Electronic adaptation and danish cross-cultural translation of PEmb-QoL and VEINES-QoL/Sym for patients with venous thromboembolism

PURPOSE

Most patient-reported outcome (PROs) used in thrombosis research and clinical practice are delivered using technology like online questionnaires. However, only few have undergone formal electronic adaptation from paper to digital versions, threatening the validity and reliability of the PROs. The present study aimed to perform an electronic adaption and cross-cultural translation of two PROs measuring health-related quality of life in a Danish cohort of patients with venous thrombosis (VTE), specifically the VEINES-QoL/Sym questionnaire and the PEmb-QoL questionnaire.

METHODS

The electronic adaption and cross-cultural translation processes followed the international guidelines recommended by ISPOR. The migration of the questionnaires from paper to electronic versions was conducted in the Research Electronic Data Capture (REDCap). Following approval of the electronically adapted and translated versions, a pretest of the questionnaires was performed by cognitive interviewing patients with VTE recruited from a hospital setting.

RESULTS

Nine men and ten women between the age of 19 and 73 years participated in cognitive interviews. The questionnaires were successfully adapted from paper to electronic versions, and during the migration process only a few modifications to the content and format were made. Most comments were related to technicalities, e.g. touch functions and checkboxes. The cross-cultural translation of both questionnaires was satisfactory, as only minor rephrasing was required.

CONCLUSIONS

The original and Danish version of VEINES-QoL/Sym and PEmb-QoL were successfully adapted into electronic versions and are ready to share for REDCap users. Furthermore, the Danish versions of the two questionnaires have shown satisfactory face validity.

CROSS-CULTURAL ADAPTATION AND LINGUISTIC VALIDATION OF THE TRANSLATED ARABIC REVISED BREASTFEEDING ATTRITION PREDICTION TOOL

Background and Purpose: The diversity of populations across the globe and the need to better compare research findings make it imperative to validate research instruments across cultures. The purpose is to systematically describe the translation and the cross-cultural validation of the Revised-Breastfeeding Attrition Prediction Tool from English to Arabic. Methods: The process of cross-cultural validation included (a) translation and linguistic validation: forward- and back-translations; (b) expert evaluation using content validity index (CVI); (c) cognitive interviews (CIs), and (d) pilot testing with postpartum mothers. Results: The item-CVI scores ranged from .8 to 1.00 and the scale-CVI was .95. The CIs identified items that required modification. The reliability coefficient of the pilot-test was .83 and subscale reliabilities ranged from .31 to .93. Discussion: The translation process provided confirmation for the appropriateness of the translated tool to Arabic.

[Balance Evaluation Systems Test: German translation, cultural adaptation and preliminary results on psychometric properties]

BACKGROUND

The Balance Evaluation Systems Test (BESTest) evaluates balance ability and identifies affected systems associated with balance deficits.

OBJECTIVE

The primary objective was the translation and cultural adaptation of the BESTest into German. Secondary objective was the preliminary evaluation of psychometric properties of the BESTest.

METHOD

In accordance with international guidelines, the BESTest was translated and adapted by a 7-step process. To test the psychometric properties, persons with subjective or objective balance deficits were included. Internal consistency was evaluated by means of Cronbach's alpha. The criterion validity was tested by measuring the correlation with the Berg Balance Scale (BBS). Construct validity was examined using the Activities-Specific Balance Confidence (ABC-D) scale and the known groups methods (fallers versus non-fallers).

RESULTS

A total of 27 subjects were included in the testing of the psychometric properties. Cronbach's alpha was 0.95 for the total scale. The correlation of BESTest scores with those of the BBS revealed a Spearmen's ρ of 0.84 (p < 0.001) and 0.61 (p < 0.001) with those of the ABC‑D scale. Fallers and non-fallers showed a trend towards different BESTest scores (p = 0.057).

DISCUSSION

This paper provides a German translation of the BESTest authorized by the developer. Our preliminary results confirm reliability and validity.

The Thai version of the Nijmegen questionnaire

Purpose

The Nijmegen questionnaire is a screening tool for detecting hyperventilation syndrome. The present study aimed to cross-culturally adapt the questionnaire to Thai language and test its psychometric properties for screening hyperventilation syndrome, in which the prevalence is increasing due to the impacts of the COVID-19 pandemic.Design/methodology/approach: The Thai version of the Nijmegen questionnaire (NQ-TH) was generated following a cross-cultural adaptation guideline including initial translation, synthesis of forward translation, back translation, expert committee review, and prefinal testing. Fifty control participants and one-hundred patients with symptoms related to hyperventilation syndrome were enrolled in this study for the determination of psychometric properties. Content validity, construct validity, internal consistency reliability, and test-retest reliability of the NQ-TH were assessed. Its discriminant ability and cutoff point for screening hyperventilation syndrome were also revealed.

Findings

The obtained IOC and disappeared floor and ceiling effects indicated excellent content validity of the questionnaire. There were significant correlations between the total scores of the NQ-TH and other questionnaires and recorded respiratory measurements obtained from the patients, i.e., SF-36-TH (r = -0.257), HADS-TH (r = 0.331), RR (r = 0.377), and BHT (r = -0.444). This supported the construct validity of the NQ-TH. An acceptable internal consistency was also observed (Cronbach's alpha = 0.789). Test-retest repeatability of the questionnaire was high (ICC = 0.90). Moreover, the NQ-TH reliability was also ensured by calculated MDC (2.68). The cutoff point of the NQ-TH was at 20 with 98% sensitivity and 94% specificity.Originality/value: The NQ-TH established by the present study is a valid and reliable tool for screening hyperventilation syndrome among Thais.

Cross-cultural translation and validation of the traumatic injuries distress scale - Spanish version

PURPOSE

The Traumatic Injuries Distress Scale is a patient-reported measure capturing experiences of distress following non-catastrophic musculoskeletal injuries. The original English version has shown adequate accuracy for predicting recovery trajectories up to 12 months later. Herein we describe the translation of the English TIDS into the TIDS-Spanish.

MATERIALS AND METHODS

The prototype version was developed through a two-step forwards-back translation involving four independent bilingual speakers. 73 participants (51% female, mean age 47 years, 32% acute) with musculoskeletal pain responded to the prototype through an online platform or in paper format through a single administration. A series of hypotheses including correlation with an external standard and factor structure were tested for both concurrent and factorial validity compared to those of the English version.

RESULTS

Despite an overall higher mean TIDS score in the Spanish-speaking participants compared to the original English development cohort, all hypotheses for concurrent associations with external pain criteria were satisfied and the three-factor structure of the original was replicated in the new TIDS-Spanish (CFI = 0.97, TLI = 0.96, RMSEA = 0.05).

CONCLUSION

While prospective data collection is needed to explore the equivalence in prognostic validity, all other analyses indicated psychometric equivalence of the new TIDS-Spanish with the original English version. Implications for RehabilitationThe Traumatic Injuries Distress Scale has previously shown prognostic validity for stratifying people with acute musculoskeletal injury into risk-recovery trajectories.A Spanish-translated version of the TIDS was developed and evaluated for psychometric equivalence with the original English version.Results indicate that we were successful in creating a conceptually and empirically equivalent version of the TIDS for use in Spanish-speaking populations.

Cross-cultural translation, adaptation, and validation of the Amharic version pain self-efficacy questionnaire in people with low back pain in Ethiopia

BACKGROUND

The Pain Self-Efficacy Questionnaire (PSEQ) is a valid and reliable instrument that evaluates pain self-efficacy beliefs in people with pain conditions. However, it has not been validated and used in Ethiopia. We conducted this study to translate, adapt, and test the psychometric properties of the PSEQ in the Amharic language and Ethiopian context for its use with people experiencing low back pain (LBP).

METHODS

The PSEQ was translated into Amharic and then back-translated into English. An expert review committee created a final Amharic version of the tool (PSEQ-Am), followed by pilot testing and cognitive debriefing with a sample of 20 people with LBP. The psychometric properties of the final version of PSEQ-Am were assessed in a sample of 240 people with LBP recruited from three rehabilitation centers in Ethiopia. Cronbach's alpha and Intra-class correlation coefficient were calculated to describe the reliability and internal consistency of the tool. The SF-36-Am bodily pain subscale was used to assess convergent validity. Confirmatory Factor Analysis (CFA) and Exploratory Factor Analysis (EFA) were performed to determine the dimensionality of the instrument.

RESULTS

PSEQ-Am demonstrated excellent test-retest reliability (ICC = 0.93) and internal consistency (Cronbach's alpha = 0.91). As hypothesized, the tool demonstrated a significant moderate correlation with the Bodily Pain subscale of the SF-36-Am (Rho = 0.51, p < 0.01). EFA analysis shows that the Amharic version of PSEQ is a dominant one factor and secondary two factor structure.

CONCLUSION

This study shows that PSEQ-Am is a reliable and valid tool that can be used in both clinical practice and research in the Ethiopian low back pain population.

The German RECAP questionnaire: linguistic validation and cognitive debriefing in German adults with self-reported atopic eczema and parents of affected children

Background

Recap of atopic eczema (RECAP) is a patient-reported outcome measure (PROM) assessing eczema control. Long-term control of eczema is one of the four core outcome domains for atopic eczema trials. This instrument has been recently developed in the UK.

Objective

This study aimed to translate the English RECAP into German and test its content validity in a German population with self-reported atopic eczema.

Methods

A six-step procedure including two forward and one backward translations, two consensus decisions and an expert review was performed to obtain a German version of RECAP. We conducted semi-standardized cognitive interviews with adults with atopic eczema (n = 7) and parents having children affected by this disease (n = 5). A “think-aloud” method was used and aspects of comprehensibility, comprehensiveness and relevance according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria were examined. Interviews were coded using qualitative content analysis.

Results

No particular linguistic problems were encountered during forward-backward translation. Minor wording changes were made as required. The title was adjusted to a more familiar German term of the disease (which is ‘Neurodermitis’). The recall period was rephrased from ‘over the last week’ to ‘over the last seven days’ since there was a different cultural understanding of the time frame. Regarding content validity, the items of the German RECAP were considered to be comprehensible, comprehensive and relevant for the participants and parents of affected children. The participants understood the instruction and considered the one-week recall period and the response options as appropriate.

Conclusions

A German version of RECAP that is linguistically equivalent to the original version is now available but further assessment of its measurement properties is needed.

[Translation of the evidence-based practice confidence (EPIC) scale into German and its cross-cultural adaption for Switzerland, Austria and Germany]

BACKGROUND

The Evidence-based Practice Confidence (EPIC) scale is a self-report questionnaire for health professionals. The EPIC scale was developed in Canada and is based on Bandura's self-efficacy theory. It comprises 11 statements on the organization and implementation of evidence-based practice (EBP) steps. The aim of the study was to translate the EPIC scale into German, to test its comprehensibility in German-speaking countries and to interculturally adapt the scale.

METHODS

The translation process followed international guidelines. After two independent translations into German and two independent back translations had been conducted, an expert committee discussed discrepancies in view of intercultural comprehensibility and agreed on a preliminary German version. The comprehensibility of this version was evaluated with physical therapists from Switzerland, Austria and Germany. They were recruited using purposeful sampling and interviewed via telephone using a semi-structured questionnaire (cognitive interviewing). The interviews were recorded and analyzed independently by two authors using a structured evaluation scheme. Based on these results, the final version was created. All changes were discussed with the author of the EPIC scale.

RESULTS

Sixteen physical therapists of the three German-speaking countries were interviewed. Demographic data showed a balanced distribution of country of origin, age group, qualification and years of work experience. In general, participants reported a good overall comprehensibility. However, they reported that (too) many scientific terms caused comprehension problems and that some of these terms were unknown to participants. During the intercultural adaptation attention was paid to simplify and shorten sentences and to paraphrase terms that were difficult to understand. Moreover, the instructions were expanded to address partial lack of knowledge of scientific terms.

CONCLUSION

The EPIC scale was successfully translated and interculturally adapted to the German language. The scale evaluates self-efficacy in EBP activities and could potentially be used to assess courses or be integrated into surveys. In the next step, the validity and reliability of the German scale should be established involving other health care professionals in this process.

Cultural translation and adaptation of the Alberta Infant Motor Scale Thai version

BACKGROUND

The Alberta Infant Motor Scale (AIMS) is a widely used screening tool used to measure gross-motor maturation for clinical and research usage in various countries. A cross-cultural translation and adaptation process is essential to produce reliable and applicable translated assessment tools.

AIMS

The purposes of this cross-sectional study were to obtain the Alberta Infant Motor Scale Thai version and to determine its reliability, validity, and applicability.

METHODS

The process of translation and cultural adaptation of the AIMS Thai version was performed. The conceptual, semantic, and idiomatic equivalences of the language of the AIMS Thai version were strictly reviewed by committee. The intra-rater/inter-rater reliabilities and concurrent validity with the Bayley III were examined in 30 full-term typically developing infants. Then, 19 infants from an orphanage and 23 typically developing infants were assessed using the final translated version of the AIMS.

RESULTS

The AIMS Thai version was generated systematically. Two therapists showed high intra-rater reliability using the Thai AIMS with an ICC of 0.995 (95% CI 0.989-0.998) and 0.979 (95%CI 0.919-0.992), and the inter-rater reliability was 0.988 (95%CI 0.976-0.994). The concurrent validity of the AIMS Thai version and the Bayley III was 0.969 (p < 0.01). The AIMS percentile of gross-motor development of orphaned infants (94.7%) were equal or lower than the 5th percentile, while the AIMS percentile of home-raised infants ranged from the 5th to the 90th percentile.

CONCLUSION

The translated and adapted AIMS Thai version is reliable and valid to use in Thai infants.

The patient experience with treatment and self-management (PETS) questionnaire: translation and cultural adaption of the Norwegian version

Background

Noncommunicable diseases represents long term medical conditions, which often puts the patients under enormous demands when following treatment, exposing them to experiencing treatment burden. The Patient Experience with Treatment and Self-Management (PETS) questionnaire was developed as a patient-reported measure to identify treatment burden of chronic illness, using modern measurement theory and tested in a variety of settings. Developed in English, this set of measures had not been previously translated into Norwegian. The objective of this study was to develop a Norwegian version of the PETS and to pretest the translated measures through a cognitive debriefing methodology.

Methods

A rigorous translation approach was applied, guided by Functional Assessment of Chronic Illness Therapy methodology. Bilingual teams from Norway and the United States reviewed the translation to develop a provisional version, which was evaluated for test content validity with cognitive interviews by probing 12 native Norwegian patients with noncommunicable diseases. The interviews applied both concurrent and retrospective verbal probing techniques, guided by a question route. Audio-recorded interviews were transcribed verbatim and analysed using systematic text condensation.

Results

Assessment of translatability identified the need for cultural adaptation on several core words, balanced with the need to keep close to the original literal meaning. Seven patients with colorectal cancer and five patients with heart failure participated in cognitive testing of the Norwegian version of the PETS. The analytical process of the cognitive interviews identified two emergent main themes, ‘comprehension and readability’ and ‘relevance of the PETS’, with seven corresponding subthemes. Most items, response options and instructions were well understood by the patients. Revisions were made concerning cultural relevance.

Conclusions

PETS items were semantically equivalent to the original. The patients with colorectal cancer and heart failure were able to comprehend the PETS and found it to express their experience with treatment burden in chronic illness. Future work will focus on psychometric construct validation and reliability testing of the PETS.

The Vespid Allergy Quality of Life Questionnaire - cultural adaptation and translation to Portuguese

A cross-cultural translation of the Vespid Allergy Quality of Life Questionnaire (VQLQ) to the Portuguese population (VQLQ-P) was performed, assessing its applicability in wasp and in non-beekeeper bee venom allergic patients. Additionally, we evaluated a Visual Analogue Scale (VAS) to estimate hymenoptera allergy interference with daily life. Methods. Cross-cultural translation was performed according to recommendations. The final VQLQ-P version, the Expectation of Outcome questionnaire (EoQ), EQ-5D and VAS were applied to wasp (n = 19) and non-beekeeper bee venom allergic patients (n = 30). Results. VQLQ-P significantly correlated with EoQ, (r = 0.76, p < 0.01), EQ-5D (usual activities and anxiety / depression dimensions) and VAS, with a good internal consistency (Cronbach α = 0.88) in wasp allergic individuals. VQLQ-P and EoQ correlation was also high (r = 0.67, p < 0.01) in bee allergy. Conclusion. The VQLQ-P is a valuable tool to evaluate quality of life impairment in Portuguese hymenoptera venom allergic individuals.