnaire twice before surgery and 1 year after surgery.The item-total correlations are all statistically significant (p < 0.001) and vary between 0.279 (item 15) and 0.817 (item 12).The internal consistency of the Moroccan version of THI, assessed through Cronbach's α, was found to be excellent at 0.953. The interclass correlation showed an excellent reliability for all subscales (0.999-1).THI scores decreased significantly from baseline to 1-year postoperative follow-up on all subscale scores, indicating clinical improvement.

CONCLUSION

The Moroccan version of THI has a good reliability comparable with translations in other languages and the original version. It is a valid tool to assess tinnitus improvement after otosclerosis surgery.

Validity and Reliability of the Urdu Version of the McLean Screening Instrument for Borderline Personality Disorder

Introduction: Although the translation and the validation of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) are performed in various languages and samples, no study has established the validity and reliability of the Urdu version of MSI-BPD in individuals with cardiac problems. Materials and Methods: The Urdu version of the MSI-BPD was prepared through the standard back-translation method. The translation and adaption were completed in four steps: forward translation, adaption and translation, back translation and committee approach, and cross-language validation. The sample, selected through the purposive sampling method, comprised of 150 adults with cardiac problems (men = 75 and women = 75), with an age range of 23-78 years (M = 55, SD = 10.6). The Cronbach alpha reliability and factorial validity of the MSI-BPD were assessed through confirmatory factor analysis (CFA) and Pearson correlation analyses. Internal consistency and test-retest reliability (at 2 weeks' interval) were used to evaluate the reliability. Statistical analyses were performed, using SPSS (version 22) and Structural Equation Modeling (SEM) software. Results: Preliminary analysis revealed that the overall instrument had good internal consistency (Urdu MSI-BPD α = 0.79; English MSI-BPD α = 0.77) as well as test-retest correlation coefficients for 15 days (r = 0.94). Conclusions: Findings suggested that the MSI-BPD, with important limitations, can be used as an effective preliminary screening tool to measure BPD in Urdu-speaking adults with cardiac problems. Further validations should be conducted to make the translated version of the MSI-BPD an appropriate tool to screen BPD in hospitals and mental health care settings.

Improved measurement of tinnitus severity: Study of the dimensionality and reliability of the Tinnitus Handicap Inventory

OBJECTIVE

The Tinnitus Handicap Inventory (THI) is widely used in clinical practice and research as a three-dimensional measure of tinnitus severity. Despite extensive use, its factor structure remains unclear. Furthermore, THI can be considered a reliable measure only if Cronbach's alpha coefficient and Classical Test Theory is used. The more modern and robust Item Response Theory (IRT) has so far not been used to psychometrically evaluate THI. In theory, IRT allows a more precise evaluation of THI's factor structure, reliability, and the quality of individual items.

METHOD

There were 1115 patients with tinnitus (556 women and 559 men), aged 19-84 years (M = 51.55; SD = 13.28). The dimensionality of THI was evaluated using several models of Confirmatory Factor Analysis and an Item Response Theory approach. Exploratory non-parametric Mokken scaling was applied to determine a unidimensional and robust scale. Several IRT polytomous models were used to assess the overall quality of THI.

RESULTS

The bifactor model had the best fit (RMSEA = 0.055; CFI = 0.976; SRMR = 0.040) and revealed one strong general factor and several weak specific factors. Mokken scaling generated a reliable unidimensional scale (Loevinger's H = 0.463). In order to refine THI we propose that five items be removed. The IRT Generalized Partial Credit Model generated good parameters in terms of item location (difficulty), discrimination, and information content of items.

CONCLUSION

Our findings support the use of THI to evaluate tinnitus severity in terms of it being a reliable unidimensional scale. However, clinicians and researchers should rely only on its overall score, which reflects global tinnitus severity. To improve its psychometric quality, several refinements of THI are proposed.