Translation and Psychometric Validation of the German Version of the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ): A Cross-Sectional Study

Supporting families experiencing critical illness through family interventions is essential to ease illness burden, enable family management, and reduce their risk for adverse health. Thus far, there is no validated German instrument to measure the perceived support families receive from nurses. We translated the 14-item Iceland-Family Perceived Support Questionnaire (ICE-FPSQ) and tested its psychometric properties with 77 family members of intensive care patients. Compared with the original instrument, the construct validity of the German ICE-FPSQ (FPSQ-G) showed unstable results with a partially divergent structure, most likely caused by the limited sample size. The first two principal components explained 61% of the overall variance and a good internal consistency with a Cronbach's alpha of .92. The FPSQ-G is a promising instrument to measure family members' perceptions of the support they received from nurses in the acute critical care setting but requires further validation.

A German translation and validation of the sense of agency scale

Sense of agency refers to the experience of controlling one's actions and through them events in the outside world. General agency beliefs can be measured with the Sense of Agency Scale (SoAS), which consists of the sense of positive agency subscale (i.e., feeling of being in control over one's own body, mind, and environment) and the sense of negative agency subscale (i.e., feeling existentially helpless). The aim of the present study was to validate a German version of the SoAS. Using factor analyzes, we replicated the two-factor structure of the original version of the SoAS. Further, the German SoAS showed good model fits, good internal consistency, and moderate test-retest reliability. Construct validity was supported by significant low to moderate correlations of the German SoAS with other conceptually similar, but still distinct constructs such as general self-efficacy. Additionally, the German SoAS has an incremental value in explaining variance in the extent of subclinical symptoms of schizotypal personality disorder that goes beyond variance explained by constructs that are conceptually similar to sense of agency. Taken together, the results indicate that the German SoAS is a valid and suitable instrument to assess one's general agency beliefs.

[Translation of the 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis and linguistic validation in German-speaking countries with healthcare professionals]

BACKGROUND

Regular physical activity is beneficial for people with rheumatic diseases and one of the cornerstones in its management. Based on the international recommendations of the World Health Organization for the general population, the "2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis" provide evidence-based recommendations on the prescription, performance, and implementation of physical activity exercises in this population for the first time.

AIM

Translation of the 2018 EULAR recommendations into German and linguistic validation in Germany, Austria and Switzerland.

METHODS

A professional translation of the EULAR recommendations into the German language was performed and revised by German-speaking experts from all three countries. The translation was validated by healthcare professionals consisting of rheumatologists, occupational therapists, physiotherapists, nurses, and medical assistants in a field test. In each of the three countries, eight structured interviews were conducted on comprehensibility, wording, completeness, and feasibility. The experts then discussed changes until consensus was reached and indicated the level of agreement with the final translation.

RESULTS

The translation of the EULAR recommendations was substantially revised. Based on the results of the cognitive test, formulations were adapted in order to increase comprehensibility. The level of agreement between 10 (SD 0.0) and 8.9 (SD 1.5) was very high.

DISCUSSION

The final German version of the EULAR recommendations is comprehensible and accepted across all three German-speaking countries. It can help to improve the structure and clarity of the handling of physical activity and promote physical activity for healthcare providers and patients.

Psychometric Analysis of a German-Language Version of the Work-Family Conflict and Family-Work Conflict Scale

The Work-Family Conflict and Family-Work Conflict Scale (WFC & FWC Scale) is a questionnaire commonly used to assess conflicts that arise when required time devotion and strain for work obligations interfere with family responsibilities (work-family conflict) and conflicts that arise when family responsibilities interfere with work responsiblities (family work conflict). Past reports on the psychometric properties and recommendations for application of the WFC & FWC Scale mostly rely on samples from the United States. The current study is the first to report psychometric properties of a German-language version of the WFC & FWC Scale, including invariance analyses across women and men, and test-retest reliabilities. The analysis of the latent structure that was based on responses from 274 employes (77.0% women, 23.0% men) of a medical university in Austria revealed that the bifactor model had a satisfactory fit with the data. Configural and metric invariance indicated a similar factor structure and similar meaning in women and men. However, scalar invariance cannot be assumed. Thus, differences in scale scores between women and men might not adequately reflect level differences in the underlying latent factor. High internal consistencies and high test-retest reliabilities offer evidence for adequate reliability. Additionally, evidence for convergent (links to work stress and relationship satisfaction) and divergent validity (no links to career ambition) were found. In summary, the current study offers adequate evidence for validity and reliability of a German-language version of the WFC & FWC Scale.

The German Three Factor Impulsivity Index: Confirmatory factor analysis and ties to demographic and health-related variables

A growing body of research has focused on the differentiation of emotion-related versus non-emotion-related impulsivity, assessed by the Three-Factor Impulsivity (TFI) index. The goal of this study is to develop a German TFI index, and to validate the emotion-related impulsivity subscales against indices of substance abuse, physical or psychological disorder, physical exercise, BMI, and hours of sleep. 395 native-German speakers completed the German TFI index and questions on validity indicators online. Factor analyses supported the three-factor structure, including Pervasive Influence of Feelings, Lack of Follow Through, and Feelings Trigger Action. Correlations between factors were higher than in the original work. Both emotion-related impulsivity subscales correlated significantly with psychological disorder, engagement in and minutes of physical exercise per week. When included in multivariate regression models, the three factors explained 3.1%, and 29.2% of variance in amount of exercise per week and psychological disorder, respectively. In sum, findings indicated that the German TFI index has a robust three-factor structure that showed expected links to validity indicators, and novel effects in relation to physical exercise.

Translation and Psychometric Validation of the German Version of the Family Nursing Practice Scale (FNPS)

This article describes the cross-cultural adaption and psychometric testing of the Family Nursing Practice Scale (FNPS) German version. The FNPS aims to examine self-reported family nursing practice skills and reciprocity in the nurse-family relationship. Using a cross-sectional design, 583 acute and critical care nurses were invited to complete the FNPS German version. Exploratory factor analysis was used to assess the structural validity. Internal consistency was determined using Cronbach's alpha. A total of 317 nurses returned a completed online questionnaire. Principal axis factor analysis suggests a one-factor solution in which all 10 items are retained, accounting for 36% of the variance. Cronbach's alpha was .84. In contrast to the original version, our findings indicate the unidimensionality of the construct. The FNPS German version appears to be a valid and reliable scale to assess nurses' perception of their family nursing practice proficiency. Further testing is needed to confirm the unidimensionality and to establish test-retest reliability.

Psychometric properties and validity of the German version of the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5)

BACKGROUND

The availability of psychometrically sound instruments for the assessment of Post-Traumatic Stress Disorder (PTSD) is indispensable for clinical and scientific work with individuals suffering from trauma-related distress.

OBJECTIVE

The aim of the present study was to translate the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5) into German and to evaluate its psychometric properties as well as convergent, discriminant, and factorial validity.

METHOD

The authorized German translation of the PDS-5 was completed by 270 patients admitted to specialized outpatient trauma clinics. Of these, 57.8% completed the PDS for a second time (mean time between assessments was 12.0 days). In order to examine convergent and discriminant validity of the PDS-5, the Post-traumatic Stress Disorder Checklist for DSM-5 as well as Patient Health Questionnaire subscales assessing depression (PHQ-9), somatization (PHQ-15), and Generalized Anxiety Disorder (GAD-7) were applied.

RESULTS

The PDS-5 total score showed excellent internal consistency (α = .91) and re-test reliability (rho = .84). Convergent validity was supported by a strong correlation with the total score of the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5; rho = .91). Correlations with Patient Health Questionnaire subscales of depression (rho = .81), anxiety (rho = .72), and somatization (rho = .65) were significantly lower (all p < .001) indicating discriminant validity of the PDS-5. Confirmative Factor Analysis did not result in a clear preference for one of the tested models. Defining a diagnostic cut-off value of ≥36 based on ROC analysis resulted in high sensitivity (.92) and specificity (.96) compared to a probable PTSD diagnosis according to the PCL-5.

CONCLUSIONS

In summary, our results indicate that the German PDS-5 translation provides valid and reliable information concerning both PTSD severity and diagnosis.

The ABC taxonomy for medication adherence translated into French and German

AIMS

We translated the ABC adherence taxonomy (i.e. 7 terms and their corresponding definitions) published by Vrijens et al. (2012) into French and German without changing the original meaning with the aim to promote a standardised taxonomy for medication adherence to French- and German-speaking researchers and clinicians.

METHODS

A Delphi survey was performed. To generate round 1, we identified French and German synonyms for the 7 adherence terms through a literature search in PubMed. Investigators translated the original English definitions into French and German. Panellists were members of ESPACOMP-the International Society for Patient Medication Adherence; experts suggested by ESPACOMP members and first authors of medication adherence publications in French and German. Google forms were used to create online questionnaires. Delphi rounds were performed until consensus was reached. The consensus was defined according to the acceptance rate as moderate consensus (50-75%), consensus (>75-95%), and strong consensus (>95%).

RESULTS

The literature search resulted in 4-6 (French) and 4-7 (German) items per English term. Delphi rounds were launched between November 2016 and April 2018. Three rounds sufficed to reach consensus on all terms and definitions from 26 French-speaking and 25 German-speaking panellists. Preferred terms for medication adherence are adhésion médicamenteuse (82%) in French and Medikamentenadhärenz (88%) in German.

CONCLUSION

The use of a common terminology for medication adherence with translations in French and German will contribute to standardise the vocabulary, to harmonise research projects and ultimately ease comparison of study results among researchers and clinicians.

Validation of the German version of the 24-item Early-Onset Scoliosis Questionnaire

OBJECTIVE

During childhood, early-onset scoliosis (EOS) may show severe progressive deformity, which consequently leads to aggressive treatment strategies, such as serial casting, long-term bracing, or surgical interventions. The latter usually includes repeated surgeries for implant lengthening every 6 months in order to allow sufficient growth of the thorax and spine. In 2011, the 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24) was introduced to measure health-related quality of life for this patient group and their families. Since then, cross-culturally adapted versions of the EOSQ-24 have been published in Spanish, Turkish, traditional Chinese, and Norwegian. The purpose of the study was to transculturally adapt the original English version of the EOSQ-24 into the German language and evaluate the reliability of the German version.

METHODS

After adaptation and forward/backward translation, the German version of the EOSQ-24 was given to the parents or caregivers of 67 EOS patients (33 male, 34 female) Data quality was evaluated by mean, standard deviation, percentage of data missing, and extent of ceiling and floor effects. Reliability was estimated by internal consistency using Cronbach α and item-total correlations.

RESULTS

In the study group (n = 67), 12 children were either observed (n = 7) or treated with a brace (n = 5). The other 55 patients were treated surgically with growth-friendly implants. The item response to the German EOSQ-24 was high with a minimum of missing data (1.7%). All items showed very good to excellent internal consistencies (0.879-0.903). Floor effects for the 24 items were between 0% and 31% and ceiling effects between 9% and 78%. The calculated Cronbach α for the 24-item scale was 0.9003, indicating excellent reliability.

CONCLUSIONS

The German adaptation of the EOSQ-24 shows excellent reliability and therefore is a valid tool to measure objective health-related quality of life in children with EOS.

The Healing Encounters and Attitudes Lists (HEAL): Psychometric Properties of a German Version (HEAL-D) in Comparison With the Original HEAL

Introduction: Over the last years, the interest in understanding health improvements that occur due to non-specific treatment effects, rather than in response to the specific active treatment ingredients, increased. Nevertheless, investigations on patients' idiosyncratic perspectives on the non-specific aspects of the healing encounter or of the treatment itself that contribute to placebo effects are still rare. The Healing Encounters and Attitudes Lists (HEAL) offer a unique and parsimonious set of instruments to measure patients' views on a variety of non-specific aspects of the caring encounter. The HEAL items can be administered as computerized adaptive tests or short forms that assess the patient-provider connection, the healthcare environment, treatment expectancy, positive outlook, spirituality, as well as attitudes towards complementary and alternative medicine. So far, no German version of the HEAL exists. Methods: The original 168 HEAL items were translated into German (HEAL-D) applying a translation-back-translation procedure. We examined the psychometric properties of HEAL-D in a sample of 165 participants who reported at least one healthcare visit during the last year. Results: The German short forms of HEAL (HEAL-D-SF) showed good internal consistency and test-retest reliability. The factor structure observed in the English original items showed low to moderate model fit in our sample. Discussion: The development of a German version of HEAL in addition to the original English items offers new possibilities for investigating patients' idiosyncratic perspectives on the non-specific aspects of treatments across language borders. We will close with presenting possible clinical application as well as promising and relevant future research directions using HEAL-D-SF, including for instance large-scale, cross-national investigations.

The German version of the Functional Walking Categories (FWC): translation and initial validation

BACKGROUND

Community ambulation is often affected after a stroke. However, no validated assessment in German to measure community ambulation on a participation level exists.

OBJECTIVES

The purpose was to translate and cross-culturally adapt the Functional Walking Categories (FWC) into German and to assess its validity and reliability in patients with stroke.

METHODS

Cross-cultural adaptation guidelines were used for translation. Face and content validity were established with the aid of an expert committee. A pilot study with patients after stroke in a neurological rehabilitation setting checked for concurrent validity using Kendall's tau and reliability using intraclass correlation coefficients.

RESULTS

The results indicated that the German version of the FWC has adequate face and content validity. A total of 30 patients (mean age 62 ± 12.315 years, 56.7% female) participated in the study. The FWC correlated well with the Functional Ambulation Categories (tau-b = 0.783), cadence (tau-b = 0.640), gait velocity (tau-b = 0.628), the comfortable 10-m timed walk (tau-b = -0.629), and the fast 10-m timed walk (tau-b = -0.634). Moderate correlations were found between the FWC and step length (tau-b = 0.483) and the Timed Up and Go (tau-b = -0.520), respectively. Intrarater reliability was moderate (ICC = 0.651) while interrater reliability was excellent (ICC = 0.751) (all correlations p < 0.001). However, the study was designed as pilot study, thus, full psychometric property testing was not possible.

CONCLUSIONS

The German FWC offers a reasonable tool for measuring community ambulation on participation level. However, a user manual seems to be helpful.

Measuring Prosocial Tendencies in Germany: Sources of Validity and Reliablity of the Revised Prosocial Tendency Measure

The prosocial tendencies measure (PTM; Carlo and Randall, 2002) is a widely used measurement for prosocial tendencies in English speaking participants. This instrument distinguishes between six different types of prosocial tendencies that partly share some common basis, but also can be opposed to each other. To examine these constructs in Germany, a study with 1067 participants was conducted. The study investigated the structure of this German version of the PTM-R via exploratory factor analysis, confirmatory factor analysis, correlations with similar constructs in subsamples as well as via measurement invariance test concerning the original English version. The German translation showed a similar factor structure to the English version in exploratory factor analysis and in confirmatory factor analysis. Measurement invariance was found between the English and German language versions of the PTM and support for the proposed six-factor structure (altruistic, anonymous, compliant, dire, emotional and public prosocial behavior) was also found in confirmatory factor analysis. Furthermore, the expected interrelations of these factors of prosocial behavior tendencies were obtained. Finally, correlations of the prosocial behavior tendencies with validating constructs and behaviors were found. Thus, the findings stress the importance of seeing prosocial behavior not as a single dimension construct, but as a factored construct which now can also be assessed in German speaking participants.

German translation and psychometric testing

BACKGROUND

The Tilburg frailty indicator (TFI) is a self-report measurement instrument which integrates the physical, psychological and social domains to assess frailty in older adults. The aim of this study was the adaptation of the TFI to a German version and testing of the psychometric properties.

MATERIAL AND METHODS

This study surveyed 210 individuals aged 64-91 years living at home. The mean age of participants was M = 75.3±5.7 years with 62 % females. The internal consistency was tested with Cronbach's alpha. The test-retest reliability was calculated after 20 weeks. The German TFI was validated using alternative measures for assessment of the quality of life, e.g. Eurohis-QoL-8 and short form health survey (SF-12), the patient health questionnaire (PHQ), the geriatric anxiety inventory short form (GAI-SF), the social support scale (F-Soz-U-K-14) and the resilience scale (RS-11).

RESULTS

The internal consistency was acceptable with a value for Cronbach's alpha of 0.67. The test-retest reliability was good after 5 months α = 0.87 (physical domain r = 0.85, psychological domain r = 0.75 and social domain r = 0.84). The inter-item correlations ranged between - 0.06 and 0.57. Correlations with alternative frailty measures showed good convergent and divergent validity.

CONCLUSION

This study showed acceptable psychometric properties of the German adaptation of the TFI which was found to be age and frailty sensitive. The results of the validity of the TFI support the three domains integrated in the frailty score. Further application and testing of the German TFI in primary care and clinical settings are suggested to consolidate the findings.