Cross-cultural adaptation,reliability and validity of the Turkish version of the Lower Limb Functional Index

Abstract

Purpose: This study aims to adapt culturally a Turkish version of the Lower Limb Functional Index (LLFI) and to determine its validity, reliability, internal consistency, measurement sensitivity and factor structure in lower limb problems. Method: The LLFI was translated into Turkish and cross-culturally adapted with a double forward–backward protocol that determined face and content validity. Individuals (n?=?120) with lower limb musculoskeletal disorders completed the LLFI and Short Form-36 questionnaires and the Timed Up and Go physical test. The psychometric properties were evaluated for the all participants from patient-reported outcome measures made at baseline and repeated at day 3 to determine criterion between scores (Pearson’s r), internal consistency (Cronbachs α) and test–retest reliability (intraclass correlation coefficient – ICC_2.1). Error was determined using standard error of the measurement (SEM) and minimal detectable change at the 90% level (MDC₉₀), while factor structure was determined using exploratory factor analysis with maximum likelihood extraction and Varimax rotation. Results: The psychometric characteristics showed strong criterion validity (r?=?0.74–0.76), high internal consistency (α?=?0.82) and high test–retest reability (ICC_2.1?=?0.97). The SEM of 3.2% gave an MDC₉₀?=?5.8%. The factor structure was uni-dimensional. Conclusions: Turkish version of LLFI was found to be valid and reliable for the measurement of lower limb function in a Turkish population.

• Implications for Rehabilitation

• Lower extremity musculoskeletal disorders are common and greatly impact activities among the affected individuals pertaining to daily living, work, leisure and quality of life.

• Patient-reported outcome (PRO) measures have advantages as they are practical, cost-effective and clinically convenient for use in patient-centered care.

• The Lower Limb Functional Index is a recently validated PRO measure shown to have strong clinimetric properties.

     

Reliability and validity of the Finnish version of the Lower Extremity Functional Scale (LEFS)

Purpose: The present study aimed to assess the psychometric properties of the Finnish version of the Lower Extremity Functional Scale (LEFS) among foot and ankle patients.

Methods: The LEFS was translated and cross-culturally adapted to Finnish. We assessed the test–retest reliability, internal consistency, floor-ceiling effect, construct validity and criterion validity in patients who underwent surgery due to musculoskeletal pathology of the foot and ankle (N?=?166).

Results: The test–retest reliability was high (ICC = 0.93, 95% CI: 0.91–0.95). The standard error of measurement was 4.1 points. The Finnish LEFS showed high internal consistency (Cronbach’s α?=?0.96). A slight ceiling effect occurred as 17% achieved the maximum score. The LEFS correlation was strong with the 15D Mobility dimension (r?=?0.74) and overall HRQoL (r?=?0.66), pain during foot and ankle activity (r=??0.69) and stiffness (r=??0.62). LEFS correlated moderately with foot and ankle pain at rest (r=??0.50) and with physical activity (r?=?0.46).

Conclusions: The Finnish version of the LEFS showed reliability and validity comparable to those of the original version. This study indicates that the Finnish version of the LEFS serves both clinical and scientific purposes in assessing lower-limb function.

• Implications for Rehabilitation

• The Finnish version of the Lower Extremity Functional Scale (LEFS) is a reliable and valid tool for assessing lower-extremity musculoskeletal disability in Finnish-speaking population.

• Investigation of the psychometric properties of the Finnish version of the LEFS showed validity and reliability comparable to those of the original English version.

• The Finnish LEFS is easy to complete and suitable for clinical, rehabilitation and research purposes.

     

Rasch validation of the Arabic version of the lower extremity functional scale

Purpose: The purpose of this study was to examine the internal construct validity of the Arabic version of the Lower Extremity Functional Scale (20-item Arabic LEFS) using Rasch analysis.

Methods: Patients (n?=?170) with lower extremity musculoskeletal dysfunction were recruited. Rasch analysis of 20-item Arabic LEFS was performed. Once the initial Rasch analysis indicated that the 20-item Arabic LEFS did not fit the Rasch model, follow-up analyses were conducted to improve the fit of the scale to the Rasch measurement model. These modifications included removing misfitting individuals, changing item scoring structure, removing misfitting items, addressing bias caused by response dependency between items and differential item functioning (DIF).

Results: Initial analysis indicated deviation of the 20-item Arabic LEFS from the Rasch model. Disordered thresholds in eight items and response dependency between six items were detected with the scale as a whole did not meet the requirement of unidimensionality. Refinements led to a 15-item Arabic LEFS that demonstrated excellent internal consistency (person separation index [PSI]?=?0.92) and satisfied all the requirement of the Rasch model.

Conclusion: Rasch analysis did not support the 20-item Arabic LEFS as a unidimensional measure of lower extremity function. The refined 15-item Arabic LEFS met all the requirement of the Rasch model and hence is a valid objective measure of lower extremity function. The Rasch-validated 15-item Arabic LEFS needs to be further tested in an independent sample to confirm its fit to the Rasch measurement model.

• Implications for Rehabilitation

• The validity of the 20-item Arabic Lower Extremity Functional Scale to measure lower extremity function is not supported.

• The 15-item Arabic version of the LEFS is a valid measure of lower extremity function and can be used to quantify lower extremity function in patients with lower extremity musculoskeletal disorders.

     

简化版青光眼患者用药自我效能量表的汉化及信效度检验

目的 汉化简化版青光眼患者用药自我效能量表（Glaucoma Medication Self-Efficacy Scale,GMSES）并对其信效度进行检验。方法 获取原量表作者授权,遵循Brislin量表翻译原则对简化版GMSES进行正译、回译,经2轮专家咨询及预调查后完成跨文化调适;采用便利抽样法,于2021年3月—11月选取浙江省及河南省共3所医院的244例青光眼患者进行调查,评价中文简化版GMSES的信效度。结果 中文简化版GMSES总量表的Cronbach’s α系数为0.837,重测信度为0.938;3个维度的Cronbach’s α系数分别为0.741、0.933、0.817;总量表的平均内容效度指数为0.990,条目水平的内容效度指数为0.833～1.000;探索性因子分析共提取出3个因子,累计方差贡献率为63.642%。结论 中文简化版GMSES具有良好的信效度,适用于评价国内青光眼患者的用药自我效能水平。     

Cross-cultural adaptation,reliability, and validity of the Persian version of the Cumberland Ankle Instability Tool

Purpose: The purpose of the present study was to translate and to cross-culturally adapt the Cumberland Ankle Instability Tool (CAIT) into Persian language and to evaluate its psychometric properties.

Method: The International Quality of Life Assessment process was pursued to translate CAIT into Persian. Two groups of Persian-speaking individuals, 105 participants with a history of ankle sprain and 30 participants with no history of ankle sprain, were asked to fill out Persian version of CAIT (CAIT-P), Foot and Ankle Ability Measure (FAAM), and Visual Analog Scale (VAS). Data obtained from the first administration of CAIT were used to evaluate floor and ceiling effects, internal consistency, dimensionality, and criterion validity. To determine the test–retest reliability, 45 individuals re-filled CAIT 5–7 days after the first session.

Results: Cronbach’s alpha was over the cutoff point of 0.70 for both ankles and in both groups. The intra-class correlation coefficient was high for right (0.95) and left (0.91) ankles. There was a strong correlation between each item and the total score of the CAIT-P. Although the CAIT-P had strong correlation with VAS, its correlation with both subscales of FAAM was moderate.

Conclusions: The CAIT-P has good validity and reliability and it can be used by clinicians and researchers for identification and investigation of functional ankle instability.

• Implications for Rehabilitation

• Chronic ankle instability is one of the most common consequences of acute ankle sprain.

• Cumberland Ankle Instability Tool is an acceptable measure to determine functional ankle instability and its severity.

• The Persian version of Cumberland Ankle Instability Tool is a valid and reliable tool for clinical and research purpose in Persian-speaking individuals.

     

Cross-cultural adaptation,validity and reliability of the Persian version of Fremantle Knee Awareness Questionnaire

Background& Objective: There is strong evidence regarding impaired knee self-perception in patients with chronic knee osteoarthritis (OA). Currently, the Fremantle Knee Awareness Questionnaire (FreKAQ) has been developed to evaluate knee self-perception. This study aimed to evaluate validity and reliability of the Persian version of FreKAQ in patients with chronic knee OA.Materials and methodsThe FreKAQ was translated via forward-backward translation. In total, 312 patients with chronic knee OA completed the questionnaire, and the construct validity of the instrument was evaluated using exploratory and confirmatory factor analyses (EFA and CFA). Moreover, its reliability was confirmed using internal consistency and Cronbach's alpha coefficient. In addition, intra-class correlation coefficient and standard error measurement (SEM) and minimal detectable change (MDC) were used to assess its relative and absolute consistency. Therefore 50 patients, completed the questionnaire twice at one-week intervals.ResultsIn EFA, Kaiser-Meyer-Olkin (0.705) and Bartlett's tests were significant (P < 0.001), and CFA also indicated acceptable fitting with three factors. Moreover, the indices of PNFI = 0.57, PCFI = 0.60, χ2/DF = 1.14, AGFI = 0.95, GFI = 0.97, and RMSEA = 0.027 confirmed the goodness of fit of the model. The Cronbach's alpha and repeatability were estimated at 0.817 and 0.874, respectively, and the SEM and MDC was 2.13, 4.91.ConclusionAccording to the results, the Persian version of FreKAQ had proper construct validity and reliability to evaluate the impairment of knee self-perception in patients with chronic knee OA.     

Cross-cultural adaptation,reliability and validity of the Persian version of the modified falls efficacy scale

Purpose.?To translate the Swedish version of the Falls Efficacy Scale (FES), the FES(S), into Persian, and to determine reliability and validity of the scale to be used for Persian speaking elderly people.

Method.?The ‘forward-backward’ procedure was applied to translate the FES(S) into Persian. A methodological study was then carried out to determine the psychometric properties of the Persian version of the scale. Eighty-one community-dwelling elderly persons (≥65 years) were included.

Results.?Both reliability and validity of the Persian FES(S) were found to be acceptable (Cronbach's α == 0.75, interclass correlation coefficients == 0.99, p < 0.001 and standard errors of measurements == 1.82). Low to moderate negative correlations of the total score of the scale with the age of the participants and number of falls in the past year were shown. There were also low to moderate correlations between the Persian FES(S) score and the Mini-Mental State Examination score, duration of walks and physical fitness. The participants who took a daily walk, felt healthy, reported no general tiredness and who had had no fall during the past year rated their self-efficacy higher than did their peers.

Conclusions.?The present study verified that the Persian FES(S) is a culturally relevant, valid and reliable tool for measuring self-perceived confidence in Iranian older adults.     

Cross-cultural adaptation, reliability and validity of the Chinese version of the Fear Avoidance Beliefs Questionnaire

The Fear Avoidance Beliefs Questionnaire (FABQ) was translated and cross-culturally adapted for China. Its psychometric properties were then evaluated in Chinese-speaking patients with low-back pain and the scales were tested for internal consistency, reproducibility, ceiling-and-floor effects, construct validity and responsiveness. A total of 15 patients were selected for pre-testing and a further 230 patients completed the FABQ (and other scales) at baseline and 14 days later. A test-retest reliability analysis was carried out on 61 of the 230 patients. The FABQ was found to be easily understood. Explorative factor analysis by principal components analysis, yielded a two-factor model for the FABQ, relating to work and physical activity, and this was confirmed by confirmatory factor analysis using structural equation modelling. The FABQ yielded high values for internal consistency and reproducibility; no ceiling-and-floor effects were detected. Generally, the FABQ scales and baseline variables were weakly correlated. Cohen's effect size was 0.22 and responsiveness was low. It was concluded that the translation and adaptation of the FABQ into Chinese was successful; the scales had acceptable factor structure, internal consistency, test-retest reliability and construct validity.     

下肢手术时气囊止血带充气压力研究

目的 :比较下肢手术使用气囊止血带时两种不同充气压力的止血效果和止血带副损伤的发生情况 ,以找出适宜的个体充气压力。方法 :将 2 0 0例下肢择期手术成年病人随机分为试验组和对照组 ,每组 10 0例。试验组采用个体充气压力 ,即以缚扎止血带处肢体周径(cm )作为气囊止血带充气压力值 (kPa) ;对照组采用传统充气压力 ( 5 3 .2kPa～79 .8kPa) ,观察止血效果和止血带副损伤的发生情况。结果 :两组止血效果均满意 ,而对照组止血带副损伤发生率明显高于试验组 (P <0 .0 0 5 )。结论 :以下肢缚扎止血带处周径 (cm )作为气囊止血带充气压力值 (kPa)是下肢手术时适宜的充气压力。     

Cross-cultural adaptation,reliability, and validity of the Japanese version of the Cumberland ankle instability tool

Purpose To study validity and reliability of a Japanese version of the Cumberland Ankle Instability Tool and to determine the optimal cutoff score. Methods In this study, the questionnaire was cross-culturally adapted into Japanese. The psychometric properties tested in the Japanese version of the CAIT were measured for criteria validity, internal consistency and test–retest reliability in 111 collegiate soccer athletes. We also established the questionnaire cutoff score for discriminating between individuals with and without CAI. Results There was a significant correlation between the Japanese version of the CAIT and the Karlsson score (r?=?0.604, p?α?=?0.833) and reliability [intraclass correlation coefficient (ICC)?=?0.826, 95% confidence interval (CI): 0.732–0.888]. The optimal cutoff score was?≤25, which was consistent with previous reports. Conclusions The Japanese version of the CAIT has been shown to be a valid and reliable questionnaire for determining the presence of CAI. We expect that researchers and clinicians will use the Japanese version of the CAIT in Japan.

• Implications for Rehabilitation

• Chronic Ankle Instability (CAI), which not only increases recurrence rate of ankle sprain but also decreases athletic performance, is a residual symptom after ankle sprain.

• Cumberland Ankle Instability Tool, which has the reliability and validity to assess CAI, will be critically useful in assessment procedure for CAI.

• It is preferable for clinicians and researchers to use the native language version of the CAIT.

     

中文版护士道德困境量表的信度和效度研究

目的 评价中文版护士道德困境量表用于中国临床护士的信度和效度.方法 根据量表的跨文化调适过程,对MDS-R (moral distress scale-revised)进行编译,形成中文版护士道德困境量表,并对238名临床护士进行调查,测定其信度和效度.结果 中文版护士道德困境量表的CVI为0.909.因子分析共提取了4个公因子,解释总变异的54.583％,表明量表具有良好的结构效度.量表的内部一致性良好,总量表Cronbach'α系数为0.879,各维度的Cronbach'α系数分别为0.846、0.724、0.738和0.566.问卷的重测信度为0.802.结论 中文版护士道德困境量表具有良好的信度和效度,可以为国内护理人员道德困境的测量提供可靠的评定工具.     

Cross-cultural adaptation,reliability and validity of the Arabic version of the reduced Western Ontario and McMaster Universities Osteoarthritis index in patients with knee osteoarthritis

Purpose: We adapted the reduced Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index for the Arabic language and tested its metric properties in patients with knee osteoarthritis (OA). Methods: One hundred and twenty-one consecutive patients who were referred for physiotherapy to the outpatient department were asked to answer the Arabic version of the reduced WOMAC index (ArWOMAC). After the completion of the ArWOMAC, the intensity of knee pain and general health status were assessed using the visual analog scale (VAS) and the 12-item short form health survey (SF-12), respectively. A second assessment was performed at least 48?h after the first session to assess test–retest reliability. The test–retest reliability was quantified using the intra-class correlation coefficient (ICC), and Cronbach’s alpha was calculated to assess the internal consistency of the Arabic questionnaire. The construct validity was assessed using Spearman rank correlation coefficients. Results: The total ArWOMAC scale and pain and function subscales were internally consistent with Cronbach’s coefficient alpha of 0.91, 0.89 and 0.90, respectively. Test–retest reliability was good to excellent with ICC of 0.91, 0.89 and 0.90, respectively. SF-12 and VAS score significantly correlated with ArWOMAC index (p?Conclusions: The ArWOMAC index is a reliable and valid instrument for evaluating the severity of knee OA, with metric properties in agreement with the original version.

• Implications for Rehabilitation

• Although, the reduced WOMAC index has been clinically utilized within the Saudi population, the Arabic version of this instrument is not validated for an Arab population to measure lower limb functional disability caused by OA.

• The Arabic version of reduced WOMAC (ArWOMAC) index is a reliable and valid scale to measure lower limb functional disability in patients with knee OA.

• The ArWOMAC index could be suitable in Saudi Arabia and other Arab countries where the language, culture and the life style are similar.

     

医院磁性要素量表的汉化及信效度检验

目的 翻译医院磁性要素量表,并检验该量表的信效度。方法 遵循Brislin模型对量表进行翻译,用中文版医院磁性要素量表对青岛市某三级曱等综合性医院的1389名临床护士进行测试,检测其信效度。结果 中文版医院磁性要素量表经过因子分析方差最大正交旋转法,共提取7个因子,45个条目,累计贡献率为72.328%,总量表的 Cronbach’s a系数为0.980,折半信度为0.919,重测信度为0.889。结论 中文版医院磁性要素量表的信度、效度良好,可用于评价我国医院护理工作环境的磁性水平。     

Cross-cultural translation and adaptation of the Danish version of the brief version of the 10-item Big Five Inventory

Background

Personality traits are associated with pain-related beliefs and coping strategies, and different chronic conditions are linked through specific personality profiles. This highlights the importance of having valid and reliable measures of personality traits for use in clinical and research settings when assessing patients in chronic pain.

Purpose

To translate and cross-culturally adapt the 10-item Big Five Inventory (BFI-10) into Danish.

Methods

A bilingual expert panel (N = 4) and a panel of laymen (N = 8) translated and culturally adapted the questionnaire into Danish. Face validity was evaluated in a group of persons suffering from recurring or ongoing painful conditions (N = 9). Data were collected to evaluate the internal consistency, test–retest reliability and factor structure (N = 96).

Results

Some of the participants in the lay panel considered the questionnaire too short, considering its aim of assessing personality. Acceptable internal consistency was found for two out of five subscales (0.78 for both Extraversion and Neuroticism), while the internal consistency was non-acceptable for the remaining subscales (0.17–0.45). Test–retest reliability was acceptable for three subscales (0.80 for Neuroticism, 0.84 for Conscientiousness, and 0.85 for Extraversion). Assumptions for determining the factor structure were not met and therefore was this analysis omitted.

Discussion

Although face valid, only two out of five subscales had acceptable internal consistency and only three subscales had acceptable test–retest reliability. These findings indicate that interpreting findings regarding personality using the Danish BFI-10 should be done with caution.

     

围手术期患者口渴不适量表的汉化及信效度检验

目的 汉化英文版围手术期患者口渴不适量表（Perioperative Thirst Discomfort Scale,PTDS）,并对其进行跨文化调试及信效度检验。方法 严格遵循量表引进原则,对量表进行翻译、回译和跨文化调试。便利选取在福建省4所三级甲等综合医院住院治疗的316例围手术期患者进行调查,验证中文版PTDS的信效度。结果 中文版PTDS的Cronbach’s α系数为0.813;量表水平的内容效度指数和条目水平的内容效度指数均为1,共提取2个公因子,即口腔干燥感和口腔异样感,累计方差贡献率为64.312%,量表总分与口渴强度数字评分呈正相关（r=0.681,P<0.001）。结论 中文版PTDS具有较好的信效度,可用于科学评估国内围手术期患者的口渴不适程度。     

心力衰竭患者口渴困扰量表的汉化及信效度研究

目的 翻译英文版心力衰竭患者口渴困扰量表（Thirst Distress Scale for Patients with Heart Failure,TDS-HF）,并对中文版TDS-HF进行信效度检验。方法 严格遵循量表引进原则,对量表进行翻译、回译和跨文化调试。便利选取在天津市某三级甲等医院心脏中心住院治疗的268例心力衰竭患者进行调查,采用SPSS 17.0进行统计学分析,计算中文版TDS-HF的信效度。结果 中文版TDS-HF的Cronbach’s α系数为0.925;量表水平的内容效度指数和条目水平的内容效度指数均为1,共提取1个公因子,方差贡献率为65.56%;量表总分与口渴强度数字评分呈正相关（r=0.601,P<0.001）。结论 中文版TDS-HF具有良好的信度和效度,可用于评价国内心力衰竭患者的口渴困扰程度。     

A Chinese version of Iowa Infant Feeding Attitude Scale: reliability and validity assessment

Background

To achieve the goal of increasing the proportion and duration of breastfeeding in Taiwan, it is essential to assess the role of attitudes in determining which method of infant feeding will be chosen. Understanding maternal attitudes toward infant feeding methods may have utility in the development and implementation of public health policy and interventions facilitating increasing breastfeeding rates. However, no validated instrument to assess breastfeeding attitudes is available in Chinese for use in Taiwan.

Objective

To translate the Iowa Infant Feeding Attitude Scale (IIFAS) into Chinese and assess its psychometric properties among Taiwanese breastfeeding women.

Design

Methodological study.

Setting

One public hospital in Taichung city, Taiwan.

Participants

A convenience sample of 140 in-hospital breastfeeding women was recruited.

Methods

The IIFAS was translated into Chinese using forward translation, back-translation, semantic equivalence, and pilot testing. Predict validity and internal consistency was assessed. The final sample consisted of 120 women (14% attrition) that were interviewed by telephone at 6 weeks postpartum to record the breastfeeding duration and infant feeding method.

Results

One item was modified to better reflect the item content. In-hospital IIFAS scores significantly predicted breastfeeding duration as well as exclusive breastfeeding at 6 weeks postpartum. The Cronbach's alpha coefficient for internal consistency was 0.74.

Conclusions

This study provides evidence that the Chinese version of the IIFAS can be considered valid and reliable scale for assessing attitudes toward breastfeeding among breastfeeding women in Taiwan.     

The Persian version of Trinity Amputation and Prosthetics Experience Scale: translation,factor structure,reliability and validity

Purpose.?The purpose of the present study was to translate the Trinity Amputation and Prosthetics Experience Scale (TAPES) into Persian and to investigate its psychometric properties.

Method.?A sample of 182 Persian-speaker individuals with lower limb amputation completed the TAPES questionnaire, of whom 103 individuals completed the Short Form 36 Health survey as well. The TAPES was re-administered to 41 participants in the retest session, with an interval of 5–7 days between the two sessions. Internal consistency, test-retest reproducibility, dimensionality, item internal consistency and discriminant validity and construct validity were assessed.

Results.?Cronbach's α's were greater than the cut-off point of 0.70 for all subscales with the exception of social adjustment subscale. Minimum intraclass correlation coefficient of 0.70 was exceeded by all subscales with the exception of social activity subscale. Principle component analysis performed on each section of the TAPES revealed loading of all items on their corresponding factors. The exceptions were item 4 of social adjustment subscale and the single item of weight subscale. Most items were stronger measures of their hypothesised subscale than the other subscales. In terms of construct validity, 75%% of a priori hypotheses were confirmed.

Conclusions.?The Persian version of TAPES seems to be a reliable and valid measure of psychological adaptation to artificial limb.